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Abdelfadil HMG, Fahmy EM, Abdelmegeed SM, Zakaria HM, Darwesh AA, Kadry AM, Elsayed SH, Aboeleneen AM, Alshimy AM. Effect of adding systematic desensitization to goal-directed paradigm on risk of falling in patients with stroke: a randomized controlled trial. Front Neurol 2024; 15:1285420. [PMID: 38784906 PMCID: PMC11111878 DOI: 10.3389/fneur.2024.1285420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Background Improvement in rehabilitation outcomes for patients suffering from chronic stroke can be attained through systematic desensitization of their fear of falling, which in turn reduces the risk of falling. Purpose This study aimed to examine the effect of adding systematic desensitization to a goal-directed paradigm on functional performance, balance, risk of falling, and fear of falling among chronic ischemic stroke patients. Methodology Two equally sized groups, each comprising 40 stroke patients of both sexes, were randomly divided. For 8 weeks, Group A received three sessions per week of combined treatment consisting of systematic desensitization and a goal-directed paradigm, while Group B received only the goal-directed paradigm. The Timed Up and Go (TUG) test and Dynamic Gait Index (DGI) were used to assess function performance; the Berg Balance Scale (BBS) and the Biodex Fall Risk Index (FRI) were used to evaluate balance; and the 16-item Fall Efficacy Scale-International (FES-I) was used to evaluate fear of falling. At baseline and after the treatment, all measurements were obtained. Results Both groups (A and B) revealed a substantial increase in functional performance through a decrease in TUG scores and an increase in DGI. Additionally, there was a decrease in the risk of falling through an increase in the BBS scores and a decrease in the FRI. Furthermore, there was a decrease in the fear of falling, as measured using the FES-I, after treatment, with superior improvement in Group A with a p-value of <0.001. Conclusion Systematic desensitization combined with a goal-directed paradigm has a superior effect on improving functional performance and reducing the risk of falling and the fear of falling in patients with stroke compared to a goal-directed paradigm alone.
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Affiliation(s)
- Heba Mohammed Gaber Abdelfadil
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | | | - Shimaa Mohamed Abdelmegeed
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hoda Mohammed Zakaria
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ashraf Ahmed Darwesh
- Department of Physical Therapy for Neurology and Neurosurgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | - Shereen Hamed Elsayed
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahmed M. Aboeleneen
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ahmed Magdy Alshimy
- Department of Physical Therapy for Neurology and Its Surgery, Faculty of Physical Therapy, Al Ryada University for Science and Technology, Sadat City, Menoufia, Egypt
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Jaywant A, Keenan A. Pathophysiology, Assessment, and Management of Post-Stroke Cognitive Impairment, Depression, and Fatigue. Phys Med Rehabil Clin N Am 2024; 35:463-478. [PMID: 38514230 DOI: 10.1016/j.pmr.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Post-stroke cognitive impairment, depression, and fatigue are common, persistent, and disabling. This review summarizes current knowledge on the pathophysiology, assessment, and management of these debilitating neuropsychiatric sequelae of stroke. We briefly review evolving knowledge on the neural mechanisms and risk factors for each condition. We describe patient-reported outcome measures and clinician rating techniques that can be used to assist in screening and comprehensive assessment. We then discuss behavioral and pharmacologic management strategies. Heterogeneity of stroke remains a challenge in management and new research is still needed to optimize and personalize treatments for stroke survivors.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA; NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, USA.
