1
|
Taylor-Rowan M, Hafdi M, Drozdowska B, Elliott E, Wardlaw J, Quinn TJ. Physical and brain frailty in ischaemic stroke or TIA: Shared occurrence and outcomes. A cohort study. Eur Stroke J 2023; 8:1011-1020. [PMID: 37421136 PMCID: PMC10683729 DOI: 10.1177/23969873231186480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND There is increasing interest in the concept of frailty in stroke, including both physical frailty and imaging-evidence of brain frailty. We aimed to establish the prevalence of brain frailty in stroke survivors as well as the concurrent and predictive validity of various frailty measures against long-term cognitive outcomes. METHODS We included consecutively admitted stroke or transient ischaemic attack (TIA) survivors from participating stroke centres. Baseline CT scans were used to generate an overall brain frailty score for each participant. We measured frailty via the Rockwood frailty index, and a Fried frailty screening tool. Presence of major or minor neurocognitive disorder at 18-months following stroke or TIA was established via a multicomponent assessment. Prevalence of brain frailty was established based upon observed percentages within groups defined by frailty status (robust, pre-frail, frail). We assessed the concurrent validity of brain frailty and frailty scales via Spearman's rank correlation. We conducted multivariable logistic regression analyses, controlling for age, sex, baseline education and stroke severity, to evaluate association between each frailty measure and 18-month cognitive impairment. RESULTS Three-hundred-forty-one stroke survivors participated. Three-quarters of people who were frail had moderate-severe brain frailty and prevalence increased according to frailty status. Brain frailty was weakly correlated with Rockwood frailty (Rho: 0.336; p < 0.001) and with Fried frailty (Rho: 0.230; p < 0.001). Brain frailty (OR: 1.64, 95% CI = 1.17-2.32), Rockwood frailty (OR: 1.05, 95% CI = 1.02-1.08) and Fried frailty (OR: 1.93, 95% CI = 1.39-2.67) were each independently associated with cognitive impairment at 18 months following stroke. CONCLUSIONS There appears to be value in the assessment of both physical and brain frailty in patients with ischaemic stroke and TIA. Both are associated with adverse cognitive outcomes and physical frailty remains important when assessing cognitive outcomes.
Collapse
Affiliation(s)
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bogna Drozdowska
- Institute of Cardiovascular and Metabolic Sciences, University of Glasgow, Glasgow, UK
| | - Emma Elliott
- Institute of Cardiovascular and Metabolic Sciences, University of Glasgow, Glasgow, UK
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, Edinburgh Center in the UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Metabolic Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
2
|
Taylor‐Rowan M, McGuire L, Hafdi M, Evans J, Stott DJ, Wetherall K, Elliott E, Drozdowska B, Quinn TJ. Comparative validity of informant tools for assessing pre-stroke cognitive impairment. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5700. [PMID: 35278006 PMCID: PMC9310907 DOI: 10.1002/gps.5700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/01/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Various informant-based questionnaires are used in clinical practice to screen for pre-stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant-based tools. METHODS We recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE-SF, 16-item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi-structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall 'brain frailty'. Finally, we described prognostic validity comparing ROC curves for 18-month clinical outcomes of dementia, death, stroke, and disability. RESULTS One-hundred-thirty-seven patient-informant dyads were recruited. At usual clinical cut-points, the IQCODE-SF had comparable sensitivity to the AD8 (both = 92%) for pre-stroke dementia, but superior specificity (IQCODE-SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE-SF demonstrated stronger associations with markers of generalised and medial-temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE-SF also demonstrated greater accuracy for predicting future dementia (IQCODE-SF AUROC = 0.903, 95% CI = 0.798-1.00; AD8 AUROC = 0.821, 95% CI = 0.664-0.977). CONCLUSIONS Both IQCODE-SF and AD8 are valid measures of pre-stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE-SF may be preferable to AD8 for pre-stroke dementia screening.
