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Shang X, Yan X, Chen H. Lower glomerular filtration rate after mild stroke induces cognitive impairment by causing endothelial dysfunction. Sci Rep 2024; 14:6964. [PMID: 38521825 PMCID: PMC10960789 DOI: 10.1038/s41598-024-57444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
The incidence of post stroke cognitive impairment (PSCI) is high in patients with mild stroke (MIS), and the risk factors and mechanism are uncertain. Increased cystatin C (CysC) levels after stroke may reflect lower glomerular filtration rate (GFR) and renal impairment. Previous studies have suggested endothelial dysfunction (ED) is closely related to renal impairment and cognitive impairment, respectively. We aimed to observe whether lower GFR estimated by CysC after MIS leaded to a high incidence of PSCI, and the role of ED in this process. 256 patients were enrolled in this prospective observational study. Renal function was assessed using GFR estimated by serum CysC. Endothelial function was evaluated by reactive hyperemia index (RHI) which calculated automatically by peripheral arterial tonometry (PAT). The cognitive function at baseline and 3 months was evaluated by MoCA score, and MoCA score ≤ 26 indicates the presence of PSCI. Spearman correlation analysis and linear regression were conducted to explore the factors affecting ED. Univariate and multivariate analysis was used to identify the independent risk factors of PSCI. The receiver operating characteristic (ROC) curve was applied to explore the optimal cutoff value of the independent risk factors levels for predicting PSCI. A total of 141 patients (55.1%) suffered from ED. Multiple linear regression analysis showed that there was a strong linear correlation between eGFRcys and RHI (p < 0.001). At the three-month follow-up, a total of 150 (58.6%) patients had been diagnosed with PSCI. Multivariate logistic regression analysis showed that RHI was an independent factor affecting the occurrence of PSCI (p < 0.05). ROC curve showed that the area under the curve was 0.724, and the optimal cut-off value of RHI was 1.655, with the sensitivity and specificity for PSCI were 72.7% and 73.6%, respectively. The lower eGFRcys level after MIS was significantly associated with ED, and ED may mediate the higher incidence of PSCI at 3 months after MIS.
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Affiliation(s)
- Xiuli Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University, 92 North Second Rd, Shenyang, 110001, Liaoning Province, China.
| | - Xu Yan
- Department of Neurology, The First Affiliated Hospital of China Medical University, 92 North Second Rd, Shenyang, 110001, Liaoning Province, China
- The First People's Hospital of Shenyang, Shenyang City, 110041, Liaoning Province, China
| | - Huan Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang City, 110032, Liaoning Province, China
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Liljehult J, Molsted S, Møller T, Overgaard D, Christensen T. Lifestyle counselling as secondary prevention in patients with minor stroke or transient ischemic attack: a randomized controlled pilot study. Pilot Feasibility Stud 2024; 10:50. [PMID: 38519983 PMCID: PMC10958836 DOI: 10.1186/s40814-024-01478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Patients with minor stroke or transient ischemic attacks have an increased risk of future strokes. These patients are often discharged home with limited specialized follow-up, although close to half of them experience cognitive deficits. Simple encouragements to avoid smoking, be physically active, and to take preventive medication are often insufficient to ensure adherence and more comprehensive interventions are needed to support the patients in adapting healthy behaviour. The aim of this study was to test the feasibility and potential effect of an early initiated, patient-centred intervention to patients with minor stroke or transient ischemic attacks targeting smoking, physical activity, and medication adherence, in a randomized, controlled pilot trial. METHODS Hospitalized patients were randomized to usual care or an intervention consisting of health behavioural counselling based on the 5A's model, telephone follow-up (4 and 8 weeks), and monitoring of physical activity. Follow-up time was 12 weeks. Feasibility was on the following domains: eligibility, acceptance, demand and practicality, adherence, attrition, and implementation and integration. RESULTS Forty patients of 84 potentially eligible were randomized to the two treatment arms (20 intervention/20 usual care). Thirty-two completed the 12-week follow-up, while 8 were either excluded or lost to follow-up. With few changes, the intervention was feasible and possible to deliver according to the protocol. CONCLUSION It was possible to identify relevant patients who could potentially benefit from a behavioural intervention, recruit and randomize them early after admission and retain most participants in the study until follow-up and derive statistical estimates to guide the design of large-scale randomized controlled trials. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03648957 . Registered 28 August 2018.
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Affiliation(s)
- Jacob Liljehult
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark.
- Department 9701, The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark.
- Faculty of Health and Technology, Department of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, Copenhagen N, 2200, Denmark.
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, Copenhagen N, 2200, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1353, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Department of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, Copenhagen N, 2200, Denmark
| | - Thomas Christensen
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, Hillerød, 3400, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, Copenhagen N, 2200, Denmark
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Liu J, Chen K, Chen J, Fu L, Zhang W, Lin J, Wan J. Incidence and risk factors of cognitive dysfunction in hemodialysis patients: A systematic review and meta-analysis. Semin Dial 2023; 36:358-365. [PMID: 37592399 DOI: 10.1111/sdi.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/10/2023] [Accepted: 07/25/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND The study aims to explore the incidence and risk factors of cognitive dysfunction in hemodialysis patients. METHODS PubMed, Embase, Cochrane Library, and Web of Science databases were searched for clinical studies on the association between hemodialysis and cognitive dysfunction from the database's inception to 1 December 2022. Two researchers independently completed data extraction and risk of bias assessments for the included studies. All statistical analyses were performed using STATA15.0 software. RESULTS Ten studies were included in this meta-analysis, with a total of 5535 hemodialysis patients, that is, 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. The Newcastle-Ottawa Scale scores of the included studies were greater than 5. Meta-analysis results suggested that the incidence of cognitive dysfunction in hemodialysis patients was (effect size = 51%, 95% confidence interval [CI] [0.33, 0.69]), and hemodialysis patients with cognitive dysfunction were often older than those with normal cognition (standard mean difference [SMD] = 0.49, 95% CI [0.31, 0.68]). Female gender was a risk factor for cognitive dysfunction in hemodialysis patients (relative risk [RR] = 1.21, 95% CI [1.04, 1.41]); diabetes (RR = 1.33, 95% CI [1.04, 1.71]) and stroke (RR = 1.66, 95% CI [1.08, 2.55]) increased the incidence of cognitive dysfunction in hemodialysis patients. CONCLUSIONS The most important risk factors for cognitive dysfunction associated with hemodialysis might be female gender, old age, diabetes, and stroke. Close attention should be paid to such patients for early prevention.
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Affiliation(s)
- Jun Liu
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Kehong Chen
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Jia Chen
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Lili Fu
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Weiwei Zhang
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Jing Lin
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
| | - Jingfang Wan
- Blood Purification Center, Department of Nephrology, Army Medical Center of PLA, Chongqing, China
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Crow J, Savage M, Gardner L, Hughes C, Corbett C, Wells M, Malhotra P. What follow-up interventions, programmes and pathways exist for minor stroke survivors after discharge from the acute setting? A scoping review. BMJ Open 2023; 13:e070323. [PMID: 37311634 DOI: 10.1136/bmjopen-2022-070323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To identify the breadth and range of follow-up interventions currently provided to people after minor stroke with a focus on the definitions used for minor stroke, intervention components, intervention theory and outcomes used. These findings will inform the development and feasibility testing of a pathway of care. DESIGN Scoping review. SEARCH STRATEGY The final search was run in January 2022. Five databases were searched-EMBASE, MEDLINE, CINAHL, British Nursing Index and PsycINFO. Grey literature was also searched. Title and abstract screening and full-text reviews were conducted by two researchers and a third was involved when differences of opinion existed. A bespoke data extraction template was created, refined and then completed. The Template for Intervention Description and Replication (TIDieR) checklist was used to describe interventions. RESULTS Twenty-five studies, using a range of research methodologies were included in the review. A range of definitions were used for minor stroke. Interventions focused largely on secondary prevention and management of increased risk of further stroke. Fewer focused on the management of hidden impairments experienced after minor stroke. Limited family involvement was reported and collaboration between secondary and primary care was seldom described. The intervention components, content, duration and delivery were varied as were the outcome measures used. CONCLUSION There is an increasing volume of research exploring how best to provide follow-up care to people after minor stroke. Personalised, holistic and theory-informed interdisciplinary follow-up is needed that balances education and support needs with adjustment to life after stroke.
