1
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Beishon L, Vasilopoulos T, Salinet ASM, Levis B, Barnes S, Hills E, Ramesh P, Gkargkoula P, Minhas JS, Castro P, Brassard P, Goettel N, Gommer ED, Jara JL, Liu J, Mueller M, Nasr N, Payne S, Robertson AD, Simpson D, Robinson TG, Panerai RB, Nogueira RC. Individual Patient Data Meta-Analysis of Dynamic Cerebral Autoregulation and Functional Outcome After Ischemic Stroke. Stroke 2024. [PMID: 38511386 DOI: 10.1161/strokeaha.123.045700] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The relationship between dynamic cerebral autoregulation (dCA) and functional outcome after acute ischemic stroke (AIS) is unclear. Previous studies are limited by small sample sizes and heterogeneity. METHODS We performed a 1-stage individual patient data meta-analysis to investigate associations between dCA and functional outcome after AIS. Participating centers were identified through a systematic search of the literature and direct invitation. We included centers with dCA data within 1 year of AIS in adults aged over 18 years, excluding intracerebral or subarachnoid hemorrhage. Data were obtained on phase, gain, coherence, and autoregulation index derived from transfer function analysis at low-frequency and very low-frequency bands. Cerebral blood velocity, arterial pressure, end-tidal carbon dioxide, heart rate, stroke severity and sub-type, and comorbidities were collected where available. Data were grouped into 4 time points after AIS: <24 hours, 24 to 72 hours, 4 to 7 days, and >3 months. The modified Rankin Scale assessed functional outcome at 3 months. Modified Rankin Scale was analyzed as both dichotomized (0 to 2 versus 3 to 6) and ordinal (modified Rankin Scale scores, 0-6) outcomes. Univariable and multivariable analyses were conducted to identify significant relationships between dCA parameters, comorbidities, and outcomes, for each time point using generalized linear (dichotomized outcome), or cumulative link (ordinal outcome) mixed models. The participating center was modeled as a random intercept to generate odds ratios with 95% CIs. RESULTS The sample included 384 individuals (35% women) from 7 centers, aged 66.3±13.7 years, with predominantly nonlacunar stroke (n=348, 69%). In the affected hemisphere, higher phase at very low-frequency predicted better outcome (dichotomized modified Rankin Scale) at <24 (crude odds ratios, 2.17 [95% CI, 1.47-3.19]; P<0.001) hours, 24-72 (crude odds ratios, 1.95 [95% CI, 1.21-3.13]; P=0.006) hours, and phase at low-frequency predicted outcome at 3 (crude odds ratios, 3.03 [95% CI, 1.10-8.33]; P=0.032) months. These results remained after covariate adjustment. CONCLUSIONS Greater transfer function analysis-derived phase was associated with improved functional outcome at 3 months after AIS. dCA parameters in the early phase of AIS may help to predict functional outcome.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, United Kingdom (L.B., J.S.M., T.G.R., R.B.P.)
| | - Terrie Vasilopoulos
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville (T.V.)
| | - Angela S M Salinet
- Neurology Department, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Brazil (A.S.M.S., R.C.N.)
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada (B.L.)
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, United Kingdom (B.L.)
| | - Samuel Barnes
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
- Department of Stroke Medicine University Hospitals of Leicester NHS Trust, Leicester, United Kingdom (S.B., P.G.)
| | - Eleanor Hills
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
| | - Pranav Ramesh
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
| | - Panagoula Gkargkoula
- Department of Stroke Medicine University Hospitals of Leicester NHS Trust, Leicester, United Kingdom (S.B., P.G.)
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, United Kingdom (L.B., J.S.M., T.G.R., R.B.P.)
| | - Pedro Castro
- Department of Neurology, Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto (P.C.)
| | - Patrice Brassard
- Département de Kinésiologie, Faculté de Médecine, Institut Universitaire de Cardiologie et de pneumologie de Québec (P.B.)
| | - Nicolai Goettel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.G.)
| | - Erik D Gommer
- Department of Clinical Neurophysiology, Maastricht University Medical Centre, the Netherlands (E.D.G.)
| | - Jose Luis Jara
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile (J.L.J.)
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology at the Chinese Academy of Sciences in Shenzhen, China (J.L.)
| | - Martin Mueller
- Department of Neurology and Neurorehabilitation, Spitalstrasse, CH 6000 Lucerne (M.M.)
| | - Nathalie Nasr
- Department of Neurology, Poitiers University Hospital, Laboratoire de Neurosciences Expérimentales et Cliniques, University of Poitiers, France (N.N.)
| | - Stephen Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei (S.P.)
| | - Andrew D Robertson
- Schlegel-UW Research Institute for Aging, University of Waterloo, ON, CA (A.D.R.)
| | - David Simpson
- Faculty of Engineering and Physical Sciences, University of Southampton (D.S.)
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, United Kingdom (L.B., J.S.M., T.G.R., R.B.P.)
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.B., S.B., E.H., P.R., J.S.M., T.G.R., R.B.P.)
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, United Kingdom (L.B., J.S.M., T.G.R., R.B.P.)
| | - Ricardo C Nogueira
- Neurology Department, Hospital das Clinicas, School of Medicine, University of Sao Paulo, Brazil (A.S.M.S., R.C.N.)
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2
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Chithiramohan T, Santhosh S, Threlfall G, Hull L, Mukaetova-Ladinska EB, Subramaniam H, Beishon L. Culture-Fair Cognitive Screening Tools for Assessment of Cognitive Impairment: A Systematic Review. J Alzheimers Dis Rep 2024; 8:289-306. [PMID: 38405352 PMCID: PMC10894602 DOI: 10.3233/adr-230194] [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] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Background Cognitive screening tools are important in the detection of dementia, including Alzheimer's disease; however, they may contain cultural biases. Objective This review examines culture-fair cognitive screening tools and evaluates their screening accuracy, strengths, and limitations. Methods Medline, Embase, PsychINFO and CINAHL were searched. The protocol was registered on PROSPERO (CRD42021288776). Included studies used a culture-fair tool to assess cognition in older adults from varying ethnicities. Narrative synthesis was conducted. Results 28 studies were included assessing eleven different tools. The Rowland Universal Dementia Assessment Scale (RUDAS) was as accurate as the Mini-Mental State Examination (MMSE) (AUC 0.62-0.93), with a similar sensitivity (52-94%) and better specificity (70-98%), and the Multicultural Cognitive Examination (MCE) had improved screening accuracy (AUC 0.99) compared to RUDAS (AUC 0.92). The Visual Cognitive Assessment Test (VCAT) was equivalent to MMSE (AUC 0.84-0.91). The Kimberley Indigenous Cognitive Assessment tool (KICA) had AUC of 0.93-0.95; sensitivity of 90.6%, specificity 92.6%. Conclusions The RUDAS, KICA and VCAT were superior to MMSE for screening dementia in ethnic minorities. Other tools also showed good screening accuracy. Further research should be done to validate tools in different populations.