Collapse
Affiliation(s)
- Martin Taylor‐Rowan
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Lucy McGuire
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Melanie Hafdi
- Department of NeurologyUniversity of AmsterdamDuivendrechtUK
| | - Jonathan Evans
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUK
| | - David J. Stott
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Kirsty Wetherall
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Emma Elliott
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Bogna Drozdowska
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| |
Collapse
|
3
|
Howe J, Chua W, Sumner E, Drozdowska B, Laverick R, Bevins RL, Jean-Baptiste E, Russell M, Rotshtein P, Wing AM. The efficacy of a task model approach to ADL rehabilitation in stroke apraxia and action disorganisation syndrome: A randomised controlled trial. PLoS One 2022; 17:e0264678. [PMID: 35239707 PMCID: PMC8893688 DOI: 10.1371/journal.pone.0264678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Apraxia and action disorganization syndrome (AADS) after stroke can disrupt activities of daily living (ADL). Occupational therapy has been effective in improving ADL performance, however, inclusion of multiple tasks means it is unclear which therapy elements contribute to improvement. We evaluated the efficacy of a task model approach to ADL rehabilitation, comparing training in making a cup of tea with a stepping training control condition. Methods Of the 29 stroke survivors with AADS who participated in this cross-over randomized controlled feasibility trial, 25 were included in analysis [44% females; mean(SD) age = 71.1(7.8) years; years post-stroke = 4.6(3.3)]. Participants attended five 1-hour weekly tea making training sessions in which progress was monitored and feedback given using a computer-based system which implemented a Markov Decision Process (MDP) task model. In a control condition, participants received five 1-hour weekly stepping sessions. Results Compared to stepping training, tea making training reduced errors across 4 different tea types. The time taken to make a cup of tea was reduced so the improvement in accuracy was not due to a speed-accuracy trade-off. No improvement linked to tea making training was evident in a complex tea preparation task (making two different cups of tea simultaneously), indicating a lack of generalisation in the training. Conclusions The clearly specified but flexible training protocol, together with information on the distribution of errors, provide pointers for further refinement of task model approaches to ADL rehabilitation. It is recommended that the approach be tested under errorless learning conditions with more impaired patients in future research. Trial registration Retrospectively registered at ClinicalTrials.gov on 5th August 2019 [NCT04044911] https://clinicaltrials.gov/ct2/show/NCT04044911?term=Cogwatch&rank=1
Collapse
Affiliation(s)
- Jo Howe
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Pharmacy, Aston University, Birmingham, United Kingdom
| | - Winnie Chua
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Emily Sumner
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Bogna Drozdowska
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rosanna Laverick
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rachel L. Bevins
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- School of Life Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
| | - Emilie Jean-Baptiste
- School of Electronic, Electrical and Systems Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Martin Russell
- School of Electronic, Electrical and Systems Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Pia Rotshtein
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alan M. Wing
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
4
|
Quinn TJ, Taylor-Rowan M, Elliott E, Drozdowska B, McMahon D, Broomfield NM, Barber M, MacLeod MJ, Cvoro V, Byrne A, Ross S, Crow J, Slade P, Dawson J, Langhorne P. Research protocol - Assessing Post-Stroke Psychology Longitudinal Evaluation (APPLE) study: A prospective cohort study in stroke. Cereb Circ Cogn Behav 2022; 3:100042. [PMID: 36324404 PMCID: PMC9616226 DOI: 10.1016/j.cccb.2022.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/30/2021] [Accepted: 01/21/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Cognitive and mood problems have been highlighted as priorities in stroke research and guidelines recommend early screening. However, there is limited detail on the preferred approach.We aimed to (1) determine the optimal methods for evaluating psychological problems that pre-date stroke; (2) assess the test accuracy, feasibility and acceptability of brief cognitive and mood tests used at various time-points following stroke; (3) describe temporal changes in cognition and mood following stroke and explore predictors of change. METHODS We established a multi-centre, prospective, observational cohort with acute stroke as the inception point - Assessing Post-stroke Psychology Longitudinal Evaluation (APPLE). We approached patients admitted with stroke or transient ischaemic attack (TIA) from 11 different hospital sites across the United Kingdom. Baseline demographics, clinical, functional, cognitive, and mood data were collected. Consenting stroke survivors were followed up with more extensive evaluations of cognition and mood at 1, 6, 12 and 18 months. RESULTS Continuous recruitment was from February 2017 to February 2019. With 357 consented to full follow-up. Eighteen-month assessments were completed in September 2020 with permissions in-place for longer term in-person or electronic follow-up. A qualitative study has been completed, and a participant sample biobank and individual participant database are both available. DISCUSSION The APPLE study will provide guidance on optimal tool selection for cognitive and mood assessment both before and after stroke, as well as information on prognosis and natural history of neuropsychological problems in stroke. The study data, neuroimaging and tissue biobank are all available as a resource for future research.
Collapse
Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Bogna Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - David McMahon
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Niall M Broomfield
- Department Clinical Psychology and Psychological Therapies, University of East Anglia, United Kingdom
| | - Mark Barber
- Stroke Unit, University Hospital Monklands, United Kingdom
| | - Mary Joan MacLeod
- Department of Medicine and Therapeutics, University of Aberdeen, United Kingdom
| | - Vera Cvoro
- Stroke Unit, Victoria Hospital, Kirkcaldy, United Kingdom
| | - Anthony Byrne
- Department of Ageing & Health, Forth Valley Royal Hospital, Larbert, United Kingdom
| | - Sarah Ross
- Stroke Unit, Perth Royal Infirmary, Perth, United Kingdom
| | - Jennifer Crow
- Imperial College Healthcare NHS Trust, United Kingdom
| | | | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| |
Collapse
|
5
|
Shaw R, Drozdowska B, Taylor-Rowan M, Elliott E, Cuthbertson G, Stott DJ, Quinn TJ. Delirium in an Acute Stroke Setting, Occurrence, and Risk Factors. Stroke 2019; 50:3265-3268. [DOI: 10.1161/strokeaha.119.025993] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Delirium is a common and serious complication of acute illness. We describe delirium occurrence in an unselected, acute stroke population.