| | - Alexandra Keenan
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065, USA
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3
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Oei CW, Ng EYK, Ng MHS, Tan RS, Chan YM, Chan LG, Acharya UR. Explainable Risk Prediction of Post-Stroke Adverse Mental Outcomes Using Machine Learning Techniques in a Population of 1780 Patients. SENSORS (BASEL, SWITZERLAND) 2023; 23:7946. [PMID: 37766004 PMCID: PMC10538068 DOI: 10.3390/s23187946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Post-stroke depression and anxiety, collectively known as post-stroke adverse mental outcome (PSAMO) are common sequelae of stroke. About 30% of stroke survivors develop depression and about 20% develop anxiety. Stroke survivors with PSAMO have poorer health outcomes with higher mortality and greater functional disability. In this study, we aimed to develop a machine learning (ML) model to predict the risk of PSAMO. We retrospectively studied 1780 patients with stroke who were divided into PSAMO vs. no PSAMO groups based on results of validated depression and anxiety questionnaires. The features collected included demographic and sociological data, quality of life scores, stroke-related information, medical and medication history, and comorbidities. Recursive feature elimination was used to select features to input in parallel to eight ML algorithms to train and test the model. Bayesian optimization was used for hyperparameter tuning. Shapley additive explanations (SHAP), an explainable AI (XAI) method, was applied to interpret the model. The best performing ML algorithm was gradient-boosted tree, which attained 74.7% binary classification accuracy. Feature importance calculated by SHAP produced a list of ranked important features that contributed to the prediction, which were consistent with findings of prior clinical studies. Some of these factors were modifiable, and potentially amenable to intervention at early stages of stroke to reduce the incidence of PSAMO.
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Affiliation(s)
- Chien Wei Oei
- Management Information Department, Office of Clinical Epidemiology, Analytics and kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore 308433, Singapore;
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Matthew Hok Shan Ng
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore 308232, Singapore;
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore 169609, Singapore;
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yam Meng Chan
- Department of General Surgery, Vascular Surgery Service, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Lai Gwen Chan
- Department of Psychiatry, Tan Tock Seng Hospital, Singapore 308433, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Udyavara Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield, QLD 4305, Australia;
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Samudio-Cruz MA, Toussaint-González P, Estrada-Cortés B, Martínez-Cortéz JA, Rodríguez-Barragán MA, Hernández-Arenas C, Quinzaños-Fresnedo J, Carrillo-Mora P. Education Level Modulates the Presence of Poststroke Depression and Anxiety, But It Depends on Age. J Nerv Ment Dis 2023:00005053-990000000-00095. [PMID: 37184446 DOI: 10.1097/nmd.0000000000001663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
ABSTRACT Depression and anxiety are common complications after stroke and little is known about the modulatory roles of education and age. Our study aimed to evaluate the modulatory effects of education level on anxiety and depression after stroke and their effect on each age group. Adults with first stroke took part in this cross-sectional observational clinical study. We used the following instruments: Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Scale, Pittsburgh Sleep Quality Index, Barthel index, and Functional Independence Measure. There were 89 patients. The mean (SD) age was 58.01 (13) years, mean (SD) years of education was 9.91 (5.22), 55.1% presented depression symptoms and 47.2% anxiety symptoms, 56.2% were young adults and 43.8% were older adults. We identified a negative association between education and anxiety score (r = -0. 269, p = 0.011) and depression score (r = -0.252, p = 0.017). In the linear regression analysis, we found that education is negatively associated with HADS, but this influence was more consistent in young adults. In conclusion, a higher education level reduces the risk of depression and anxiety, but their effect is less consistent in older adults.