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Affiliation(s)
| | | | | | - Louise Hull
- Library and Information Service, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Elizabeta B. Mukaetova-Ladinska
- Leicestershire Partnership NHS Trust, Leicester UK
- Department of Psychology and Visual Sciences, University of Leicester, Leicester, UK
| | | | - Lucy Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
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3
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Hammant A, Chithiramohan T, Haunton V, Beishon L. Cognitive testing following transient ischaemic attack: A systematic review of clinical assessment tools. Cogent Psychology 2023; 10:2196005. [PMID: 37025393 PMCID: PMC10069374 DOI: 10.1080/23311908.2023.2196005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Cognitive deficits are prevalent after transient ischaemic attack (TIA) and result in loss of function, poorer quality of life and increased risks of dependency and mortality. This systematic review aimed to synthesise the available evidence on cognitive assessment in TIA patients to determine the prevalence of cognitive deficits, and the optimal tests for cognitive assessment. Medline, Embase, PsychINFO and CINAHL databases were searched for relevant articles. Articles were screened by title and abstract. Full-text analysis and quality assessment was performed using the National Institute of Health Tool. Data were extracted on study characteristics, prevalence of TIA deficits, and key study findings. Due to significant heterogeneity, meta-analysis was not possible. Twenty-five full-text articles met the review inclusion criteria. There was significant heterogeneity in terms of cognitive tests used, definitions of cognitive impairment and TIA, time points post-event, and analysis methods. The majority of studies used the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) (n = 23). Prevalence of cognitive impairment ranged from 2% to 100%, depending on the time-point and cognitive domain studied. The MoCA was more sensitive than the MMSE for identifying cognitive deficits. Deficits were common in executive function, attention, and language. No studies assessed diagnostic test accuracy against a reference standard diagnosis of cognitive impairment. Recommendations on cognitive testing after TIA are hampered by significant heterogeneity between studies, as well as a lack of diagnostic test accuracy studies. Future research should focus on harmonising tools, definitions, and time-points, and validating tools specifically for the TIA population.
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Affiliation(s)
- Alexander Hammant
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | | | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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4
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Brasil S, Caldas J, Beishon L, Minhas JS, Nogueira RC. Cerebral Autoregulation Monitoring: A Guide While Navigating in Troubled Waters. Neurocrit Care 2023; 39:736-737. [PMID: 37726547 DOI: 10.1007/s12028-023-01840-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Sérgio Brasil
- Department of Neurology, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar 255, São Paulo, Brazil.
| | - Juliana Caldas
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Instituto D'Or de Pesquisa e Ensino, Salvador, Bahia, Brazil
| | - Lucy Beishon
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- National Institute for Health and Care Research Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Ricardo C Nogueira
- Department of Neurology, University of São Paulo School of Medicine, Av. Dr. Enéas de Carvalho Aguiar 255, São Paulo, Brazil
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5
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van Oppen JD, Owen RK, Jones W, Beishon L, Coats TJ. The effect of relative hypotension on 30-day mortality in older people receiving emergency care. Intern Emerg Med 2023:10.1007/s11739-023-03468-5. [PMID: 37940793 DOI: 10.1007/s11739-023-03468-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
Research has observed increased mortality among older people attending the emergency department (ED) who had systolic pressure > 7 mmHg lower than baseline primary care values. This study aimed to (1) assess feasibility of identifying this 'relative hypotension' using readily available ED data, (2) externally validate the 7 mmHg threshold, and (3) refine a threshold for clinically important relative hypotension. A single-centre retrospective cohort study linked year 2019 data for ED attendances by people aged over 64 to hospital discharge vital signs within the previous 18 months. Frailty and comorbidity scores were calculated. Previous discharge ('baseline') vital signs were subtracted from initial ED values to give individuals' relative change. Cox regression analysis compared relative hypotension > 7 mmHg with mean time to mortality censored at 30 days. The relative hypotension threshold was refined using a fully adjusted risk tool formed of logistic regression models. Receiver operating characteristics were compared to NEWS2 models with and without incorporation of relative systolic. 5136 (16%) of 32,548 ED attendances were linkable with recent discharge vital signs. Relative hypotension > 7 mmHg was associated with increased 30-day mortality (HR 1.98; 95% CI 1.66-2.35). The adjusted risk tool (AUC: 0.69; sensitivity: 0.61; specificity: 0.68) estimated each 1 mmHg relative hypotension to increase 30-day mortality by 2% (OR 1.02; 95% CI 1.02-1.02). 30-day mortality prediction was marginally better with NEWS2 (AUC: 0.73; sensitivity: 0.59; specificity: 0.78) and NEWS2 + relative systolic (AUC: 0.74; sensitivity: 0.63; specificity: 0.75). Comparison of ED vital signs with recent discharge observations was feasible for 16% individuals. The association of relative hypotension > 7 mmHg with 30-day mortality was externally validated. Indeed, any relative hypotension appeared to increase risk, but model characteristics were poor. These findings are limited to the context of older people with recent hospital admissions.
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Affiliation(s)
- James David van Oppen
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
- Emergency and Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | | | - William Jones
- Emergency and Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Timothy John Coats
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Emergency and Specialist Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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6
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Beishon L, Haunton VJ, Panerai RB. Antihypertensives in dementia: Good or bad for the brain? J Cereb Blood Flow Metab 2023; 43:1800-1802. [PMID: 36284494 PMCID: PMC10581243 DOI: 10.1177/0271678x221133473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/15/2022]
Abstract
Hypertension is associated with both ageing and dementia. Despite this, optimal blood pressure targets in dementia remain unclear. Both high and low blood pressure are associated with poorer cognition. Changes in vascular physiology in dementia may increase the vulnerability of the brain to hypoperfusion associated with antihypertensives. We discuss the potential risks of antihypertensives in the context of altered cerebral haemodynamics, and evidence from antihypertensive trials in dementia. We suggest that individualised blood pressure targets should be the focus for antihypertensive therapy in dementia, rather than strict control to uniform targets extrapolated from trials in cognitively healthy individuals.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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7
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Hague JP, Keelan J, Beishon L, Swienton D, Robinson TG, Chung EML. Three-dimensional simulations of embolic stroke and an equation for sizing emboli from imaging. Sci Rep 2023; 13:3021. [PMID: 36810427 PMCID: PMC9944911 DOI: 10.1038/s41598-023-29974-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023] Open
Abstract
Stroke simulations are needed to run in-silico trials, develop hypotheses for clinical studies and to interpret ultrasound monitoring and radiological imaging. We describe proof-of-concept three-dimensional stroke simulations, carrying out in silico trials to relate lesion volume to embolus diameter and calculate probabilistic lesion overlap maps, building on our previous Monte Carlo method. Simulated emboli were released into an in silico vasculature to simulate 1000 s of strokes. Infarct volume distributions and probabilistic lesion overlap maps were determined. Computer-generated lesions were assessed by clinicians and compared with radiological images. The key result of this study is development of a three-dimensional simulation for embolic stroke and its application to an in silico clinical trial. Probabilistic lesion overlap maps showed that the lesions from small emboli are homogeneously distributed throughout the cerebral vasculature. Mid-sized emboli were preferentially found in posterior cerebral artery (PCA) and posterior region of the middle cerebral artery (MCA) territories. For large emboli, MCA, PCA and anterior cerebral artery (ACA) lesions were comparable to clinical observations, with MCA, PCA then ACA territories identified as the most to least probable regions for lesions to occur. A power law relationship between lesion volume and embolus diameter was found. In conclusion, this article showed proof-of-concept for large in silico trials of embolic stroke including 3D information, identifying that embolus diameter could be determined from infarct volume and that embolus size is critically important to the resting place of emboli. We anticipate this work will form the basis of clinical applications including intraoperative monitoring, determining stroke origins, and in silico trials for complex situations such as multiple embolisation.