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Affiliation(s)
- Jennifer Crow
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Occupational Therapy, Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Savage
- Department of Physiotherapy, Imperial College Healthcare NHS Trust, London, UK
| | - Lisa Gardner
- Library and Evidence Services, Imperial College London, London, UK
| | - Catherine Hughes
- Department of Physiotherapy, Imperial College Healthcare NHS Trust, London, UK
| | - Ceile Corbett
- Department of Occupational Therapy, Imperial College Healthcare NHS Trust, London, UK
| | - Mary Wells
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, UK
| | - Paresh Malhotra
- Department of Brain Sciences, Imperial College London, London, UK
- Department of Neurology, Imperial College Healthcare NHS Trust, London, UK
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Gao L, Zheng X, Baker SN, Li P, Scheer FAJL, Nogueira RC, Hu K. Associations of rest-activity rhythm disturbances with stroke risk and post-stroke adverse outcomes. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.14.23289966. [PMID: 37292791 PMCID: PMC10246053 DOI: 10.1101/2023.05.14.23289966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Almost all biological and disease processes are influenced by circadian clocks and display ∼24-hour rhythms. Disruption of these rhythms may be an important novel risk factor for stroke. We evaluated the association between 24-h rest-activity rhythm measures, stroke risk, and major post-stroke adverse outcomes. Methods In this cohort study, we examined ∼100,000 participants in the UK Biobank (44-79 years old; ∼57% females) who underwent an actigraphy (6-7 days) and 5-year median follow-up. We derived: (1) most active 10 hours activity counts ( M10 ) across the 24-h cycle and the timing of its midpoint ( M10 midpoint ); (2) the least active 5 hours counts ( L5 ) and its midpoint timing ( L5 midpoint ); (3) relative amplitude ( RA ) - (M10-L5)/(M10+L5); (4) interdaily stability (IS): stability and (5) intradaily variability (IV), fragmentation of the rhythm. Cox proportional hazard models were constructed for time to (i) incident stroke (n=1,652); and (ii) post-stroke adverse outcomes (dementia, depression, disability, or death). Results Suppressed RA (lower M10 and higher L5) was associated with stroke risk after adjusting for demographics; the risk was highest in the lowest quartile [Q1] for RA (HR=1.62; 95% CI:1.36-1.93, p <0.001) compared to the top quartile [Q4]. Participants with later M10 midpoint timing (14:00-15:26, HR=1.26, CI:1.07-1.49, p =0.007) also had a higher risk for stroke than earlier (12:17-13:10) participants. A fragmented rhythm (IV) was also associated with a higher risk for stroke (Q4 vs. Q1; HR=1.27; CI:1.06-1.50, p =0.008), but differences in the stability of rhythms (IS) were not. Suppressed RA was associated with an increased risk of unfavorable post-stroke outcomes (Q1 vs. Q4; 1.78 [1.29-2.47]; p <0.001). All the associations were independent of age, sex, race, obesity, sleep disorders, cardiovascular diseases or risks, and other morbidity burdens. Conclusion Suppressed 24-h rest-activity rhythm may be a risk factor for stroke and an early indicator of major post-stroke adverse outcomes.
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Marsh EB, Girgenti S, Llinas EJ, Brunson AO. Outcomes in Patients with Minor Stroke: Diagnosis and Management in the Post-thrombectomy Era. Neurotherapeutics 2023; 20:732-743. [PMID: 36752947 PMCID: PMC10275835 DOI: 10.1007/s13311-023-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
In the era of mechanical thrombectomy and better preventative strategies, a higher number of patients are being discharged home from the hospital with the so-called minor strokes. This has significantly changed the landscape of stroke recovery. Unfortunately, while symptoms may be categorized as mild compared to individuals with higher NIH Stroke Scale scores, the physical, cognitive, and emotional sequelae can be disabling and result in failure to return to work and poor quality of life in a population with significant potential to recover fully. In this review, we discuss the current state of minor stroke, the most common pattern of resulting deficits, what is known about the underlying pathophysiology that leads to a relatively global pattern of impaired cognition following an infarct in any location, and special considerations for treatment based on this population's unique needs. Raising awareness of the current morbidity associated with minor stroke, the need for a uniform definition that allows for comparisons of individuals across studies, and further research focused on this population to optimize outcomes, has the potential to significantly improve recovery.
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Affiliation(s)
- Elisabeth B Marsh
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA.
| | - Sophia Girgenti
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Edward J Llinas
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Autumn O Brunson
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
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Smith S, Parkinson J, Caitens T, Sanders A, Murphy L, Hamilton K. Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke. BMJ Open 2023; 13:e068003. [PMID: 36693692 PMCID: PMC9884915 DOI: 10.1136/bmjopen-2022-068003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Survivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However, many patients do not receive adequate postdischarge support for secondary prevention, particularly if not referred to inpatient rehabilitation. Living Well After Stroke is a health promotion programme based on the health action process approach (HAPA), which is designed to support this underserviced group to improve and self-manage secondary prevention behavioural performance (eg, diet, exercise, medication-adherence) by equipping participants with a toolkit of theory-based and evidence-based behaviour change strategies and techniques that are transferable to different behavioural contexts. METHODS AND ANALYSIS The target sample is 118 adults living in Queensland, Australia, with stroke or transient ischaemic attack not referred to inpatient rehabilitation. Adopting a prospective single-arm trial design, the intervention comprises five behaviour change sessions over an 8-week period. Participants will receive a mix of individual-based and group-based assessments and interventions, based on the HAPA theoretical framework, delivered via telehealth or in-person (eg, public library). Measures of primary (ie, goal behaviours 1 and 2) and secondary outcomes (intention, outcome expectancy, risk perception, self-efficacy, planning, action control, subjective well-being) will be taken at 2 weeks, 4 weeks, 8 weeks and 16 weeks. The primary outcomes of the trial will be behavioural performance and transferability of behaviour change skills at 16 weeks. ETHICS AND DISSEMINATION The study has received ethical approval from the Griffith University Human Research Ethics Committee (Ref no: 2022/308). Informed consent is obtained via telephone prior to data collection. Findings will be presented in the form of peer-reviewed journal articles, industry reports and conference presentations, and will be used to inform the continued development and refinement of the programme for testing in a future fully powered trial.
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Affiliation(s)
- Stephanie Smith
- National Stroke Foundation, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
| | - Joy Parkinson
- Australian eHealth Research Centre, CSIRO, Herston, Queensland, Australia
| | - Thomas Caitens
- National Stroke Foundation, Brisbane, Queensland, Australia
| | - Andrea Sanders
- National Stroke Foundation, Brisbane, Queensland, Australia
| | - Lisa Murphy
- National Stroke Foundation, Melbourne, Victoria, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Health Sciences Research Institute, University of California, Merced, California, USA
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Mastering health following minor stroke-A qualitative explorative study. J Stroke Cerebrovasc Dis 2022; 31:106607. [PMID: 35753094 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106607] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with minor stroke or transient ischemic attack are encouraged to adopt a healthy lifestyle to prevent recurrent stroke. After discharge health behaviour is performed in an individual everyday context and must be properly understood within this context, including which aspects act as facilitators or barriers for healthy behaviour. OBJECTIVES To explore the experience of daily life in patients discharged home after minor stroke or transient ischemic attack, focusing on perceived health and reflection on health behaviour, and how this is associated with their overall experience of returning to their everyday context in relation to potential sequelae of stroke. METHODS Semi-structured qualitative interviews were conducted 3 - 13 months after discharge with sixteen patients discharged home after minor stroke or transient ischemic attack. Inductive thematic analysis was performed to analyse the interviews. RESULTS Participants associated their health and behaviour within a lens of worrying for future life prospect and triggered by perceived intrusive changes in their life condition. Even though some found it possible to resume participation in everyday life within weeks, they became increasingly aware that minor cognitive deficits, difficulties with planning, multi-tasking, memory, and fatigue influenced their health believes and behavioural patterns. The need for social and professional support had to be balanced against a wish for independence. CONCLUSION Patients with minor stroke or transient ischemic attacks experience changes as both being concrete in the form of persisting symptoms and abstract in the form of worries and uncertainty about the future. Perceived health was associated with a new sense of vulnerability due to realisations about the risk of recurrent stroke. Worries were anchored within the individual to handle, but for some they serve as a motivator to regulate their behaviour in order to master health.