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Affiliation(s)
| | - Paola Toussaint-González
- Physical Medicine and Rehabilitation Department, Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Berenice Estrada-Cortés
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación LGII, México City, México
| | - José A Martínez-Cortéz
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación LGII, México City, México
| | | | - Claudia Hernández-Arenas
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación LGII, México City, México
| | - Jimena Quinzaños-Fresnedo
- División de Rehabilitación Neurológica, Instituto Nacional de Rehabilitación LGII, México City, México
| | - Paul Carrillo-Mora
- Division de Neurociencias Clínicas, Instituto Nacional de Rehabilitación LGII, México City, México
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Peng M, Wu B, Wang X, Ding Y, Li Y, Cheng X. Clinical Factors Affecting the Recovery of Sensory Impairment After Cerebral Infarction: A Retrospective Study. Neurologist 2023; 28:117-122. [PMID: 35776691 DOI: 10.1097/nrl.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND About 75% of patients with cerebral infarction suffer from sensory impairment in varying degrees. It prolongs the time for patients to resume normal life and work. The aim of this study was to retrospectively investigate the clinical characteristics affecting the recovery of sensory impairment. MATERIALS AND METHODS This was a retrospective case-control study. Data of inpatients at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were investigated. We collected information on the patients with sensory disturbances after cerebral infarction. Cases were defined according to whether the National Institutes of Health Stroke Scale (NIHSS) and visual analogue scale (VAS) scores improved. A total of 1078 inpatients from January 1, 2019, to December 31, 2021, were screened. Among those, 187 cases included in this study were divided into no improvement and improvement groups. We compared the clinical characteristics affecting the rehabilitation of these patients. RESULTS The number of patients aged between 63 and 73 years in the no improvement group were significantly higher ( P <0.05). The incidence of coronary heart disease and thalamus infarction was significantly higher in patients in the no improvement cohort ( P <0.05). Furthermore, coronary heart disease [odds ratio=0.466, 95% confidence interval (0.252, 0.863), P =0.015] and thalamic infarction [odds ratio=0.457, 95% confidence interval (0.230, 0.908), P =0.025] were the independent risk factors against the recovery of sensory disturbance after cerebral infarction. CONCLUSIONS Patients with thalamus infarction and coronary heart disease may be more inclined to recover poorly from somatosensory deficits.
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Affiliation(s)
- Maohan Peng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bangqi Wu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Xuhui Wang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Yi Ding
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yibing Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinyue Cheng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Zhang H, Ma J, Sun Y, Xiao LD, Yan F, Tang S. Anxiety subtypes in rural ischaemic stroke survivors: A latent profile analysis. Nurs Open 2023; 10:4083-4092. [PMID: 36807562 PMCID: PMC10170921 DOI: 10.1002/nop2.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/04/2023] [Indexed: 02/22/2023] Open
Abstract
AIM To determine the potential profile classes of anxiety reported by ischaemic stroke survivors in rural China, and to explore the characteristics of patients having different types of post-stroke anxiety. DESIGN A cross-sectional survey. METHODS A cross-sectional survey was conducted by using convenience sampling to collect data from 661 ischaemic stroke survivors in rural Anyang city, Henan Province, China, from July 2021 to September 2021. The parameters included in the study were the socio-demographic characteristics, self-rating anxiety scale (SAS), self-rating depression scale (SDS) and the Barthel index of daily activity ability. Potential profile analysis was done to recognize subgroups of post-stroke anxiety. The Chi-square test was performed to explore the characteristics of individuals with different types of post-stroke anxiety. RESULTS The model fitting indices of stroke survivors supported three classes of anxiety models which were as follows: (a) Class 1, low-level, stable group (65.3%, N = 431); (b) Class 2, moderate-level, unstable group (17.9%, N = 118) and (c) Class 3, high-level, stable group (16.9%, N = 112). The risk factors associated with post-stroke anxiety were female patients, lower levels of education, living alone, lower monthly household income, other chronic diseases, impaired daily activity ability and depression. CONCLUSIONS This study identified three different subgroups of post-ischaemic stroke anxiety and their characteristics in patients in rural China. IMPACT This study has significance in providing evidence for the development of targeted intervention measures to reduce negative emotions in different subgroups of post-stroke anxiety patients. PATIENT OR PUBLIC CONTRIBUTION In this study, the researchers arranged the time of questionnaire collection with the village committee in advance, gathered the patients to the village committee for face-to-face questionnaire survey and collected the household data of the patients with mobility difficulties.