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Affiliation(s)
- James P. Hague
- grid.10837.3d0000 0000 9606 9301School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Jonathan Keelan
- grid.10837.3d0000 0000 9606 9301School of Physical Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6AA UK
| | - Lucy Beishon
- grid.9918.90000 0004 1936 8411Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH UK
| | - David Swienton
- grid.269014.80000 0001 0435 9078Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW UK
| | - Thompson G. Robinson
- grid.511501.1NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Leicester, LE3 9QP UK
| | - Emma M. L. Chung
- grid.9918.90000 0004 1936 8411Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH UK ,grid.269014.80000 0001 0435 9078Department of Medical Physics, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW UK ,grid.13097.3c0000 0001 2322 6764School of Life Course and Population Sciences, King’s College London, Guy’s Campus, London, SE1 1UL UK
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8
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Abstract
BACKGROUND Agreeing on priority topics for stroke research can help make best use of limited funding, people, and time. Formal priority-setting exercises collate stakeholders' opinions to reach consensus on the most important research questions. Several stroke research priority setting exercises have been published. Exploring commonalities and differences between these exercises could bring a better understanding of priority research topics. AIM We collated and compared published stroke research priority setting exercises across international healthcare systems. SUMMARY OF REVIEW Multidisciplinary, electronic literature databases were searched from 2000 to 2021, using a validated search syntax. Inclusion criteria were: full article; stroke focus (any subtype); prioritization method described; and lists priorities for research. Priorities were extracted, coded, and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice and the Reporting guideline for priority setting of health research checklists were used to assess methodological and reporting quality respectively. From 623 titles assessed, 14 studies were eligible for inclusion, including 2410 participants and describing 165 priorities. The majority of priority setting exercises were conducted in high-income countries (86%, n = 12 articles), published between 2011 and 2021 (64%, n = 9), and included views of healthcare professionals (57%, n = 8), and stroke survivors (50%, n = 7). Caregivers (n = 3, 21%) were under-represented. The James Lind Alliance priority setting method was most commonly used (50%, n = 7). Priorities were grouped into 10 thematic categories. Rehabilitation and follow-up was the most common priority theme (15%, n = 25 priorities), followed by psychological recovery (14%, n = 23), pathology (14%, n = 23), and caregivers and support (14%, n = 23). Priorities differed by year and case-mix (stakeholder group and demographics) of respondents. No article was judged high quality for all aspects of method or reporting. Common limitations were around inclusiveness and evaluation of the exercise. CONCLUSION Stroke research priorities are dynamic and context-specific. However, there was a common theme of prioritizing research that considered life after stroke. Future priority settings should consider the inclusion of nonindustrialized countries and stroke survivors with a range of impairments.
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Affiliation(s)
- Stephanie Leitch
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Monica Logan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Chin K, Ghosh S, Subramaniam H, Beishon L. Cardiovascular disease in older people with serious mental illness: Current challenges and future directions. Front Psychiatry 2023; 14:1110361. [PMID: 36926467 PMCID: PMC10011471 DOI: 10.3389/fpsyt.2023.1110361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Katherine Chin
- Department of Ageing and Health, Guy's and St Thomas' Hospital, London, United Kingdom
| | - Sudip Ghosh
- Leicester School of Allied Health Sciences, De Montfort University, Leicester, United Kingdom
| | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,National Institute for Health Research Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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10
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Chithiramohan T, Threlfall G, Abdelaziz H, Ellahi A, Subramaniam H, Beishon L, Mukaetova-Ladinska EB. Ethnic Variations in Patient Outcomes in a Memory Clinic Setting Between 2013 and 2021. J Alzheimers Dis 2023; 92:71-79. [PMID: 36710679 DOI: 10.3233/jad-220925] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The incidence of dementia in Black and Asian populations in the UK is set to rise. There is concern surrounding differences in services provided for different ethnic groups. OBJECTIVE This study aimed to examine ethnic variations in survival, services accessed, and medication use across White, Black, and Asian groups in routine memory clinic setting. METHODS We retrospectively examined referrals to a memory service between 2013 and 2021. A random sample of 104 White, 99 Asian, and 74 Black patients were analyzed for differences in support services, voluntary services, medication use, and survival rate. RESULTS There were statistically significant differences in survival of the Asian compared to the White group (Hazard ratio (HR = 2.17,95% confidence interval (CI) 1.23-3.85, p = 0.008)) following adjustment for age, gender, diagnosis, cognitive impairment, severity, access to support and voluntary services, and use of cholinesterase inhibitors, N-methyl-D-aspartate antagonists, and antipsychotics. The Asian group showed a statistically significantly reduction in access to support services compared to the White group (HR = 0.05, 95% CI 0.01-0.37, p = 0.003). In contrast, the survival rate was similar between the White and Black dementia patients. CONCLUSION We found significantly reduced survival and reduced access to support services in Asian compared to White patients with dementia. Further research is needed to investigate the generalizability of our results, and determine the cause, and consequent remedies of these associations in ethnic minority groups.
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Affiliation(s)
- Tamara Chithiramohan
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | | | | | - Amira Ellahi
- Leicestershire Partnership NHS Trust, Leicester, UK
| | - Hari Subramaniam
- Leicestershire Partnership NHS Trust, Leicester, UK.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Lucy Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK
| | - Elizabeta B Mukaetova-Ladinska
- Leicestershire Partnership NHS Trust, Leicester, UK.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
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11
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Logan M, Leitch S, Bosakh Z, Beishon L, Quinn TJ. Comparing international dementia research priorities-Systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5836. [PMID: 36326065 PMCID: PMC9828247 DOI: 10.1002/gps.5836] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Research priority setting aims to collate stakeholder opinion to determine the most pressing research questions. Priority setting exercises influence decisions around research funding, development and policy. We compared published dementia research priority setting exercises from international healthcare systems. METHODS Four multidisciplinary, international, electronic databases were searched for relevant studies (2010 until 2021). Priorities were extracted, coded and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice (9CTGP) and the Reporting guideline for priority setting of health research (REPRISE) checklists were used to assess methodological and reporting quality respectively. RESULTS From 265 titles, 10 priority setting exercises (1179 participants, 147 priorities) were included. Studies spanned four continents and the majority included people living with dementia and their care-givers in the priority setting process (68%). Only one paper met all the best practice indicators. Issues around inclusiveness, implementation and evaluation of the priorities were apparent in nine papers. We categorised priorities under eight themes: caregivers (25%, n = 37), support (24%, n = 35), awareness and education (16%, n = 24), drugs and interventions (14%, n = 21), diagnosis (8%, n = 12), pathology (6%, n = 9), research design (5%, n = 7), and prevention (1%, n = 2). Priorities varied by geographical region, with awareness and education of higher priority in low-middle income countries, compared to caregivers and support in high income countries. CONCLUSIONS Key priorities were identified with some commonality around themes considered of greatest importance. There is scope to improve the process and reporting of priority setting. Priorities differed according to contextual factors and so, priorities specific to one healthcare setting may not be applicable to others.
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Affiliation(s)
- Monica Logan
- School of MedicineUniversity of GlasgowGlasgowUK
| | | | | | - Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
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12
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Alablani FJ, Chan HSA, Beishon L, Patel N, Almudayni A, Bu'Lock F, Chung EML. Paediatric brain MRI findings following congenital heart surgery: a systematic review. Arch Dis Child 2022; 107:818-825. [PMID: 35318194 PMCID: PMC9411899 DOI: 10.1136/archdischild-2021-323132] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This systematic review aimed to establish the relative incidence of new postoperative brain MRI findings following paediatric congenital cardiac surgery. DESIGN To distinguish perioperative changes from pre-existing MR findings, our systematic search strategy focused on identifying original research studies reporting both presurgery and postsurgery brain MRI scans. Patient demographics, study methods and brain MR findings were extracted. RESULTS Twenty-one eligible publications, including two case-control and one randomised controlled trial, were identified. Pre-existing brain MRI findings were noted in 43% (513/1205) of neonates prior to surgery, mainly white matter injuries (WMI). Surgery was performed at a median age of 8 days with comparison of preoperative and postoperative MR scans revealing additional new postoperative findings in 51% (550/1075) of patients, mainly WMI. Four studies adopted a brain injury scoring system, but the majority did not indicate the severity or time course of findings. In a subgroup analysis, approximately 32% of patients with pre-existing lesions went on to develop additional new lesions postsurgery. Pre-existing findings were not found to confer a higher risk of acquiring brain lesions postoperatively. No evidence was identified linking new MR findings with later neurodevelopmental delay. CONCLUSION This systematic review suggests that surgery approximately doubles the number of patients with new brain lesions.