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Yan X, Chen H, Shang XL. Association between serum cystatin C level and post-stroke cognitive impairment in patients with acute mild ischemic stroke. Brain Behav 2022; 12:e2519. [PMID: 35148465 PMCID: PMC8933790 DOI: 10.1002/brb3.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 01/24/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mild ischemic stroke (MIS) has been proved to be closely related to post-stroke cognitive impairment (PSCI). However, there are relatively few studies on the risk factors of MIS. We aimed to evaluate the relationship between serum cystatin C (CysC) level and cognitive function in patients with acute MIS. METHODS Four hundred consecutive patients with acute MIS were screened and 281 patients were eligible for this study. The serum CysC levels were detected within 24 h after admission. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at 3 months after acute MIS. Logistic regression was used to identify the predictors of PSCI, and the receiver operating characteristic (ROC) curve was applied to explore the optimal cut-off value. RESULTS One hundred sixty-four (58.4%) patients were diagnosed with PSCI at 3 months follow-up. The serum CysC levels in patients with PSCI were significantly higher than patients without PSCI (p < .001). The binary logistic regression analysis showed that higher serum CysC level was an independent predictor for PSCI at 3 months (odds ratio [OR], 5.745; 95% confidence interval, [CI], 1.089-30.311; p = 0.039). The ROC curve showed that area under the curve (AUC) was 0.723, and at a 0.945 mg/l CysC cut-off point, the sensitivity and specificity for PSCI at 3 months were 79.9% and 58.1%, respectively. CONCLUSION Our findings suggested that the serum CysC levels were increased after acute MIS, and higher serum CysC levels at baseline might be an independent risk factor for PSCI in patients with acute MIS, but further research are warranted.
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Affiliation(s)
- Xu Yan
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China.,Department of Neurology, The First people's Hospital of Shenyang, Shenyang, China
| | - Huan Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiu-Li Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China
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Ramírez-Moreno J, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona E. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:38-44. [DOI: 10.1016/j.nrleng.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/17/2018] [Indexed: 10/23/2022] Open
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Verberne DPJ, van Mastrigt GAPG, Ponds RWHM, van Heugten CM, Kroese MEAL. Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual. BMJ Open 2021; 11:e039201. [PMID: 33632749 PMCID: PMC7908908 DOI: 10.1136/bmjopen-2020-039201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. DESIGN Economic evaluation within a comparative effectiveness research design. SETTING Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. PARTICIPANTS Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. INTERVENTIONS Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. PRIMARY AND SECONDARY OUTCOME MEASURES Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. RESULTS Health outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level. CONCLUSIONS Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.
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Affiliation(s)
- Daan P J Verberne
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - Ghislaine A P G van Mastrigt
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Rudolf W H M Ponds
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M van Heugten
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Verberne DPJ, Kroese MEAL, Staals J, Ponds RWHM, van Heugten CM. Nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual. Disabil Rehabil 2020; 44:2849-2857. [PMID: 33242261 DOI: 10.1080/09638288.2020.1849417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To examine whether nurse-led stroke aftercare is beneficial for long-term psychosocial outcome of community-dwelling persons with stroke. MATERIALS AND METHODS Comparative effectiveness research design in which a prospective stroke aftercare cohort (n = 87) was compared to care-as-usual (n = 363) at six- and 12-months post stroke. Changes over time in cognitive and emotional problems experienced in daily life, fatigue and stroke impact on daily life were examined for stroke aftercare only. Multilevel modelling was used to compare stroke aftercare to care-as-usual concerning anxiety and depression symptoms, social participation and quality of life, over time. RESULTS Sample characteristics did not differ between cohorts except for stroke type and on average, more severe stroke in the stroke aftercare cohort (p < 0.05). Following stroke aftercare, anxiety and emotional problems decreased significantly (p < 0.05), whereas care-as-usual remained stable over time in terms of anxiety. No significant changes over time were observed on the other outcome domains. CONCLUSIONS Nurse-led stroke aftercare showed to be beneficial for emotional well-being in comparison to care-as-usual. Providing psychoeducation and emotional support seem effective elements but adding other therapeutic elements such as self-management strategies might increase the effectiveness of nurse-led stroke aftercare.Implications for rehabilitationRoutine stroke follow-up care should pay attention to psychosocial and emotional outcome in a systematic manner, in addition to secondary prevention.Healthcare professionals such as (specialized) nurses are needed to appropriately address the hidden cognitive and emotional consequences of stroke.Providing psychoeducation and emotional support in stroke aftercare diminish insecurities and worries in community-dwelling persons with stroke, leading to better outcomes.
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Affiliation(s)
- D P J Verberne
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands
| | - M E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - J Staals
- Department of Neurology and Cardiovascular Research Institute (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - R W H M Ponds
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.,Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C M van Heugten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht University Medical Center, The Netherlands.,Limburg Brain Injury Centre, Maastricht, The Netherlands.,Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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13
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Slenders JPL, Van den Berg-Vos RM, van Heugten CM, Visser-Meily JMA, Evers SMAA, de Haan RJ, de Man-van Ginkel JM, Kwa VIH. Screening and patient-tailored care for emotional and cognitive problems compared to care as usual in patients discharged home after ischemic stroke (ECO-stroke): a protocol for a multicenter, patient-blinded, cluster randomized controlled trial. BMC Health Serv Res 2020; 20:1049. [PMID: 33203405 PMCID: PMC7670662 DOI: 10.1186/s12913-020-05902-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Ischemic stroke patients with a good outcome in terms of motor functioning and communication are likely to be discharged home without further rehabilitation. A significant number of these patients experience cognitive and emotional problems resulting in lower quality of life and decreased participation in society. This paper presents the protocol of a study examining the clinical effectiveness, cost-effectiveness and implementation of an intervention focused on screening and patient-tailored care for cognitive and emotional problems as compared to usual care in patients discharged home after ischemic stroke. Methods / design A multicenter, patient-blinded, cluster randomized controlled trial will be performed. Centers will be randomized (1:1) to the intervention group or the usual care group. Patients (> 18 years old) with a neurological confirmed diagnosis of ischemic stroke who can be discharged home without follow-up treatment at an outpatient rehabilitation clinic will be included. In the intervention group, patients will receive a short, individualized, semi-structured consultation by specialized nurses in addition to usual care. This consultation includes 1) screening for cognitive and emotional problems, 2) screening for restrictions in participation, 3) promotion of self-management strategies and 4) a decision tool for referral to rehabilitation services. The intervention will be performed approximately 6 weeks after the stroke at the neurology outpatient clinics and will take approximately 60 min. The control group will receive care as usual. Both groups will be followed-up at 6 weeks, 3 months and 12 months after stroke. The primary outcome will be the level of participation measured with the Restriction subscale of the Utrecht Scale for Evaluation of Rehabilitation on the level of Participation (USER-Participation-R) at 12 months. A cost-effectiveness analysis and process evaluation will be performed alongside. Discussion This trial is the first to evaluate clinical effectiveness, cost-effectiveness and implementation of screening and patient-tailored care for cognitive and emotional problems compared to care as usual in patients discharged home after ischemic stroke. Potentially, this will improve the outcomes for patients with frequently occurring cognitive and emotional problems after stroke. Trial registration Netherlands Trial Register: NL7295, registered 25 September 2018
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Affiliation(s)
- J P L Slenders
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands. .,Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - R M Van den Berg-Vos
- Department of Neurology, Amsterdam UMC, Amsterdam, the Netherlands.,Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - C M van Heugten
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience (FPN), Maastricht University, Maastricht, the Netherlands.,School for Mental Health & Neuroscience, Department of Psychiatry & Neuropsychology, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University Medical Center, Maastricht, the Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - S M A A Evers
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute (CAPHRI) of the Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands.,Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - R J de Haan
- Clinical Research Unit, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J M de Man-van Ginkel
- Department of Nursing Science, Julius Center for Health Science and Primary Care & UMC Utrecht Brain Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - V I H Kwa
- Department of Neurology, OLVG, Amsterdam, the Netherlands
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14
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Liljehult J, Christensen T, Molsted S, Overgaard D, Mesot Liljehult M, Møller T. Effect and efficacy of lifestyle interventions as secondary prevention. Acta Neurol Scand 2020; 142:299-313. [PMID: 32620044 PMCID: PMC7540464 DOI: 10.1111/ane.13308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. AIM In this systematic review and meta-analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. METHODS PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta-analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. RESULTS Twenty-nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; -3.85 mmHg [95%CI -6.43; -1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; -9.83 mmHg [95%CI -16.56; -3.09]). CONCLUSION Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.