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Affiliation(s)
- Huimin Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Junyan Ma
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Yuyan Sun
- College of Nursing, Xinxiang medical University, Xinxiang, Henan, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Fang Yan
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
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Zhou J, Fan L, Hu H, Shen K, Wu L, Lin X, Gao H. The Efficacy of Integrated Rehabilitation for Post-Stroke Anxiety: Study Protocol for a Prospective, Multicenter, Randomized Controlled Trial. Int J Gen Med 2022; 15:7101-7111. [PMID: 36097565 PMCID: PMC9464039 DOI: 10.2147/ijgm.s381434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Conclusion Trial Registration
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Affiliation(s)
- Jie Zhou
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Lijuan Fan
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Ke Shen
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Liya Wu
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiaoqi Lin
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
- Correspondence: Hong Gao, Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Hangzhou, People’s Republic of China, Email
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Li M, Wang Y, Li K, Xu X, Zhuang L. The efficacy and safety of Jin's three-needle therapy vs. placebo acupuncture on anxiety symptoms in patients with post-stroke anxiety: A study protocol for a randomized controlled trial. Front Psychiatry 2022; 13:941566. [PMID: 36159932 PMCID: PMC9490304 DOI: 10.3389/fpsyt.2022.941566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A large number of clinical RCTs have verified that Jin's three-needle therapy (JTNT) has a great contribution to promoting the function of paralyzed limbs and relieving anxiety disorders for patients with post-stroke anxiety (PSA). However, there is still a lack of sham needle control, and its placebo effect cannot be ruled out. This study firstly verifies the real effectiveness of JTNT. Besides, the changes in serum indexes on the hypothalamic-pituitary-adrenal axis (HPA axis) are observed dynamically by the Enzyme-Linked ImmunoSorbent Assay (ELISA). The activation of different brain regions by JTNT is recorded using resting functional magnetic resonance imaging (rs-fMRI). Therefore, we can provide more practical and powerful evidence-based medical evidence for clinical decisions. METHOD This is a 16 week parallel, single-blind, random, controlled trial, including baseline, 4 weeks of treatment, and 12 weeks of follow-up. A total of 114 participants will be randomly divided into three groups in the proportion of 1:1:1. Participants will receive Jin's three-needle therapy in the active acupuncture group and accept sham needle treatment in the sham acupuncture group. In the waitlist control group, patients will not receive any acupuncture treatment. Outcomes cover three types of indicators, including scale indicators, serum indicators, and imaging indicators. The primary outcome is the change in the performance of anxiety symptoms, which is estimated by the 14-item Hamilton Anxiety Rating Scale (HAMA-14) and the 7-item Generalized Anxiety Disorder scale (GAD-7). Secondary outcomes are physical recovery and daily quality of life, which are evaluated by the National Institute of Health stroke scale (NIHSS) and the Modified Barthel Index Score (MBI Scale). Therefore, the assessment of the scale is carried out at baseline, 2nd, 4th, 8, 12, and 16 weeks. Adrenocorticotropin and cortisol will be quantitatively detected by ELISA at baseline and 4 weeks after treatment. In addition, regional homogeneity analysis (ReHo) will be used to record the activity of brain regions at baseline and 4 weeks after intervention. DISCUSSION The study aims to provide high-quality clinical evidence on the effectiveness and safety of JTNT for patients with PSA. In addition, this trial explores a possible mechanism of JTNT for patients with PSA. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier [ChiCTR2200058992].