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Affiliation(s)
- Fatmah Jamal Alablani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hoi Shan Asia Chan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Nikil Patel
- Department of Clinical Neuroscience, St George's University of London, London, UK
| | - Alanoud Almudayni
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Frances Bu'Lock
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Emma ML Chung
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK,Faculty of Life Sciences and Medicine, King's College London, London, UK
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13
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Barnes SC, Panerai RB, Beishon L, Hanby M, Robinson TG, Haunton VJ. Cerebrovascular responses to somatomotor stimulation in Parkinson's disease: A multivariate analysis. J Cereb Blood Flow Metab 2022; 42:1547-1558. [PMID: 35287495 PMCID: PMC9274867 DOI: 10.1177/0271678x211065204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Indexed: 11/16/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder, yet little is known about cerebral haemodynamics in this patient population. Previous studies assessing dynamic cerebral autoregulation (dCA), neurovascular coupling (NVC) and vasomotor reactivity (VMR) have yielded conflicting findings. By using multi-variate modelling, we aimed to determine whether cerebral blood flow (CBF) regulation is impaired in PD patients.55 healthy controls (HC) and 49 PD patients were recruited. PD subjects underwent a second recording following a period of abstinence from their anti-Parkinsonian medication. Continuous bilateral transcranial Doppler in the middle cerebral arteries, beat-to-beat mean arterial blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (EtCO2; capnography) were measured. After a 5-min baseline period, a passive motor paradigm comprising 60 s of elbow flexion was performed. Multi-variate modelling quantified the contributions of MAP, ETCO2 and neural stimulation to changes in CBF velocity (CBFV). dCA, VMR and NVC were quantified to assess the integrity of CBF regulation.Neural stimulation was the dominant input. dCA, NVC and VMR were all found to be impaired in the PD population relative to HC (p < 0.01, p = 0.04, p < 0.01, respectively). Our data suggest PD may be associated with depressed CBF regulation. This warrants further assessment using different neural stimuli.
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Affiliation(s)
- Sam C Barnes
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.,NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.,NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Martha Hanby
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.,NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, UK.,NIHR Leicester Biomedical Research Centre, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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14
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Lane D, Beishon L, Sharma V, Salim F, Sze S, Timmins MA, Robinson T, Eveson D, Mistri A, Patel P, Gupta P. High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA. J Stroke Cerebrovasc Dis 2022; 31:106665. [PMID: 35901588 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence. METHODS One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables. RESULTS The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01). CONCLUSIONS LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events.
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Affiliation(s)
- Dan Lane
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Vinoda Sharma
- Department of Cardiology, Sandwell and West Birmingham Hospitals NHS Trust, United Kingdom
| | - Farah Salim
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Shirley Sze
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Matthew A Timmins
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom; Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom; National Institute for Health Research Leicester Biomedical Research Centre, University of Leicester, United Kingdom
| | - David Eveson
- Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Amit Mistri
- Department of Stroke Medicine, University Hospitals of Leicester NHS Trust, United Kingdom
| | - Prashanth Patel
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, United Kingdom
| | - Pankaj Gupta
- Department of Metabolic Diseases and Chemical Pathology, University Hospitals of Leicester NHS Trust, Level 4, Sandringham Building, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom; Department of Cardiovascular Sciences, University of Leicester, United Kingdom.
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15
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Beishon L, Haunton V, Bradbury-Jones C, Subramaniam H, Mukaetova-Ladinska EB, Panerai RB, Robinson T, Evley R. The Cognition and Flow Study (CogFlowS): A Mixed Method Evaluation of a Randomized Feasibility Trial of Cognitive Training in Dementia. J Alzheimers Dis 2022; 87:1013-1031. [DOI: 10.3233/jad-215726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cognitive training (CT) may be beneficial in delaying the onset or slowing dementia progression. CT has been evaluated quantitatively and qualitatively, but none have used mixed methods approaches. Objective: The aim of this study was to use a mixed methods approach to identify those who may selectively benefit from CT. Methods: This was an explanatory sequential mixed methods study involving a quantitative randomized trial of 12 weeks multi-domain CT in healthy older adults (HC, n = 20), and people living with mild cognitive impairment (MCI; n = 12) and dementia (n = 24). Quantitative outcomes included: cognition, mood, quality of life, and activities of daily living. 28 (10 HC, 6 MCI, 12 dementia) training participants completed semi-structured interviews with their carer. Quantitative and qualitative data were integrated using joint displays. Results: Three participants dropped out from the training early-on, leaving 25 participants with follow-up data for full integration (10 HC, 6 MCI, 9 dementia). Dropouts and lower adherence to training were more common in dementia participants with greater non-modifiable barriers. High adherers were more resilient to negative emotions, and poorer or fluctuating performance. Integrated analysis found the majority of participants (n = 24) benefited across outcomes, with no clear profile of individuals who benefited more than others. Participants made a number of key recommendations to improve adherence and minimize dropout to CT. Conclusion: Reasons for dropout and low adherence were identified, with recommendations provided for the design of CT for dementia. An individual approach to training should be adopted and low adherence should not preclude engagement with CT.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK
| | | | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Neuroscience, University of Leicester, Psychology and Behaviour, Leicester, UK
| | - Elizabeta B. Mukaetova-Ladinska
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
- Department of Neuroscience, University of Leicester, Psychology and Behaviour, Leicester, UK
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK
| | - Rachel Evley
- Injury, Recovery and Inflammation Science, University of Nottingham, UK
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16
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Ball J, Panerai RB, Williams CA, Beishon L. Principal component analysis to identify the major contributors to task-activated neurovascular responses. Cerebral Circulation - Cognition and Behavior 2022; 3:100039. [PMID: 36324414 PMCID: PMC9616234 DOI: 10.1016/j.cccb.2022.100039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
A range of metrics are available to measure to cerebrovascular responses to task activation. We used principal component analysis to reduce dimensionality in a large dataset and determine physiological variables with the greatest contribution to the cerebrovascular response. Peak percentage change in cerebrovascular response was a consistent marker across datasets and the visuospatial task contributed the most variance. There was limited overlap between cognitive tasks and domains suggesting lack of redundancy in the data.
Background Consensus on the optimal metrics for neurovascular coupling (NVC) is lacking. The aim of this study was to use principal component analysis (PCA) to determine the most significant contributors to NVC responses in healthy adults (HC), Alzheimer's disease (AD), and mild cognitive impairment (MCI). New method PCA was applied to three datasets: 1) 69 HC, 2) 30 older HC, 34 AD, and 22 MCI, 3) 1&2 combined. Data were extracted on peak percentage change in cerebral blood flow velocity (CBFv), variance ratio (VR), cross-correlation function peak (CCF), and blood pressure, for five cognitive tasks. An equamax rotation was applied and factors were significant where the eignevalue was ≥1. Rotated factor loadings ≥0.4 determined significant NVC variables. Results PCA identified 12 significant factors accounting for 78% of variance (all datasets). Contributing variables loaded differently on the factors across the datasets. In datasets 1&2, peak percentage change in CBFv contributed to factors explaining the most variance (45–58%), whereas cognitive test scores, fluency and memory domains contributed the least (15–37%). In the combined dataset, CBFv, CCF and fluency domain contributed the majority (33–43%), whereas VR and attention the least (6–24%). Conclusions Peak percentage change in CBFv and the visuospatial task consistently accounted for a large proportion of the variance, suggesting these are robust NVC markers for future studies.