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Affiliation(s)
- Jacob Liljehult
- Department of NeurologyNordsjællands HospitalHillerødDenmark
- The University Hospitals Centre for Health Research UCSFDepartment 9701 Copenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
- Faculty of Health and TechnologyInstitute of Nursing and NutritionCopenhagen University CollegeCopenhagen NDenmark
| | - Thomas Christensen
- Department of NeurologyNordsjællands HospitalHillerødDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagen NDenmark
| | - Stig Molsted
- Department of Clinical ResearchNordsjællands HospitalHillerødDenmark
| | - Dorthe Overgaard
- Faculty of Health and TechnologyInstitute of Nursing and NutritionCopenhagen University CollegeCopenhagen NDenmark
| | | | - Tom Møller
- The University Hospitals Centre for Health Research UCSFDepartment 9701 Copenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
- Institute of Public HealthUniversity of CopenhagenCopenhagen KDenmark
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15
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Lutz BJ, Reimold AE, Coleman SW, Guzik AK, Russell LP, Radman MD, Johnson AM, Duncan PW, Bushnell CD, Rosamond WD, Gesell SB. Implementation of a Transitional Care Model for Stroke: Perspectives From Frontline Clinicians, Administrators, and COMPASS-TC Implementation Staff. THE GERONTOLOGIST 2020; 60:1071-1084. [PMID: 32275060 PMCID: PMC7427484 DOI: 10.1093/geront/gnaa029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke is a chronic, complex condition that disproportionally affects older adults. Health systems are evaluating innovative transitional care (TC) models to improve outcomes in these patients. The Comprehensive Post-Acute Stroke Services (COMPASS) Study, a large cluster-randomized pragmatic trial, tested a TC model for patients with stroke or transient ischemic attack discharged home from the hospital. The implementation of COMPASS-TC in complex real-world settings was evaluated to identify successes and challenges with integration into the clinical workflow. RESEARCH DESIGN AND METHODS We conducted a concurrent process evaluation of COMPASS-TC implementation during the first year of the trial. Qualitative data were collected from 4 sources across 19 intervention hospitals. We analyzed transcripts from 43 conference calls with hospital clinicians, individual and group interviews with leaders and clinicians from 9 hospitals, and 2 interviews with the COMPASS-TC Director of Implementation using iterative thematic analysis. Themes were compared to the domains of the RE-AIM framework. RESULTS Organizational, individual, and community factors related to Reach, Adoption, and Implementation were identified. Organizational readiness was an additional key factor to successful implementation, in that hospitals that were not "organizationally ready" had more difficulty addressing implementation challenges. DISCUSSION AND IMPLICATIONS Multifaceted TC models are challenging to implement. Facilitators of implementation were organizational commitment and capacity, prioritizing implementation of innovative delivery models to provide comprehensive care, being able to address challenges quickly, implementing systems for tracking patients throughout the intervention, providing clinicians with autonomy and support to address challenges, and adequately resourcing the intervention. CLINICAL TRIAL REGISTRATION NCT02588664.
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Affiliation(s)
- Barbara J Lutz
- School of Nursing, University of North Carolina at Wilmington
| | | | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy K Guzik
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laurie P Russell
- Division of Public Health Sciences, Wake Forest University Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Sabina B Gesell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Geraghty J, Ablewhite J, das Nair R, Lincoln N, Kontou E, Roffe J, Lannin N, Drummond A. Results of a UK-wide vignette study with occupational therapists to explore cognitive screening post stroke. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims There is a paucity of evidence in the UK regarding cognitive screening performed by occupational therapists and whether, and how, cognitive impairments are identified and assessed. The aim of this study was to identify current occupational therapy practice for the assessment of cognitive problems in patients following stroke. Methods Occupational therapists were invited to complete an online vignette study. Participants were asked to: identify any presenting cognitive problems; decide whether to complete cognitive assessments; and list any assessments they would use. Data were analysed using descriptive analysis. Results A total of 53 occupational therapists from across the UK participated. Participants identified key cognitive issues, but some problems, such as apraxia and attention, were overlooked. A large number of potential assessments were suggested, the most common being the Montreal Cognitive Assessment and Oxford Cognitive Screen. Conclusions The variation found in occupational therapists' recognition and assessment of cognitive problems has the potential to impact on management and rehabilitation in stroke services, survivor outcomes, education and research.
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Affiliation(s)
- Jennifer Geraghty
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Joanne Ablewhite
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Roshan das Nair
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nadina Lincoln
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Eirini Kontou
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jack Roffe
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Natasha Lannin
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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17
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Askew RL, Capo-Lugo CE, Naidech A, Prabhakaran S. Differential Effects of Time to Initiation of Therapy on Disability and Quality of Life in Patients With Mild and Moderate to Severe Ischemic Stroke. Arch Phys Med Rehabil 2020; 101:1515-1522.e1. [PMID: 32450061 DOI: 10.1016/j.apmr.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 04/02/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the effect of time to acute therapy on health-related quality of life (HRQoL) and disability after ischemic stroke. DESIGN Prospective cohort study. SETTING Comprehensive stroke care center in a large metropolitan city. PARTICIPANTS Patients (N=553; mean age, 67 y; 51.9% male; 64.4% white; 88.8% ischemic stroke) with ischemic stroke or transient ischemic attack (TIA) enrolled in a longitudinal observational study between August 2012 to January 2014 who received rehabilitation services. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Disability status was assessed with the modified Rankin Scale (mRS) and Barthel Index (BI). HRQoL was assessed using the Quality of Life in Neurological Disorders measures of executive function, general cognitive concerns, upper extremity dexterity, and lower extremity mobility. Time to therapy consult and treatment were defined as the number of days from hospital admission to initial consult by a therapist and number of days from hospital admission to initial treatment, respectively. RESULTS Among the participants, the median number of days from hospital admission to acute therapy consult was 2 days (interquartile range, 1-3d). Multivariable linear and logistic regression models indicated that for those with the National Institutes of Health Stroke Scale (NIHSS) score<5, longer time to therapy consult was associated with worse BI scores (BI=100; odds ratio [OR], 0.818; P=.008), executive function T scores (b=-0.865; P=.001), and general cognitive concerns T scores (b=-0.609; P=.009) at 1-month in adjusted analyses. In those with NIHSS score≥5, longer time to therapy treatment led to increased disability (ie, mRS≥ 2; OR, 1.15; P=.039) and lower extremity mobility T scores (b=-0.591; P=.046) at 1 month in adjusted analyses. CONCLUSIONS Longer time to initiation of acute therapy has differential effects on poststroke disability and HRQoL up to 1-month after ischemic stroke and TIA. The effect of acute therapy consult is more notable for those with mild deficits, while the effect of acute therapy treatment is more notable for those with moderate to severe deficits. Minimizing time to therapy consults and treatments in the acute hospital period might improve outcomes after ischemic stroke and TIA.