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Affiliation(s)
- Meichen Li
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuting Wang
- Clinical Medical College of Acupuncture-Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keyi Li
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Xu
- The First Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lixing Zhuang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
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Ghorbanpour Z, Taghizadeh G, Hosseini SA, Pishyareh E, Ghomsheh FT, Bakhshi E, Mehdizadeh H. Overload of anxiety on postural control impairments in chronic stroke survivors: The role of external focus and cognitive task on the automaticity of postural control. PLoS One 2021; 16:e0252131. [PMID: 34292945 PMCID: PMC8297887 DOI: 10.1371/journal.pone.0252131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background Despite the high prevalence of anxiety among chronic stroke survivors and evidence of its negative effects on postural control in healthy subjects, it is unclear whether anxiety also affects postural control in these patients. Recent evidence of improved postural control of healthy subjects by distracting the attention using an external focus (EF) or cognitive task, raises the question of whether similar benefits would be observed in stroke survivors. Thus, the current study aimed to investigate the effects of anxiety and distracting the attention on postural control of chronic stroke survivors in terms of both postural sway measures and neuromuscular regulation. Methods Postural sway measures and ankle muscle activity of chronic stroke survivors with the high and low level of anxiety (HA-stroke (n = 17), and LA-stroke (n = 17), respectively) and age-, sex-, height-, and weight-matched healthy subjects (n = 17) were assessed while standing on rigid and foam surfaces under following conditions: baseline, internal focus (IF), EF, simple and hard cognitive tasks (SC and HC, respectively). Results Stroke survivors, particularly HA-stroke participants, showed greater postural sway measures (i.e. postural instability) and enhanced co-contraction of ankle muscles (i.e. stiffening of the neuromuscular system) compared with healthy subjects. As opposed to baseline and IF conditions, postural instability and neuromuscular stiffening significantly reduced in EF condition and decreased more in cognitive task conditions, particularly HC condition. Conclusions The results suggest that anxiety enhances stroke-induced postural instability promoting improper neuromuscular control of posture with stiffening strategy, which can be alleviated by EF and cognitive tasks.
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Affiliation(s)
- Zahra Ghorbanpour
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ghorban Taghizadeh
- Department of Occupational Therapy, Rehabilitation Research Center, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
| | - Ebrahim Pishyareh
- Department of Occupational Therapy, School of Rehabilitation Sciences, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran
- * E-mail:
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Enayatollah Bakhshi
- Department of Biostatistics and Epidemiology, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran,Iran
| | - Hajar Mehdizadeh
- Department of Neurosciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Wang J, Zhao D, Lin M, Huang X, Shang X. Post-stroke Anxiety Analysis via Machine Learning Methods. Front Aging Neurosci 2021; 13:657937. [PMID: 34248599 PMCID: PMC8267915 DOI: 10.3389/fnagi.2021.657937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Post-stroke anxiety (PSA) has caused wide public concern in recent years, and the study on risk factors analysis and prediction is still an open issue. With the deepening of the research, machine learning has been widely applied to various scenarios and make great achievements increasingly, which brings new approaches to this field. In this paper, 395 patients with acute ischemic stroke are collected and evaluated by anxiety scales (i.e., HADS-A, HAMA, and SAS), hence the patients are divided into anxiety group and non-anxiety group. Afterward, the results of demographic data and general laboratory examination between the two groups are compared to identify the risk factors with statistical differences accordingly. Then the factors with statistical differences are incorporated into a multivariate logistic regression to obtain risk factors and protective factors of PSA. Statistical analysis shows great differences in gender, age, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level between PSA group and non-anxiety group with HADS-A and HAMA evaluation. Meanwhile, as evaluated by SAS scale, gender, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level differ in the PSA group and the non-anxiety group. Multivariate logistic regression analysis of HADS-A, HAMA, and SAS scales suggest that hypertension, diabetes mellitus, drinking, high NIHSS score, and low serum HDL-C level are related to PSA. In other words, gender, age, disability, hypertension, diabetes mellitus, HDL-C, and drinking are closely related to anxiety during the acute stage of ischemic stroke. Hypertension, diabetes mellitus, drinking, and disability increased the risk of PSA, and higher serum HDL-C level decreased the risk of PSA. Several machine learning methods are employed to predict PSA according to HADS-A, HAMA, and SAS scores, respectively. The experimental results indicate that random forest outperforms the competitive methods in PSA prediction, which contributes to early intervention for clinical treatment.