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17
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Barnes SC, Haunton VJ, Beishon L, Llwyd O, Robinson TG, Panerai RB. Extremes of cerebral blood flow during hypercapnic squat-stand maneuvers. Physiol Rep 2021; 9:e15021. [PMID: 34617685 PMCID: PMC8495794 DOI: 10.14814/phy2.15021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022] Open
Abstract
Squat-stand maneuvers (SSMs) are a popular method of inducing blood pressure (BP) oscillations to reliably assess dynamic cerebral autoregulation (dCA), but their effects on the cerebral circulation remain controversial. We designed a protocol whereby participants would perform SSMs under hypercapnic conditions. Alarmingly high values of cerebral blood flow velocity (CBFV) were recorded, leading to early study termination after the recruitment of a single participant. One healthy subject underwent recordings at rest (5 min sitting, 5 min standing) and during two SSMs (fixed and random frequency). Two sets of recordings were collected; one while breathing room air, one while breathing 5% CO2 . Continuous recordings of bilateral CBFV (transcranial Doppler), heart rate (ECG), BP (Finometer), and end-tidal CO2 (capnography) were collected. Peak values of systolic CBFV were significantly higher during hypercapnia (p < 0.01), and maximal values exceeded 200 cm.s-1 . Estimates of dCA (ARI) during hypercapnia were impaired relative to poikilocapnia (p = 0.03). The phase was significantly reduced under hypercapnic conditions (p = 0.03). Here we report extremely high values of CBFV in response to repeated SSMs during induced hypercapnia, in an otherwise healthy subject. Our findings suggest that protocols performing hypercapnic SSMs are potentially dangerous. We, therefore, urge caution if other research groups plan to undertake similar protocols.
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Affiliation(s)
- Samuel C. Barnes
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Victoria J. Haunton
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Osian Llwyd
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Thompson G. Robinson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Ronney B. Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- National Institute for Health Research (NIHR) Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
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18
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Beishon L, Haunton V, Subramaniam H, Mukaetova-Ladinska EB, Panerai RB, Robinson T, Evley R. Qualitative Analysis of the Cognition and Flow (CoGFlowS) Study: An Individualized Approach to Cognitive Training for Dementia Is Needed. J Alzheimers Dis 2021; 83:209-225. [PMID: 34250940 DOI: 10.3233/jad-210428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive training (CT) may have benefits for both healthy older adults (HC) and those with early cognitive disorders [mild cognitive impairment (MCI) and dementia]. However, few studies have qualitatively evaluated home-based, computerized CT programs. OBJECTIVE We present the qualitative arm of a feasibility randomized controlled trial evaluating a CT program for HC and people living with MCI or dementia. METHODS Participants underwent semi-structured interviews after 12 weeks of CT. Where possible, participants were interviewed with their carers. The interview schedule and analysis were underpinned by the health belief model. Interviews were audio-recorded, transcribed, open-coded, and categorized into themes. The analytical framework was developed, and themes were condensed under five major categories: benefits, barriers, threat, self-efficacy, and cues to action. RESULTS 37 participants underwent interviews. CT was feasible and acceptable to participants. Benefits included: enjoyment, improved awareness, benchmarking cognitive function, reassurance of abilities and giving back control. Barriers were more prevalent among those with dementia: problems with technology, frustration, conflict between patients and carers, apathy and lack of insight, anxiety or low mood, and lack of portability. HC and MCI perceived the severity of dementia risk as high, partially mitigated by CT. Participants living with dementia valued a more individualized approach to training, accounting for baseline characteristics. CONCLUSION CT was a feasible intervention for HC and people living with dementia and MCI. Benefits were present, but the identified barriers need to be addressed for CT to be implemented successfully.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Victoria Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK
| | - Elizabeta B Mukaetova-Ladinska
- The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachel Evley
- Inflammatory, Injury & Recovery Science, School of Medicine, University of Nottingham, Nottingham, UK
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19
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Beishon L, Panerai RB, Robinson TG, Haunton VJ. Cerebral blood flow response rate to task-activation using a novel method can discriminate cognitive impairment from healthy aging. Physiol Meas 2021; 42. [PMID: 34229305 DOI: 10.1088/1361-6579/ac1185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022]
Abstract
Objective.A new method to classify individuals as 'responders' to task-activated cerebral blood flow velocity (CBFv) has recently been developed. This study investigated whether CBFv response rate to task-activation is affected by Alzheimer's disease (AD) and mild cognitive impairment (MCI).Approach.The 95th thresholds for cross correlation function peak and variance ratio were derived from 270 unstimulated, healthy hemispheres, and were used to classify the presence of a response to task-activation. Thresholds were applied to five cognitive tasks (attention, verbal fluency, language, visuospatial, memory) in CBFv data from 30 healthy older adults (HC), 35 AD and 22 MCI participants. Cumulative response rate (CRR) was calculated from the sum of responses across five tasks, for both hemispheres. Area under the curve (AUC) was derived from receiver operating characteristic (ROC) curve analysis.Main results. The number of responders differed significantly between tasks (p < 0.005) and diagnostic groups (p = 0.011). On post hoc tests there were more responders in the visuospatial (79%-90%) compared to fluency (45%-80%), language (50%-77%), and memory (44%-70%) tasks bilaterally, and responders were greater in the HC (70%) compared to AD (41%) and MCI (23%) groups to at least eight out of ten tasks. At an optimal threshold of 7.5 out of 10 responses, the AUC-ROC distinguished HC from AD and MCI with a; sensitivity 66% and specificity 70% (AUC = 0.72).Significance. Using a novel method to classify responders to cognitive task-activation, HC demonstrated a higher CRR than those with MCI or AD, and a threshold of <8 responses distinguished healthy ageing from dementia.
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Affiliation(s)
- Lucy Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Victoria J Haunton
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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20
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Beishon L, Panerai RB. The Neurovascular Unit in Dementia: An Opinion on Current Research and Future Directions. Front Aging Neurosci 2021; 13:721937. [PMID: 34393765 PMCID: PMC8355558 DOI: 10.3389/fnagi.2021.721937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/06/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.,National Institute for Health Research Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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21
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Beishon L, Haunton V, Subramaniam H, Mukaetova-Ladinska E, Paneraia R, Robinson T, Evley R. 407 QUALITATIVE ASSESSMENT OF COGNITIVE TRAINING FOR PEOPLE LIVING WITH DEMENTIA: AN INDIVIDUALISED APPROACH IS NEEDED AUTHORS. Age Ageing 2021. [DOI: 10.1093/ageing/afab117.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cognitive training (CT) may be beneficial in mild cognitive impairment (MCI) and early dementia. However, few studies have qualitatively evaluated CT programmes in dementia. The aim of this analysis was to explore the benefits and barriers to a home-based computerised CT programme for healthy older adults, and people living with MCI or dementia.
Methods
This was a nested qualitative study within a larger feasibility randomised trial of CT. Participants underwent semi-structured interviews after 12 weeks of CT. Where possible, participants were interviewed with their carers. The interview schedule and analysis were underpinned by the health belief model. Interviews were audio-recorded, transcribed, open-coded, and categorised into themes. The analytical framework was developed, and themes were condensed under four major categories: benefits and efficacy, barriers, threat, and behaviour.
Results
37 participants underwent interviews (10 healthy older adults, 4 MCI, 5 dementia, 9 patient-carer dyads [2 MCI, 7 dementia]). CT was feasible and acceptable to participants. Benefits included: enjoyment, improved awareness, benchmarking cognitive function, reassurance of abilities, and giving back control. Barriers were more prevalent amongst those with dementia: problems with technology, frustration, conflict between patients and carers, apathy and lack of insight, anxiety or low mood, and lack of portability. Perceived risk susceptibility of dementia varied between participants. Healthy older adults and MCI perceived the severity of dementia risk as high, which was only partially mitigated by CT. Participants living with dementia valued a more individualised approach to training, accounting for baseline characteristics. For people living with dementia, maintenance was as valued as improvement of cognitive function.
Conclusions
CT was a feasible intervention for healthy older adults, and people living with dementia and MCI. Benefits were present, but the identified barriers need to be addressed for CT to be implemented successfully.