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Affiliation(s)
- Robert L Askew
- Department of Psychology, Stetson University, DeLand, Florida.
| | - Carmen E Capo-Lugo
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Naidech
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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18
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Liljehult J, Molsted S, Møller T, Overgaard D, Adamsen L, Jarden M, Christensen T. Lifestyle counselling as secondary prevention in patients with minor stroke and transient ischemic attack: study protocol for a randomized controlled pilot study. Pilot Feasibility Stud 2020; 6:40. [PMID: 32226634 PMCID: PMC7093950 DOI: 10.1186/s40814-020-00583-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/11/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Most patients with minor stroke or transient ischemic attack (TIA) are discharged with little or no specialised follow-up. Nonetheless, these patients have a high prevalence of cognitive impairments and a considerable risk of recurrent stroke. Smoking cessation, physical activity, and adherence to antihypertensive and antithrombotic medication are highly recommended in patients with minor stroke and TIA. Evidence suggests that simple encouragement to change lifestyle is ineffective. Behavioural interventions might therefore be needed to support patients in managing their own health post-discharge. OBJECTIVES We aim to test the (1) feasibility of randomisation acceptance and an early initiated, client-centred lifestyle and behavioural intervention in a clinical setting, and (2) potential effect of the intervention on arterial blood pressure in patients with minor stroke or TIA and (3) explore the participants experience of barriers and facilitators for health behaviour after a stroke, including perceived needs and social support. METHODS We will conduct a randomized controlled pilot trial: Eligible patients with acute minor stroke or TIA (n = 40) will be randomly allocated to either early initiated counselling with four weekly post-discharge follow-up sessions for 12 weeks or usual care. The primary outcome will be program feasibility and to discuss the relevance of arterial blood pressure as primary outcome after 12 weeks intervention. Selected participants will be invited to participate in semi-structured interviews, based on purposeful sampling, to evaluate the intervention and explore their experience of life after a stroke. The interviews will be analysed using a five-step thematic analysis approach. DISCUSSION The study will provide evidence of the feasibility and potential effect of early initiated counselling on cardiovascular risk factors in patients with minor stroke and TIA. Qualitative interviews will contribute with a more nuanced understanding of the barriers and facilitators of health enhancing behaviour. Optimizing health behaviour counselling and providing formal support to the patients' post-discharge may ease the transition and help more patients adhere to lifestyle and medication recommendations. TRIAL REGISTRATION ClinicalTrial.gov, NCT03648957.
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Affiliation(s)
- Jacob Liljehult
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
- Department 9701, The University Hospitals Centre for Health Research UCSF, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Faculty of Health and Technology, Institute of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, DK-2200 Copenhagen N, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
| | - Tom Møller
- Department 9701, The University Hospitals Centre for Health Research UCSF, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - Dorthe Overgaard
- Faculty of Health and Technology, Institute of Nursing and Nutrition, Copenhagen University College, Tagensvej 86, DK-2200 Copenhagen N, Denmark
| | - Lis Adamsen
- Department 9701, The University Hospitals Centre for Health Research UCSF, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - Mary Jarden
- Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
| | - Thomas Christensen
- Department of Neurology, Nordsjællands Hospital, Dyrehavevej 29, DK-3400 Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3, DK-2200 Copenhagen N, Denmark
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19
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Ablewhite J, Geraghty J, das Nair R, Lincoln N, Drummond A. Cognitive Management Pathways in Stroke Services (COMPASS): A qualitative investigation of key issues in relation to community stroke teams undertaking cognitive assessments. Br J Occup Ther 2019. [DOI: 10.1177/0308022619841320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joanne Ablewhite
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Jenni Geraghty
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Roshan das Nair
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Nadina Lincoln
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Avril Drummond
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
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20
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Grimley RS, Rosbergen ICM, Gustaffson L, Horton E, Green T, Cadigan G, Cadilhac DA, Kuys S. Assessment and selection for rehabilitation following acute stroke: a prospective cohort study in Queensland, Australia. Clin Rehabil 2019; 33:1252-1263. [DOI: 10.1177/0269215519837585] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rohan S Grimley
- Sunshine Coast Clinical School, The University of Queensland, Birtinya, QLD, Australia
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Ingrid CM Rosbergen
- Allied Health Services, Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Louise Gustaffson
- School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Eleanor Horton
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Maroochydore, QLD, Australia
| | - Theresa Green
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Clinical Nursing, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | - Greg Cadigan
- Queensland State-Wide Stroke Clinical Network, Clinical Excellence Division, Queensland Department of Health, Brisbane, QLD, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, VIC, Australia
| | - Suzanne Kuys
- Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
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21
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Ramírez-Moreno JM, Bartolomé Alberca S, Muñoz Vega P, Guerrero Barona EJ. Screening for cognitive impairment with the Montreal Cognitive Assessment in Spanish patients with minor stroke or transient ischaemic attack. Neurologia 2019; 37:38-44. [PMID: 30737125 DOI: 10.1016/j.nrl.2018.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The symptoms of minor stroke and transient ischemic attack (TIA) are temporary and mild. Despite the transient nature of the focal symptoms and the absence of visible brain lesions in some patients, many experience persistent cognitive problems subsequently. We aimed to establish the discriminant capacity of the Montreal Cognitive Assessment (MoCA) in screening for cognitive impairment (CI) within 90 days of TIA. METHOD A total of 50 patients with minor stroke or TIA were recruited. Patients were administered the MoCA test and a formal neuropsychological test battery. CI was defined clinically according to neuropsychological test findings. RESULTS The average age of recruited patients was 57.7±8.0 years; 70.0% were men; all patients had completed at least primary education. Thirty-seven patients (74.0%) presented CI. Receiver operating characteristic curve analysis obtained an optimal MoCA cut-off point of 25 for discriminating between patients with CI and those without, with an area under the curve of 0.835 (95% confidence interval [95% CI] 0.720-0.949), sensitivity of 78.4% (95% CI 62.8-88.6%), specificity of 76.9% (95% CI 49.7-91.8%), positive predictive value of 90.6% (95% CI 81.0-95.6%), and negative predictive value of 55.6% (95% CI 39.5-70.4%). CONCLUSIONS More than half of the patients presented CI as determined by the formal battery of neuropsychological tests. A MoCA cut-off point of 25 is sufficiently sensitive and specific for detecting CI after minor stroke or TIA, and may be implemented as a screening technique in routine clinical practice.
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Affiliation(s)
- J M Ramírez-Moreno
- Departamento de Ciencias Biomédicas, Universidad de Extremadura, Badajoz, España; Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España; Grupo de Investigación Multidisciplinar de Extremadura (GRIMEX), Villanueva de la Serena, España.
| | - S Bartolomé Alberca
- Centro de Ictus, Sección de Neurología, Hospital Universitario Infanta Cristina, Badajoz, España
| | - P Muñoz Vega
- Centro de Neurorrehabilitación Casaverde, Mérida, España
| | - E J Guerrero Barona
- Departamento de Psicología y Antropología, Universidad de Extremadura, Badajoz, España
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22
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Accelerated long-term forgetting after TIA or minor stroke: A more sensitive measure for detecting subtle memory dysfunction? Cortex 2019; 110:150-156. [DOI: 10.1016/j.cortex.2018.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 12/04/2017] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
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Katzan IL, Schuster A, Newey C, Uchino K, Lapin B. Patient-reported outcomes across cerebrovascular event types: More similar than different. Neurology 2018; 91:e2182-e2191. [PMID: 30381370 DOI: 10.1212/wnl.0000000000006626] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the degrees to which 8 domains of health are affected across types of cerebrovascular events and to identify factors associated with domain scores in different event types. METHODS This was an observational cohort study of 2,181 patients with ischemic stroke, intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or TIA in a cerebrovascular clinic from February 17, 2015, to June 2, 2017 who completed Quality of Life in Neurologic Disorders executive function and the following Patient-Reported Outcomes Measurement Information System scales as part of routine care: physical function, satisfaction with social roles, fatigue, anxiety, depression, pain interference, and sleep disturbance. RESULTS All health domains were affected to similar degrees in patients with ICH, SAH, and ischemic stroke after adjustment for disability and other clinical factors, whereas patients with TIA had worse adjusted scores for 5 of the 8 domains of health. Female sex, younger age, lower income, and event <90 days were associated with worse scores in multiple domains. Factors associated with health domain scores were similar for all cerebrovascular events. Most affected domains for all were physical function, satisfaction with social roles, and executive function. CONCLUSIONS The subtype of stroke (ischemic stroke, ICH, and SAH) had similar effects in multiple health domains, while patients with TIA had worse adjusted outcomes, suggesting that the mechanisms for outcomes after TIA may differ from those of other cerebrovascular events. The most affected domains across all event types were physical function, satisfaction with social roles, and executive function, highlighting the need to develop effective interventions to improve these health domains in survivors of these cerebrovascular events.