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Affiliation(s)
- Jirui Wang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Defeng Zhao
- The First Clinical Department, China Medical University, Shenyang, China
| | - Meiqing Lin
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinyu Huang
- Software College, Northeastern University, Shenyang, China
| | - Xiuli Shang
- Department of Neurology, The First Affiliated Hospital, China Medical University, Shenyang, China
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11
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Reminiscence therapy serves as an optional nursing care strategy in attenuating cognitive impairment, anxiety, and depression in acute ischemic stroke patients. Ir J Med Sci 2021; 191:877-884. [PMID: 33755917 DOI: 10.1007/s11845-021-02600-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reminiscence therapy is revealed to improve cognitive function and attenuate psychological disorders in neurological diseases such as Alzheimer's disease patients, while its application in acute ischemic stroke (AIS) is seldom reported. So, the current study aimed to explore the effect of reminiscence therapy on cognitive impairment, anxiety, depression, and disease recurrence in AIS patients. METHODS A total of 216 first-ever AIS patients were enrolled and randomized into reminiscence therapy group or control group in 1:1 ratio. MMSE, HADS, and Zung SAS/SDS scales were evaluated at the discharge from hospital (M0), 3 months (M3), 6 months (M6), 9 months (M9), and 12 months (M12), respectively. Besides, patients were further followed up to 36 months for recurrence-free survival (RFS) calculation. RESULTS Reminiscence therapy group showed higher MMSE score at M9 and M12, lower cognitive impairment rate by MMSE at M12 compared to control group. As to anxiety, HADS-anxiety score and anxiety rate by HADS were of no difference at each time point, while SAS score and anxiety rate by SAS were lower at M12 in reminiscence therapy group compared with control group. Regarding depression, HADS-depression score and depression rate by HADS at M12, SDS score at M9 and M12, and depression rate by SDS at M12 were all lower in reminiscence therapy group compared with control group. In terms of RFS, it was similar between reminiscence therapy group and control group. CONCLUSION Reminiscence therapy cripples cognitive impairment, anxiety, and depression, but does not affect RFS in AIS patients, indicating its potential for post-stroke management.
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12
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Naqvi IA, Montiel TC, Bittar Y, Hunter N, Okpala M, Johnson C, Weiner MG, Savitz S, Sharrief A, Beauchamp JES. Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study. JMIR Form Res 2021; 5:e25123. [PMID: 33683206 PMCID: PMC7985796 DOI: 10.2196/25123] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.
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Affiliation(s)
- Imama Ali Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Tahani Casameni Montiel
- Department of Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yazan Bittar
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Norma Hunter
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Constance Johnson
- Department of Nursing Research, Cizik School of Nursing and School of Bioinformatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Sean Savitz
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Elizabeth Sanner Beauchamp
- Department of Nursing Research, Cizik School of Nursing, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, TX, United States
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13
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Li H, Gui H, Yao Y, Lin J. Anxiety Network of Brain Function in Patients with Acute Cerebral Infarction. Health (London) 2021. [DOI: 10.4236/health.2021.137060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Yao M, Li H, Luo Y, Li L, Yu J. High Prevalence of Post-stroke Anxiety in Elderly Patients Following COVID-19 Outbreak. Front Psychiatry 2021; 12:699869. [PMID: 34248720 PMCID: PMC8264416 DOI: 10.3389/fpsyt.2021.699869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: Post-stroke anxiety (PSA) is a common affective disorder in patients with ischemic stroke. The elderly are more susceptible to mental health issues, however, few studies have so far focused on PSA in elderly patients, especially in the context of the COVID-19, causing psychological issues in the general population. The aim of the present study was to assess the prevalence and risk factors of PSA in elderly patients following COVID-19 outbreak. Methods: We retrospectively analyzed 206 elderly inpatients with newly diagnosed acute ischemic stroke in the First Affiliated Hospital, Sun Yat-sen University, from January 2020 to December 2020. Patients were categorized into the PSA group and the non-PSA group based on Hamilton Anxiety Scale scores at admission (within 1 week after stroke onset). Demographic and clinical data, mental state by Mini-Mental State Examination, depression by Hamilton Depression Scales (HAMD), and stroke severity and outcome by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to analyze risk factors associated with PSA. We determined the cutoff scores for significant predictors of PSA using the area under the curve (AUC) and receiver operating characteristic. Results: Of the 206 stroke patients, 62 (30.1%) developed anxiety. Binary logistic regression analysis showed that female gender [adjusted odds ratio (aOR): 2.288, 95% confidence interval (CI):1.021-5.128, P = 0.044], high NIHSS scores [aOR: 1.264, 95% CI: 1.074-1.486, P = 0.005] and HAMD scores [aOR: 1.345, 95% CI: 1.215-1.490, P < 0.001] were independent risk factors for PSA. The cutoff threshold for the NIHSS scores was 3.5 points with an AUC of 0.64 and the cutoff threshold for HAMD scores was 5.5 points with an AUC of 0.89. Conclusion: Our results showed a high incidence of PSA in elderly patients after the COVID-19 outbreak. Female gender, high NIHSS and HAMD scores were the independent risk factors for PSA.