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Affiliation(s)
- L Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - V Haunton
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - H Subramaniam
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - E Mukaetova-Ladinska
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - R Paneraia
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - T Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
| | - R Evley
- University of Leicester, Department of Cardiovascular Sciences, Leicester, UK; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK; The Evington Centre, Leicestershire Partnership NHS Trust, Leicester, UK; University of Leicester, Department of Neuroscience, Psychology and Behaviour, Leicester, UK; Division of Clini
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Nogueira RC, Beishon L, Bor-Seng-Shu E, Panerai RB, Robinson TG. Cerebral Autoregulation in Ischemic Stroke: From Pathophysiology to Clinical Concepts. Brain Sci 2021; 11:511. [PMID: 33923721 PMCID: PMC8073938 DOI: 10.3390/brainsci11040511] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Ischemic stroke (IS) is one of the most impacting diseases in the world. In the last decades, new therapies have been introduced to improve outcomes after IS, most of them aiming for recanalization of the occluded vessel. However, despite this advance, there are still a large number of patients that remain disabled. One interesting possible therapeutic approach would be interventions guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). Supportive hemodynamic therapies aiming to optimize perfusion in the ischemic area could protect the brain and may even extend the therapeutic window for reperfusion therapies. However, the knowledge of how to implement these therapies in the complex pathophysiology of brain ischemia is challenging and still not fully understood. This comprehensive review will focus on the state of the art in this promising area with emphasis on the following aspects: (1) pathophysiology of CA in the ischemic process; (2) methodology used to evaluate CA in IS; (3) CA studies in IS patients; (4) potential non-reperfusion therapies for IS patients based on the CA concept; and (5) the impact of common IS-associated comorbidities and phenotype on CA status. The review also points to the gaps existing in the current research to be further explored in future trials.
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Affiliation(s)
- Ricardo C. Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo 01246-904, Brazil;
- Department of Neurology, Hospital Nove de Julho, São Paulo 01409-002, Brazil
| | - Lucy Beishon
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (L.B.); (R.B.P.); (T.G.R.)
| | - Edson Bor-Seng-Shu
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo 01246-904, Brazil;
| | - Ronney B. Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (L.B.); (R.B.P.); (T.G.R.)
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Thompson G. Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK; (L.B.); (R.B.P.); (T.G.R.)
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University of Leicester, Leicester LE5 4PW, UK
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23
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Beishon L, Clough RH, Kadicheeni M, Chithiramohan T, Panerai RB, Haunton VJ, Minhas JS, Robinson TG. Vascular and haemodynamic issues of brain ageing. Pflugers Arch 2021; 473:735-751. [PMID: 33439324 PMCID: PMC8076154 DOI: 10.1007/s00424-020-02508-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023]
Abstract
The population is ageing worldwide, thus increasing the burden of common age-related disorders to the individual, society and economy. Cerebrovascular diseases (stroke, dementia) contribute a significant proportion of this burden and are associated with high morbidity and mortality. Thus, understanding and promoting healthy vascular brain ageing are becoming an increasing priority for healthcare systems. In this review, we consider the effects of normal ageing on two major physiological processes responsible for vascular brain function: Cerebral autoregulation (CA) and neurovascular coupling (NVC). CA is the process by which the brain regulates cerebral blood flow (CBF) and protects against falls and surges in cerebral perfusion pressure, which risk hypoxic brain injury and pressure damage, respectively. In contrast, NVC is the process by which CBF is matched to cerebral metabolic activity, ensuring adequate local oxygenation and nutrient delivery for increased neuronal activity. Healthy ageing is associated with a number of key physiological adaptations in these processes to mitigate age-related functional and structural declines. Through multiple different paradigms assessing CA in healthy younger and older humans, generating conflicting findings, carbon dioxide studies in CA have provided the greatest understanding of intrinsic vascular anatomical factors that may mediate healthy ageing responses. In NVC, studies have found mixed results, with reduced, equivalent and increased activation of vascular responses to cognitive stimulation. In summary, vascular and haemodynamic changes occur in response to ageing and are important in distinguishing “normal” ageing from disease states and may help to develop effective therapeutic strategies to promote healthy brain ageing.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.
| | - Rebecca H Clough
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Meeriam Kadicheeni
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Tamara Chithiramohan
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Beishon L, Woodhouse LJ, Bereczki D, Christensen HK, Collins R, Gommans J, Kruuse C, Ntaios G, Ozturk S, Phillips S, Pocock S, Szatmari S, Wardlaw J, Sprigg N, Bath PM. Relationship between nitrate headache and outcome in patients with acute stroke: results from the efficacy of nitric oxide in stroke (ENOS) trial. Stroke Vasc Neurol 2020; 6:180-186. [PMID: 33154177 PMCID: PMC8258084 DOI: 10.1136/svn-2020-000498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/13/2020] [Revised: 09/16/2020] [Accepted: 09/19/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Nitrate-induced headache is common and may signify responsive cerebral vasculature. We assessed the relationship between nitrate headache and outcome in patients with acute stroke. MATERIALS AND METHODS Patients were those randomised to glyceryl trinitrate (GTN) versus no GTN in the efficacy of nitric oxide in stroke trial. Development of headache by end of treatment (day 7), and functional outcome (modified Rankin Scale, primary outcome) at day 90, were assessed. Analyses are adjusted for baseline prognostic factors and give OR and mean difference (MD) with 95% CI. RESULTS In 4011 patients, headache was more common in GTN than control (360, 18.0% vs 170, 8.5%; p<0.001). Nitrate-related headache was associated with: younger age, female sex, higher diastolic blood pressure, non-total anterior circulation syndrome, milder stroke and absence of dysphasia (p<0.05). Nitrate headache was not associated with improved functional outcome (OR 0.90, 95% CI 0.73 to 1.10, p=0.30) or death (day 90) (HR 0.64, 95% CI 0.40 to 1.02, p=0.062), but reduced death or deterioration (day 7) (OR 0.45, 95% CI 0.25 to 0.82), death in hospital (OR 0.44, 95% CI 0.22 to 0.88) and improved activities of daily living (Barthel index, MD 3.7, 95% CI 0.3 to 7.1) and cognition (telephone interview cognitive screen, MD 2.0, 95% CI 0.7 to 3.3) (day 90). Non-nitrate headache was not associated with death, disability or cognition. DISCUSSION AND CONCLUSION Development of a nitrate headache by day 7 after stroke may be associated with improved activities of daily living and cognitive impairment at day 90, which was not seen with non-nitrate headache.
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Affiliation(s)
- Lucy Beishon
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lisa J Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Daniel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Hanne K Christensen
- Bispebjerg Hospital and University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ronan Collins
- Department of Geriatric and Stroke Medicine, Adelaide and Meath Hospital, Dublin, Ireland
| | - John Gommans
- Department of Medicine, Hawke's Bay Hospital, Camberley, New Zealand
| | - Christina Kruuse
- Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - George Ntaios
- Department of Medicine, Larissa University Hospital, University of Thessaly, Volos, Greece
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Stephen Phillips
- Department of Neurology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Stuart Pocock
- Medical Statistics Unit, London School of Hygiene & Tropical Medicine, London, UK
| | - Szabolcs Szatmari
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Targu Mures, Romania
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Beishon L, Intharakham K, Swienton D, Panerai RB, Robinson TG, Haunton VJ. Neuroimaging Outcomes in Studies of Cognitive Training in Mild Cognitive Impairment and Early Alzheimer’s Disease: A Systematic Review. Curr Alzheimer Res 2020; 17:472-486. [DOI: 10.2174/1567205017666200624202425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 11/22/2022]
Abstract
Background:
Cognitive Training (CT) has demonstrated some benefits to cognitive and psychosocial
function in Mild Cognitive Impairment (MCI) and early dementia, but the certainty related to
those findings remains unclear. Therefore, understanding the mechanisms by which CT improves cognitive
functioning may help to understand the relationships between CT and cognitive function.