Methods—
We collected data from consecutive stroke admissions. We performed comprehensive cognitive assessment within the first week including Diagnostic Statistical Manual-5–based delirium diagnosis. We reported proportion with delirium and the clinical and demographic associations with delirium using multiple logistic regression.
Results—
Of 708 patients, median age of 71 years (interquartile range, 59–80), we recorded delirium in 187 of 708 (26.4%; 95% CI, 23.0–30.0). Across 395 patients with complete risk factor data (105 delirium), factors independently associated with delirium were: age (odds ratio, 1.05; 95% CI, 1.03–1.08), drug/alcohol misuse (odds ratio, 2.64; 95% CI, 1.10–6.26), and stroke severity (odds ratio, 1.22; 95% CI, 1.14–1.31).
Conclusions—
Delirium is common in acute stroke, affecting 1 in 4. It may be possible to predict those at risk using prestroke and stroke-specific factors.
Clinical Trial Registration—
URL:
researchregistry.com
. Protocol: 1147.
Collapse
Affiliation(s)
- Robert Shaw
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Bogna Drozdowska
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Martin Taylor-Rowan
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Emma Elliott
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Gillian Cuthbertson
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - David J. Stott
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| | - Terence J. Quinn
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Scotland
| |
Collapse
|
6
|
Taylor-Rowan M, Cuthbertson G, Keir R, Shaw R, Drozdowska B, Elliott E, Stott D, Quinn TJ. The prevalence of frailty among acute stroke patients, and evaluation of method of assessment. Clin Rehabil 2019; 33:1688-1696. [DOI: 10.1177/0269215519841417] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective:We aimed to determine prevalence of pre-stroke frailty in acute stroke and describe validity of a Frailty Index–based assessment.Design:Cross-sectional.Setting:Single UK urban teaching hospital.Subjects:Consecutive acute stroke unit admissions, recruited in four waves (May 2016–August 2018). We performed the assessments within first week and attempted to include all admissions.Main measures:Our primary measure was a Frailty Index, based on cumulative disorders. A proportion of participants were also assessed with the ‘Frail non-disabled’ questionnaire. We evaluated concurrent validity of Frailty Index against variables associated with frailty in non-stroke populations. We described predictive validity of Frailty Index for stroke severity and delirium. We described convergent validity, quantifying agreement between frailty assessments and a measure of pre-stroke disability (modified Rankin Scale) using kappa statistics and correlations.Results:We included 546 patients. A Frailty Index–defined frailty syndrome was observed in 427 of 545 patients (78%), of whom, 151 (28%) had frank frailty and 276 (51%) were pre-frail. Phenotypic frailty was observed in 72 of 258 patients (28%). We demonstrated concurrent validity via significant associations with all variables (all p < 0.01). We demonstrated predictive validity for stroke severity and delirium ( p < 0.01). Agreement between the frailty measures was poor (kappa = –0.06) and convergent validity was moderate (Frail non-disabled ‘Cramer’s V’ = 0.25; modified Rankin Scale ‘Cramer’s V’ = 0.47).Conclusion:Frailty is present in around one in four patients with acute stroke; if pre-frailty is included, then a frailty syndrome is seen in three out of four patients. The Frailty Index is a valid measure of frailty in stroke; however, there is little agreement between this scale and other measurements of frailty.
Collapse
Affiliation(s)
- Martin Taylor-Rowan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gillian Cuthbertson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ruth Keir
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Robert Shaw
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Bogna Drozdowska
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Emma Elliott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - David Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
7
|
Wójcik S, Koszowski R, Drozdowska B, Śmieszek-Wilczewska J, Raczkowska-Siostrzonek A. Maxillary fibrous dysplasia associated with McCune-Albright syndrome. A case study. Open Med (Wars) 2017; 11:465-470. [PMID: 28352837 PMCID: PMC5329869 DOI: 10.1515/med-2016-0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/08/2016] [Indexed: 11/25/2022] Open
Abstract
McCune Albright syndrome (MCA) is a rare complication of genetic origin. The authors present a case study of a patient with MCA diagnosed with multifocal fibrous dysplasia in his limb and craniofacial bones. The symptoms of the disease in the patient’s facial and oral tissue and the treatment administered have been described.
Collapse
Affiliation(s)
- Sylwia Wójcik
- Chair of Dental Surgery, Department of Cranio-Maxillofacial Surgery and Oral Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Rafał Koszowski
- Chair of Dental Surgery, Department of Cranio-Maxillofacial Surgery and Oral Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Bogna Drozdowska
- Chair of Pathomorphology, Medical University of Silesia in Katowice, Poland
| | - Joanna Śmieszek-Wilczewska
- Chair of Dental Surgery, Department of Cranio-Maxillofacial Surgery and Oral Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Agnieszka Raczkowska-Siostrzonek
- Chair of Dental Surgery, Department of Cranio-Maxillofacial Surgery and Oral Surgery, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| |
Collapse
|