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Affiliation(s)
- Meiling Yao
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Hongjie Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Ying Luo
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Ling Li
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
| | - Jian Yu
- Department of Neurology, The First Affiliated Hospital, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
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15
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Taroza S, Rastenytė D, Burkauskas J, Podlipskytė A, Kažukauskienė N, Patamsytė V, Mickuvienė N. Deiodinases, organic anion transporter polypeptide polymorphisms and symptoms of anxiety and depression after ischemic stroke. J Stroke Cerebrovasc Dis 2020; 29:105040. [PMID: 32807452 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/29/2020] [Accepted: 06/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Emotional disturbances, such as anxiety and depression are common after acute ischemic stroke (AIS). Individual variation in emotional outcome is strongly influenced by genetic factors. One of pituitary axis, is the hypothalamic-pituitary-thyroid axis, a critical regulator of post-stroke recovery, suggesting that allelic variants in thyroid hormone (TH) signaling regulation can influence stroke outcome. AIM To determine associations between AIS emotional outcome and allelic variants of the TH metabolizing enzymes 1-3 type deiodinase (DIO1-3) and the membrane transporting organic anion polypeptide 1C1 (OATP1C1). METHODS Eligible AIS patients from Lithuania (n=168) were genotyped for ten DIO1-3 and OATP1C1 single nucleotide polymorphisms (SNP): DIO1 rs12095080-A/G, rs11206244-C/T, and rs2235544-A/C; DIO2 rs225014-T/C and rs225015-G/A; DIO3 rs945006-T/G; OATP1C1 rs974453-G/A, rs10444412-T/C, rs10770704-C/T, and rs1515777-A/G. Emotional outcome was evaluated using the Hospital Anxiety and Depression Scale at discharge from the neurology department after experienced index AIS. RESULTS After adjustment for potential confounders, the major allelic (wild-type) DIO1-rs12095080 genotype (AA) was associated with higher odds ratio of anxiety symptoms (OR = 5.16; 95% CI: 1.04-25.58; p = 0.045), conversely, DIO1-rs11206244 wild-type genotype (CC) and wild-type OATP1C1-rs1515777 allele containing the genotypes (AA + AG) were associated with lower odds ratio of symptoms of anxiety (OR = 0.37; 95% CI: 0.14-0.96; p = 0.041 and OR = 0.30; 95% CI: 0.12-0.76; p = 0.011, respectively). Wild-type OATP1C1-rs974453 genotype (GG) was associated with higher odds ratio of symptoms of depression (OR = 2.73; 95% CI: 1.04-7.12; p = 0.041). CONCLUSION Allelic variants in thyroid axis genes may predict emotional outcomes of AIS.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioural Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
| | - Daiva Rastenytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Julius Burkauskas
- Laboratory of Behavioural Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
| | - Aurelija Podlipskytė
- Laboratory of Behavioural Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
| | - Nijolė Kažukauskienė
- Laboratory of Behavioural Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
| | - Vaiva Patamsytė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Narseta Mickuvienė
- Laboratory of Behavioural Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
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Zhang S, Xu M, Liu ZJ, Feng J, Ma Y. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World J Psychiatry 2020; 10:125-138. [PMID: 32742946 PMCID: PMC7360525 DOI: 10.5498/wjp.v10.i6.125] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/13/2020] [Accepted: 04/25/2020] [Indexed: 02/05/2023] Open
Abstract
A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Michael Xu
- Department of Clinical Medicine, International Education School, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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