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Affiliation(s)
- Irene L Katzan
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH.
| | - Andrew Schuster
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Christopher Newey
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Ken Uchino
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
| | - Brittany Lapin
- From the Neurological Institute Center for Outcomes Research & Evaluation (I.L.K., A.S., B.L.) and Cerebrovascular Center (I.L.K. C.N., K.U.), Cleveland Clinic, OH
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Executive Function Declines in the First 6 Months After a Transient Ischemic Attack or Transient Neurological Attack. Stroke 2017; 48:3323-3328. [DOI: 10.1161/strokeaha.117.018298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 11/16/2022]
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Subjective Cognitive Impairment, Depressive Symptoms, and Fatigue after a TIA or Transient Neurological Attack: A Prospective Study. Behav Neurol 2017; 2017:5181024. [PMID: 29348702 PMCID: PMC5733631 DOI: 10.1155/2017/5181024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/30/2017] [Accepted: 10/08/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Subjective cognitive impairment (SCI), depressive symptoms, and fatigue are common after stroke and are associated with reduced quality of life. We prospectively investigated their prevalence and course after a transient ischemic attack (TIA) or nonfocal transient neurological attack (TNA) and the association with diffusion-weighted imaging (DWI) lesions. Methods The Cognitive Failures Questionnaire, Hospital Anxiety and Depression Scale, and Subjective Fatigue subscale from the Checklist Individual Strength were used to assess subjective complaints shortly after TIA or TNA and six months later. With repeated measure analysis, the associations between DWI lesion presence or clinical diagnosis (TIA or TNA) and subjective complaints over time were determined. Results We included 103 patients (28 DWI positive). At baseline, SCI and fatigue were less severe in DWI positive than in DWI negative patients, whereas at follow-up, there were no differences. SCI (p = 0.02) and fatigue (p = 0.01) increased in severity only in DWI positive patients. There were no differences between TIA and TNA. Conclusions Subjective complaints are highly prevalent in TIA and TNA patients. The short-term prognosis is not different between DWI-positive and DWI negative patients, but SCI and fatigue increase in severity within six months after the event when an initial DWI lesion is present.
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van Rooij FG, Kessels RPC, Richard E, De Leeuw FE, van Dijk EJ. Cognitive Impairment in Transient Ischemic Attack Patients: A Systematic Review. Cerebrovasc Dis 2017; 42:1-9. [PMID: 26886189 DOI: 10.1159/000444282] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although by definition a transient ischemic attack (TIA) lasts less than 24 h, many patients experience cognitive complaints beyond focal symptom resolution. However, their prevalence, causes and profile are unclear. We therefore performed a systematic review on cognitive impairment after TIA. SUMMARY Medline and Embase were searched for relevant studies. Risk of bias was assessed, and data synthesis was performed according to the severity of cognitive impairment. Thirteen studies were included, with considerable heterogeneity concerning methods and timing of cognitive testing. Confounding, detection bias and attrition were the main causes of a high risk of bias in several studies. The prevalence of post-TIA mild cognitive impairment ranged from 29 to 68%. Severe cognitive impairment was found in 8-22% of patients. Studies using a cognitive screening instrument and those performed shortly after TIA or several years later, reported the highest frequencies of impairment. Patients evaluated with a screening tool were substantially older than those who underwent a full neuropsychological assessment (weighted mean age difference 10.9 years). Based on limited data, the post-TIA cognitive profile showed prominent executive function deficits. Insufficient data refrained us from drawing conclusions on causality. The few studies that reported neuroimaging results found a minor correlation with cognitive impairment. KEY MESSAGES Mild cognitive impairment is present in more than a third of the TIA patients and has a profile comparable with vascular cognitive impairment. Reported rates of post-TIA cognitive impairment are highly variable and higher frequencies are found with cognitive screening tools. Considerable heterogeneity and insufficient data limit further conclusions about potential causative factors.
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Affiliation(s)
- Frank G van Rooij
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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Tang EYH, Price C, Stephan BCM, Robinson L, Exley C. Gaps in care for patients with memory deficits after stroke: views of healthcare providers. BMC Health Serv Res 2017; 17:634. [PMID: 28886738 PMCID: PMC5591549 DOI: 10.1186/s12913-017-2569-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/25/2017] [Indexed: 11/14/2022] Open
Abstract
Background Stroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care. Methods Seventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation. Results Data analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care. Conclusions The care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.
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Affiliation(s)
- Eugene Yee Hing Tang
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Christopher Price
- Institute of Neuroscience, Stroke Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom Christa Maree Stephan
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Robinson
- Institute of Health and Society and Newcastle University Institute for Ageing, Newcastle University, Level 2, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Faux SG, Arora P, Shiner CT, Thompson-Butel AG, Klein LA. Rehabilitation and education are underutilized for mild stroke and TIA sufferers. Disabil Rehabil 2017; 40:1480-1484. [DOI: 10.1080/09638288.2017.1295473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven G. Faux
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Pooja Arora
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | - Christine T. Shiner
- Department of Rehabilitation Medicine, St Vincent’s Hospital, Sydney, New South Wales, Australia
| | | | - Linda A. Klein
- Sydney Medical School, University of Sydney, New South Wales, Australia
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Maaijwee NAMM, Tendolkar I, Rutten-Jacobs LCA, Arntz RM, Schaapsmeerders P, Dorresteijn LD, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Long-term depressive symptoms and anxiety after transient ischaemic attack or ischaemic stroke in young adults. Eur J Neurol 2016; 23:1262-8. [PMID: 27094933 DOI: 10.1111/ene.13009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Few studies exist on long-term post-stroke depressive symptoms and anxiety in young adults, although these young patients have a particular interest in their long-term prognosis, given their usually long life expectancy and being in the midst of an active social, working and family life. The aims of this study were to investigate the prevalence of depressive symptoms and anxiety and their association with clinical and demographic variables and with functional outcome after stroke in young adults. METHODS AND RESULTS Long-term prevalence of depressive symptoms and anxiety was calculated in 511 patients with a transient ischaemic attack or ischaemic stroke, aged 18-50 years, using the Hospital Anxiety and Depression scale, compared with 147 controls. Functional outcome was assessed with the modified Rankin Score (mRS) and the Instrumental Activities of Daily Living scale (IADL). 16.8% of patients had depressive symptoms and 23.0% had anxiety, versus 6.1% (P = 0.001) and 12.2% (P < 0.001) in controls. In ischaemic stroke patients, depressive symptoms and anxiety were associated with poor functional outcome (mRS > 2 or IADL < 8). CONCLUSION Even a decade after stroke at young age, depressive symptoms and anxiety were prevalent and associated with poor functional outcome. Therefore, even in the long term, treating physicians should be aware of the long-term presence of these symptoms as their recognition may be the first step in improving long-term functional independence.