The purpose of this review was to identify the evidence for neuroimaging outcomes in studies of CT in
MCI and early Alzheimer’s Disease (AD).
Methods:
Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were
searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion
where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic
Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria.
Results:
Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were
searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion
where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic
Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria.
Conclusions:
CT resulted in variable functional and structural changes in dementia, and conclusions are
limited by heterogeneity and study quality. Larger, more robust studies are required to correlate these
findings with clinical benefits from CT.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Kannakorn Intharakham
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - David Swienton
- Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 7RH, United Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Thompson G. Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
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Beishon L, Minhas JS, Patrick K, Shanmugam I, Williams CAL, Panerai RB, Robinson TG, Haunton VJ. The Effects of Healthy Ageing on Cerebral Blood Flow Responses to Cognitive Testing. Curr Aging Sci 2020; 11:226-235. [PMID: 30706798 PMCID: PMC6635423 DOI: 10.2174/1874609812666190131165310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/17/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 01/29/2023]
Abstract
Background: Transcranial Doppler Ultrasonography (TCD) can be utilised to measure the tight coupling of cerebral blood flow velocity (CBFv) in response to cognitive demand by task activation, termed neurovascular coupling. Aims: To investigate the differences in neurovascular coupling between healthy older (>50 years) and younger (18-49 years) adults in response to cognitive testing. Methods: Fifty-four older (n=25) and younger (n=29) adults underwent continuous bilateral TCD, beat-to-beat blood pressure (MAP; Finapres), heart rate (HR; electrocardiogram), and end-tidal CO2 (ETCO2; capnography) monitoring. After a 5-min baseline period, memory (M1-4: recalling three learned words, learning a name and address, recalling US presidents and UK prime ministers, and recalling the previously learned name and address) and visuospatial (V1-4: drawing a cube and infinity diagram, drawing a clock face, counting dots, and recognising obscured letters) tasks from the Addenbrooke's Cognitive Examination (ACE-III) were performed. Data are mean (standard deviation). Results: In the memory paradigms, the peak percentage change in CBFv differed significantly between younger and older groups only in the dominant hemisphere during the M1 task, (2.17 (9.16)% vs. 8.38 (9.27)%, respectively, p=0.017). In the visuospatial paradigm, there were also significant differences in peak percentage change in CBFv between younger and older groups in the V1 (5.87 (8.32)% vs. 11.89 (6.60)%, p=0.005) and V2 tasks (6.30 (8.72)% vs. 11.30 (7.77)%, p=0.032). Conclusion: Healthy older adults demonstrate augmented cerebrovascular physiology in response to cognitive challenge compared to younger adults. The impact of abnormal ageing on cerebrovascular physiology, for example, related to cognitively impaired states, requires further investigation.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Jatinder S Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Kate Patrick
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Iswariya Shanmugam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Claire A L Williams
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE1 7RH, United Kingdom.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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Beishon L, Minhas JS, Nogueira R, Castro P, Budgeon C, Aries M, Payne S, Robinson TG, Panerai RB. INFOMATAS multi-center systematic review and meta-analysis individual patient data of dynamic cerebral autoregulation in ischemic stroke. Int J Stroke 2020; 15:807-812. [PMID: 32090712 PMCID: PMC7534203 DOI: 10.1177/1747493020907003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 12/05/2022]
Abstract
Rationale Disturbances in dynamic cerebral autoregulation after ischemic stroke may have important implications for prognosis. Recent meta-analyses have been hampered by heterogeneity and small samples. Aim and/or hypothesis The aim of study is to undertake an individual patient data meta-analysis (IPD-MA) of dynamic cerebral autoregulation changes post-ischemic stroke and to determine a predictive model for outcome in ischemic stroke using information combined from dynamic cerebral autoregulation, clinical history, and neuroimaging. Sample size estimates To detect a change of 2% between categories in modified Rankin scale requires a sample size of ∼1500 patients with moderate to severe stroke, and a change of 1 in autoregulation index requires a sample size of 45 healthy individuals (powered at 80%, α = 0.05). Pooled estimates of mean and standard deviation derived from this study will be used to inform sample size calculations for adequately powered future dynamic cerebral autoregulation studies in ischemic stroke. Methods and design This is an IPD-MA as part of an international, multi-center collaboration (INFOMATAS) with three phases. Firstly, univariate analyses will be constructed for primary (modified Rankin scale) and secondary outcomes, with key co-variates and dynamic cerebral autoregulation parameters. Participants clustering from within studies will be accounted for with random effects. Secondly, dynamic cerebral autoregulation variables will be validated for diagnostic and prognostic accuracy in ischemic stroke using summary receiver operating characteristic curve analysis. Finally, the prognostic accuracy will be determined for four different models combining clinical history, neuroimaging, and dynamic cerebral autoregulation parameters. Study outcome(s) The outcomes for this study are to determine the relationship between clinical outcome, dynamic cerebral autoregulation changes, and baseline patient demographics, to determine the diagnostic and prognostic accuracy of dynamic cerebral autoregulation parameters, and to develop a prognostic model using dynamic cerebral autoregulation in ischemic stroke. Discussion This is the first international collaboration to use IPD-MA to determine prognostic models of dynamic cerebral autoregulation for patients with ischemic stroke.
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Affiliation(s)
- L Beishon
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - J S Minhas
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - R Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Post Brazil
| | - P Castro
- Stroke Unit and Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Budgeon
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - M Aries
- Department of Intensive Care, University Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - S Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - T G Robinson
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - R B Panerai
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Intharakham K, Beishon L, Panerai RB, Haunton VJ, Robinson TG. Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest. J Cereb Blood Flow Metab 2019; 39:2105-2116. [PMID: 31433714 PMCID: PMC6827119 DOI: 10.1177/0271678x19871013] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dynamic cerebral autoregulation (dCA) has been shown to be impaired in cerebrovascular diseases, but there is a lack of consistency across different studies and the different metrics that have been proposed for assessment. We performed a systematic review and meta-analyses involving assessment of dCA in ischemic and hemorrhagic stroke. Thirty-three articles describing assessment of dCA with transfer function analysis (TFA) were included, with meta-analyses performed for derived parameters of gain, phase and autoregulation index (ARI). A total of 1233 patients were pooled from 12 studies on acute ischemic stroke (AIS) and two studies on intracerebral hemorrhage (ICH). In comparison with controls, TFA phase of AIS was significantly reduced (nine studies), in both hemispheres (P < 0.0001). TFA gain provided inconsistent results, with reduced values in relation to controls, for both hemispheres. The ARI (six studies) was reduced compared to controls, in both hemispheres (P < 0.005). In ICH, gain showed higher values compared to controls for the unaffected (P = 0.01), but not for the affected hemisphere. Meta-analyses in AIS have demonstrated that phase and the ARI index can show highly significant differences in comparison with healthy controls, while ICH have been limited by the scarcity of studies and the diversity of units adopted for gain.