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Affiliation(s)
- N A M M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - R M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L D Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - H C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - F-E de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Kjörk E, Blomstrand C, Carlsson G, Lundgren-Nilsson Å, Gustafsson C. Daily life consequences, cognitive impairment, and fatigue after transient ischemic attack. Acta Neurol Scand 2016; 133:103-110. [PMID: 25955112 DOI: 10.1111/ane.12435] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Studies suggest that fatigue and cognitive impairment may be present after transient ischemic attack (TIA), but little is known about consequences in daily life. The main aim was to longitudinally explore the presence of fatigue, cognitive impairment, and consequences in daily life including communication after clinically diagnosed TIA at 1 and 9 months after the event. MATERIAL AND METHODS A consecutive sample of 46 patients (23 women, 69 ± 12.3 years) was assessed at discharge from hospital and at 1 and 9 months after TIA regarding cognition, mental fatigue, tiredness, and activities of daily life. This served as basis for an interview concerning experienced changes related to the TIA. RESULTS Problems in daily life with probable association with the TIA were experienced by 37% (n = 45) of participants 9 months after the TIA event. Cognitive impairment was present in 40% (n = 44) after 1 month and 30% (n = 23) after 9 months. Mental fatigue was experienced by 26% (n = 42) after 1 month and 17% (n = 39) after 9 months. Communication problems were reported and increased from 7 to 14 participants between the two time points. CONCLUSIONS A third of the TIA patients experienced problems in performance of complex activities in daily life and often communication problems within the first 9 months. Cognitive impairment and mental fatigue could be factors influencing performance in daily life and at work, but this needs to be verified in a larger sample. The risk of activity limitations indicates need for multiprofessional support and systematic routines for TIA follow-up.
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Affiliation(s)
- E. Kjörk
- Sahlgrenska University Hospital; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Section of Clinical Neuroscience and Rehabilitation; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - C. Blomstrand
- Section of Clinical Neuroscience and Rehabilitation; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - G. Carlsson
- Section of Clinical Neuroscience and Rehabilitation; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Å. Lundgren-Nilsson
- Section of Clinical Neuroscience and Rehabilitation; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - C. Gustafsson
- Sahlgrenska University Hospital; Institute of Neuroscience and Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, Ruff I, Cella D, Naidech AM, Prabhakaran S. Quality of life in patients with TIA and minor ischemic stroke. Neurology 2015; 85:1957-63. [PMID: 26537051 DOI: 10.1212/wnl.0000000000002164] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system. METHODS Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression. RESULTS Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months. CONCLUSIONS Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.
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Affiliation(s)
- Rajbeer S Sangha
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Fan Z Caprio
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Askew
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Corado
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard Bernstein
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yvonne Curran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana Ruff
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shyam Prabhakaran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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van Rooij FG, Tuladhar AM, Kessels RPC, Vermeer SE, Góraj BM, Koudstaal PJ, Norris DG, de Leeuw FE, van Dijk EJ. Cohort study ON Neuroimaging, Etiology and Cognitive consequences of Transient neurological attacks (CONNECT): study rationale and protocol. BMC Neurol 2015; 15:36. [PMID: 25880287 PMCID: PMC4379587 DOI: 10.1186/s12883-015-0295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/05/2015] [Indexed: 12/04/2022] Open
Abstract
Background Transient ischemic attacks (TIA) are characterized by acute onset focal neurological symptoms and complete recovery within 24 hours. Attacks of nonfocal symptoms not fulfilling the criteria for TIA but lacking a clear alternative diagnosis are called transient neurological attacks (TNA). Although TIA symptoms are transient in nature, cognitive complaints may persist. In particular, attacks consisting of both focal and nonfocal symptoms (mixed TNA) have been found to be associated with an increased risk of dementia. We aim to study the prevalence, etiology and risk factors of cognitive impairment after TIA or TNA. Methods/Design CONNECT is a prospective cohort study on cognitive function after TIA and TNA. In total, 150 patients aged ≥45 years with a recent (<7 days after onset) TIA or TNA and no history of stroke or dementia will be included. We will classify events as: TIA, nonfocal TNA, or mixed TNA. Known short lasting paroxysmal neurological disorders like migraine aura, seizures and Ménière disease are excluded from the diagnosis of TNA. Patients will complete a comprehensive neuropsychological assessment and undergo MRI <7 days after the qualifying event and again after six months. The primary clinical outcomes will be cognitive function at baseline and six months after the primary event. Imaging outcomes include the prevalence and evolution of DWI lesions, white matter hyperintensities and lacunes, as well as resting state networks functionality and white matter microstructural integrity. Differences between types of event and DWI, as well as determinants of both clinical and imaging outcomes, will be assessed. Discussion CONNECT can provide insight in the prevalence, etiology and risk factors of cognitive impairment after TIA and TNA and thereby potentially identify a new group of patients at increased risk of cognitive impairment.
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Affiliation(s)
- Frank G van Rooij
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Anil M Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands. .,Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University Nijmegen, 6500 HE, Nijmegen, Netherlands.
| | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, Netherlands.
| | - Bozena M Góraj
- Department of Radiology, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Peter J Koudstaal
- Erasmus Medical Center, Department of Neurology, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
| | - David G Norris
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Radboud University Nijmegen, 6500 HE, Nijmegen, Netherlands.
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, Netherlands.
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Croot EJ, Ryan TW, Read J, Campbell F, O'Cathain A, Venables G. Transient ischaemic attack: a qualitative study of the long term consequences for patients. BMC FAMILY PRACTICE 2014; 15:174. [PMID: 25359664 PMCID: PMC4221669 DOI: 10.1186/s12875-014-0174-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/10/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Transient ischaemic attack (TIA) is characterised by its transient nature with symptoms of neurological dysfunction resolving within 24 hours. The occurrence of TIA is a major risk factor for stroke with 10-15% of TIA patients going on to have ischaemic stroke. Internationally, recommendations for the management of TIA focus on the need for early diagnosis and medical management of the acute increased risk of ischaemic stroke. However there is a limited amount of evidence that some patients suffer enduring consequences as a result of this 'transient' event. This paper focusses on patients' long term lived experience following a TIA. METHODS Semi structured interviews were carried out with patients who had a TIA between two and 24 months previously. Participants were asked about their TIA, the advice and management received and any changes made as a result of the TIA. Interviews were recorded and transcribed verbatim. Thematic content analysis involved scrutinising transcripts to look for links and associations within and between accounts in a process similar to the grounded theory approach of open coding. The category of transience emerged and was explored in more detail to examine the enduring consequences of TIA. RESULTS Thirty nine patients aged between 31 and 89 years were interviewed. Accounts detailed the long term impact of the TIA and the subsequent 'at risk' status, on the physical and psychosocial wellbeing of participants. Some participants sought to proactively manage the consequences of their TIA but found it difficult to obtain the information and support they needed, whereas others felt that no further action was needed to prevent future stroke. CONCLUSION Current definitions conceptualise TIA as a transient event however our study suggests that some patients experienced long term consequences as a result of their TIA. These included anxiety and uncertainty in the light of their increased stroke risk. TIA patients need access to detailed, evidence based stroke prevention information from a credible source, and support to help them understand and apply the information over time, if they are to effectively self-manage the long term consequences of TIA and reduce their risk of future stroke.
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van Rooij FG, Schaapsmeerders P, Maaijwee NAM, van Duijnhoven DAHJ, de Leeuw FE, Kessels RPC, van Dijk EJ. Persistent cognitive impairment after transient ischemic attack. Stroke 2014; 45:2270-4. [PMID: 25070959 DOI: 10.1161/strokeaha.114.005205] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE By definition, the symptoms of a transient ischemic attack (TIA) subside completely within 24 hours. Imaging studies show signs of persistent ischemic tissue damage in a substantial amount of patients with TIA. Cerebral infarction can cause permanent cognitive impairment. Whether permanent cognitive impairment occurs after TIA is unclear, as is its profile. METHODS Patients with TIA aged 45 to 65 years without prior stroke or dementia underwent comprehensive neuropsychological testing within 3 months. Z scores per cognitive domain were obtained, based on the mean of a control group within the same age range. Cognitive impairment was defined as a domain z score <-1.65. Patients underwent either computed tomography or MRI brain imaging. RESULTS One hundred seven patients with TIA (63% women, mean age, 56.6 years) were included and compared with 81 controls (56% women, mean age, 52.9 years). Patients performed worse on all cognitive domains except episodic memory. Working memory (25%), attention (22%), and information processing speed (16%) were most frequently impaired and more often than in the control group (age- and sex-adjusted odds ratios, respectively, 22.5 [95% confidence interval, 2.9-174.3], 6.8 [1.9-24.3], 7.1 [1.5-32.5]). More than 35% of patients with TIA had impairment of ≥1 cognitive domain. Presence of silent brain infarcts was related to worse executive functioning but did not explain the whole relationship between TIA and cognitive impairment. CONCLUSIONS More than a third of patients with TIA have impairment of ≥1 cognitive domain within 3 months after their TIA. The affected domains fit in the vascular cognitive impairment profile.
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Affiliation(s)
- Frank G van Rooij
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Pauline Schaapsmeerders
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Noortje A M Maaijwee
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Dirk A H J van Duijnhoven
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Roy P C Kessels
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Departments of Neurology (F.G.v.R., P.S., N.A.M.M., F.-E.d.L., E.J.v.D.) and Medical Psychology (D.A.H.J.v.D., R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands.
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Moran GM, Fletcher B, Feltham MG, Calvert M, Sackley C, Marshall T. Fatigue, psychological and cognitive impairment following transient ischaemic attack and minor stroke: a systematic review. Eur J Neurol 2014; 21:1258-67. [PMID: 24861479 DOI: 10.1111/ene.12469] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
Transient ischaemic attack (TIA) and minor stroke are characterized by short-lasting symptoms; however, anecdotal and empirical evidence suggests that these patients experience ongoing cognitive/psychological impairment for which they are not routinely treated. The aims were (i) to investigate the prevalence and time course of fatigue, anxiety, depression, post-traumatic stress disorder(PTSD) and cognitive impairment following TIA/minor stroke; (ii) to explore the impact on quality of life (QoL), change in emotions and return to work; and (iii) to identify where further research is required and potentially inform an intervention study. A systematic review of MEDLINE, EMBASE, PSYCINFO, CINAHL, the Cochrane libraries and the grey literature between January 1993 and April 2013 was undertaken. Literature was screened and data were extracted by two independent reviewers. Studies were included of adult TIA/minor stroke participants with any of the outcomes of interest: fatigue, anxiety, depression, PTSD, cognitive impairment, QoL, change in emotions and return to work. Random-effects meta-analysis pooled outcomes by measurement tool. Searches identified 5976 records, 289 were assessed for eligibility and 31 studies were included. Results suggest high levels of cognitive impairment and depression post-TIA/minor stroke which decreased over time. However, frequencies varied between studies. Limited information was available on anxiety, PTSD and fatigue. Meta-analysis revealed that the measurement tool administered influenced the prevalence of cognitive impairment: Mini-Mental State Examination 17% [95% confidence interval (CI) 7, 26]; neuropsychological test battery 39% (95% CI 28, 50); Montreal Cognitive Assessment 54% (95% CI 43, 66). There is evidence to suggest that TIA/minor stroke patients may experience residual impairments; however, results should be interpreted with caution because of the few high quality studies. Notwithstanding, it is important to raise awareness of potential subtle but meaningful residual impairments.
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Affiliation(s)
- G M Moran
- Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Arntz RM, van Alebeek ME, Synhaeve NE, Brouwers PJ, van Dijk GW, Gons RA, den Heijer T, de Kort PLM, de Laat KF, van Norden AG, Vermeer SE, van der Vlugt MJ, Kessels RPC, van Dijk EJ, de Leeuw FE. Observational Dutch Young Symptomatic StrokE studY (ODYSSEY): study rationale and protocol of a multicentre prospective cohort study. BMC Neurol 2014; 14:55. [PMID: 24655479 PMCID: PMC3998025 DOI: 10.1186/1471-2377-14-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 03/05/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The proportion of strokes occurring in younger adults has been rising over the past decade. Due to the far longer life expectancy in the young, stroke in this group has an even larger socio-economic impact. However, information on etiology and prognosis remains scarce. METHODS/DESIGN ODYSSEY is a multicentre prospective cohort study on the prognosis and risk factors of patients with a first-ever TIA, ischemic stroke or intracerebral hemorrhage aged 18 to 49 years. Our aim is to include 1500 patients. Primary outcome will be all cause mortality and risk of recurrent vascular events. Secondary outcome will be the risk of post-stroke epilepsy and cognitive impairment. Patients will complete structured questionnaires on outcome measures and risk factors. Both well-documented and less well-documented risk factors and potentially acute trigger factors will be investigated. Patients will be followed every 6 months for at least 3 years. In addition, an extensive neuropsychological assessment will be administered both at baseline and 1 year after the stroke/TIA. Furthermore we will include 250 stroke-free controls, who will complete baseline assessment and one neuropsychological assessment. DISCUSSION ODYSSEY is designed to prospectively determine prognosis after a young stroke and get more insight into etiology of patients with a TIA, ischemic stroke and intracerebral hemorrhage in patients aged 18 to 49 years old in a large sample size.
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Affiliation(s)
- Renate M Arntz
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Mayte E van Alebeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, St. Elisabeth Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
- Department of Neurology, TweeSteden Hospital, PO Box 90107, 5000, LA Tilburg, the Netherlands
| | - Paul J Brouwers
- Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500, KA Enschede, the Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius-Wilhelmina Hospital, PO Box 9015, 6500, GS Nijmegen, the Netherlands
| | - Rob A Gons
- Department of Neurology, Catharina Hospital, PO Box 1350, 5602, ZA Eindhoven, the Netherlands
| | - Tom den Heijer
- Department of Neurology, Sint Franciscus Gasthuis, PO Box 109000, 3004, BA Rotterdam, the Netherlands
| | - Paul LM de Kort
- Department of Neurology, St. Elisabeth Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
- Department of Neurology, TweeSteden Hospital, PO Box 90107, 5000, LA Tilburg, the Netherlands
| | - Karlijn F de Laat
- Department of Neurology, Haga Hospital, PO Box 40551, 2504, LN Den Haag, Netherlands
| | - Anouk G van Norden
- Department of Neurology, Amphia Hospital, PO Box 90157, 4800, RL Breda, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, PO Box 9555, 6800, TA Arnhem, the Netherlands
| | - Maureen J van der Vlugt
- Radboud University Medical Centre, department of Cardiology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Roy PC Kessels
- Department of Medical Psychology, Radboud University Medical Centre, PO Box 9101, 6500, HB Nijmegen, the Netherlands
- Donders Institute for Brain, Radboud University Nijmegen, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Ewoud J van Dijk
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
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Francois S, Borgermans L, Van Casteren V, Vanthomme K, Devroey D. Availability of informal caregivers in surviving stroke patients in Belgium. Scand J Caring Sci 2013; 28:683-8. [PMID: 24188399 DOI: 10.1111/scs.12093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/25/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify the availability of informal caregivers in surviving stroke patients residing at home in Belgium. METHODS National estimates on the availability of informal caregivers were made using data from a nationwide observational registration of family physicians working in sentinel practices and a nationwide administrative database for reimbursement of hospitals in Belgium. RESULTS A total of 189 Belgian family physicians (FPs) from 141 practices participated in the study and recorded 326 patients (144 men and 182 women) with stroke. These FPs reach 1.5% of the Belgian population. After 1 month, 71% of the male and 75% of the female stroke survivors received support from family caregivers (p = 0.547). After 6 months, the percentage of male patients who received support from family caregivers decreased to 60% compared with 75% in female (p = 0.038). Of all patients with stroke admitted to Belgian hospitals during the reference year 2009 (n = 16.437), 8.997 returned home. Based on the findings from the sentinel practices, it is estimated that a mean of 73% (n = 6.568) and 67.5% (n = 6.073) of surviving patients with stroke can rely on informal caregivers in their home setting after one and 6 months, respectively. CONCLUSIONS A vast majority of surviving stroke patients in Belgium can rely on informal caregivers in their home setting, but their availability rapidly decreases 6 months after the event. These findings underline the importance of proactive health policy making in stroke care taking into account the potentially decreasing number of available informal caregivers in the decades to come.
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Affiliation(s)
- Silke Francois
- Department of Family Medicine, Vrije Universiteit Brussel, Brussel, Belgium
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