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Affiliation(s)
| | - Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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29
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Beishon L, Evley R, Panerai RB, Subramaniam H, Mukaetova-Ladinska E, Robinson T, Haunton V. Effects of brain training on brain blood flow (The Cognition and Flow Study-CogFlowS): protocol for a feasibility randomised controlled trial of cognitive training in dementia. BMJ Open 2019; 9:e027817. [PMID: 31122994 PMCID: PMC6538045 DOI: 10.1136/bmjopen-2018-027817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 04/11/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cognitive training is an emerging non-pharmacological treatment to improve cognitive and physical function in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Abnormal brain blood flow is a key process in the development of cognitive decline. However, no studies have explored the effects of cognitive training on brain blood flow in dementia. The primary aim of this study is to assess the feasibility for a large-scale, randomised controlled trial of cognitive training in healthy older adults (HC), MCI and early AD. METHODS AND ANALYSIS This study will recruit 60 participants, in three subgroups of 20 (MCI, HC, AD), from primary, secondary and community services. Participants will be randomised to a 12-week computerised cognitive training programme (five × 30 min sessions per week), or waiting-list control. Participants will undergo baseline and follow-up assessments of: mood, cognition, quality of life and activities of daily living. Cerebral blood flow will be measured at rest and during task activation (pretraining and post-training) by bilateral transcranial Doppler ultrasonography, alongside heart rate (3-lead ECG), end-tidal CO2 (capnography) and beat-to-beat blood pressure (Finometer). Participants will be offered to join a focus group or semistructured interview to explore barriers and facilitators to cognitive training in patients with dementia. Qualitative data will be analysed using framework analysis, and data will be integrated using mixed methods matrices. ETHICS AND DISSEMINATION Bradford Leeds Research Ethics committee awarded a favourable opinion (18/YH/0396). Results of the study will be published in peer-reviewed journals, and presented at national and international conferences on ageing and dementia. TRIALS REGISTRATION NUMBER NCT03656107; Pre-results.
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Affiliation(s)
- Lucy Beishon
- Cardiovascular Sciences, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
| | - Rachel Evley
- Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Ronney B Panerai
- Cardiovascular Sciences, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Hari Subramaniam
- The Evington Centre, Leicestershire Partnership NHSTrust, Leicester, UK
| | | | - Thompson Robinson
- Cardiovascular Sciences, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, University of Leicester, Leicester, UK
| | - Victoria Haunton
- Cardiovascular Sciences, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester, UK
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, University of Leicester, Leicester, UK
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Beishon L, Williams CAL, Robinson TG, Haunton VJ, Panerai RB. Neurovascular coupling response to cognitive examination in healthy controls: a multivariate analysis. Physiol Rep 2018; 6:e13803. [PMID: 30033685 PMCID: PMC6055030 DOI: 10.14814/phy2.13803] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/24/2018] [Indexed: 12/21/2022] Open
Abstract
Cognitive testing with transcranial Doppler ultrasonography (TCD) has been used to assess neurovascular coupling (NVC), but few studies address its multiple contributions. Subcomponent analysis considers the relative myogenic (resistance area product, RAP) and metabolic (critical closing pressure (CrCP)) contributors. The aim of this study was to investigate the changes in subcomponents that occur with cognitive stimulation with the Addenbrooke's Cognitive Examination (ACE-III) in healthy controls. Healthy volunteers underwent continuous recording of bilateral TCD, heart rate (HR, three-lead ECG), end-tidal CO2 (ETCO2 , capnography), and mean arterial pressure (MAP, Finometer). The study comprised a 5-min baseline recording, followed by all 20 paradigms from the ACE-III. The cerebral blood flow velocity (CBFv) response was decomposed into the relative contributions (subcomponents); VBP (MAP), VCrCP (CrCP), and VRAP (RAP). Data are presented as peak population normalized mean changes from baseline, and median area under the curve (AUC). Forty bilateral datasets were obtained (27 female, 37 right hand dominant). VBP increased at task initiation in all paradigms but differed between tasks (range (SD): 4.06 (8.92)-16.04 (12.23) %, P < 0.05). HR, but not ETCO2 , also differed significantly (P < 0.05). Changes in VRAP reflected changes in MAP, but in some paradigms atypical responses were seen. VCrCP AUC varied significantly within paradigm sections (range [SD]: 18.4 [24.17] to 244.21 [243.21] %*s, P < 0.05). All paradigms demonstrated changes in subcomponents with cognitive stimulation, and can be ranked based on their relative presumed metabolic demand. The integrity of NVC requires further investigation in patient populations.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
| | | | - Thompson G. Robinson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Victoria J. Haunton
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
| | - Ronney B. Panerai
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUnited Kingdom
- NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUnited Kingdom
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Abstract
BACKGROUND The incidence of dementia is projected to rise over the coming decades, but with no sensitive diagnostic tests available. Vascular pathology precedes the deposition of amyloid and is an attractive early target. OBJECTIVE The aim of this review was to investigate the use of cerebral hemodynamics and oxygenation as a novel biomarker for mild cognitive impairment (MCI), focusing on transcranial Doppler ultrasonography (TCD) and near-infrared spectroscopy (NIRS). METHODS 2,698 articles were identified from Medline, Embase, PsychINFO, and Web of Science databases. 306 articles were screened and quality assessed independently by two reviewers; 26 met the inclusion criteria. Meta-analyses were performed for each marker with two or more studies and limited heterogeneity. RESULTS Eleven studies were TCD, 8 NIRS, 5 magnetic resonance imaging, and 2 positron/single photon emission tomography. Meta-analyses showed reduced tissue oxygenation index, cerebral blood flow and velocity, with higher pulsatility index, phase and cerebrovascular resistance in MCI compared to controls. The majority of studies found reduced CO2 reactivity in MCI, with mixed findings in neuroactivation studies. CONCLUSION Despite small sample sizes and heterogeneity, meta-analyses demonstrate clear abnormalities in cerebral hemodynamic and oxygenation parameters, even at an early stage of cognitive decline. Further work is required to investigate the use of cerebral hemodynamic and oxygenation parameters as a sensitive biomarker for dementia.
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Affiliation(s)
- Lucy Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Victoria J Haunton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Ronney B Panerai
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Biomedical Research Unit in Cardiovascular Disease, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
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Krishnan K, Beishon L, Berge E, Christensen H, Dineen RA, Ozturk S, Sprigg N, Wardlaw JM, Bath PM. Relationship between race and outcome in Asian, Black, and Caucasian patients with spontaneous intracerebral hemorrhage: Data from the Virtual International Stroke Trials Archive and Efficacy of Nitric Oxide in Stroke trial. Int J Stroke 2017; 13:362-373. [PMID: 29165060 DOI: 10.1177/1747493017744463] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and purpose Although poor prognosis after intracerebral hemorrhage relates to risk factors and hematoma characteristics, there is limited evidence for the effect of race-ethnicity. Methods Data from 1011 patients with intracerebral hemorrhage enrolled into hyperacute trials and randomized to control were obtained from the Virtual International Stroke Trials Archive and Efficacy of Nitric Oxide in Stroke Trial. Clinical characteristics and functional outcome were compared among three racial groups - Asians, Blacks, and Caucasians. Results The majority of patients were Caucasian (78.1%) followed by Asians (14.5%) and Blacks (5.5%). At baseline, Caucasians were older and had larger hematoma volumes; Blacks had lower Glasgow Coma Scale and higher systolic blood pressure (all p < 0.05). Although the primary outcome of modified Rankin Scale did not differ at 90 days (p = 0.14), there were significant differences in mortality (p < 0.0001) and quality of life (EQ-5D p < 0.0001; EQ-VAS p 0.015). In test of multiple comparisons, Caucasians were more likely to die (p = 0.0003) and had worse quality of life (EQ-5D p = 0.003; EQ-VAS p < 0.0001) as compared to Asians. Conclusion Race-ethnicity appears to explain some of the variation in clinical characteristics and outcomes after acute intracerebral hemorrhage. Factors that explain this variation need to be identified.
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Affiliation(s)
- Kailash Krishnan
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Lucy Beishon
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Eivind Berge
- 2 Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Robert A Dineen
- 4 Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Serefnur Ozturk
- 5 Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Nikola Sprigg
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Joanna M Wardlaw
- 6 Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, UK
| | - Philip M Bath
- 1 Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
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Beishon L, McDonald J, Thompson JP, Lambert DG. Long-term activation of polymorph cannabinoid receptors does not affect receptor gene transcription. Br J Anaesth 2014; 113:197-8. [PMID: 24942723 DOI: 10.1093/bja/aeu218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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