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Orange C, Lanhers C, Coll G, Coste N, Dutheil F, Hauret I, Pereira B, Coudeyre E. Determinants of Return to Work After a Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:359-368. [PMID: 37797913 DOI: 10.1016/j.apmr.2023.08.027] [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] [Received: 08/22/2022] [Revised: 08/13/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To identify prognostic factors for return to work (RTW) after stroke. DATA SOURCES PubMed, MEDLINE, Cochrane, and Embase were systematically searched. STUDY SELECTION Studies had to include people of working age (<65 years old) at the time of stroke (ischemic, hemorrhagic, or subarachnoid hemorrhage). The evaluation of RTW and rate of RTW had to be mentioned. Study selection was done by 2 independent authors. In total, 1241 articles were screened, 39 met all inclusion criteria. DATA EXTRACTION Characteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or with a third author. Quality was assessed using the Scottish Intercollegiate Guidelines Network quality assessment tool. DATA SYNTHESIS Among the 39 studies, prognostic factors for RTW were hemorrhagic stroke (odds ratio 0.53 [95% confidence interval 0.45-0.60], n=18 studies), sex (men) (1.26 [1.14-1.40], n=31), aphasia (0.37 [0.20-0.69], n=7), occupation (white collar worker) (1.84 [1.64-2.06], n=17), independence in activities of daily living (3.99 [1.73-9.23], n=7), and stroke severity (NIHSS) (1.23 [1.08-1.39], n=6). CONCLUSIONS This meta-analysis highlighted positive and negative prognostic factors associated with RTW after stroke. Two categories were distinguished: modifiable and non-modifiable prognostic factors. This study provides information to help understand the issues, set appropriate objectives and implement appropriate strategies to guide people to RTW after stroke. Randomized controlled studies are needed to better evaluate work-place intervention programs as well as the effects of intravenous thrombolysis, and cognitive and neuropsychological rehabilitation on return-to-work rates after stroke.
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Affiliation(s)
- Charles Orange
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France; Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Charlotte Lanhers
- Physical Medicine and Rehabilitation, CMPR Maurice Gantchoula Pionsat, France
| | - Guillaume Coll
- University hospital of Clermont-Ferrand, Neurosurgery B, Clermont-Ferrand, France
| | - Nicolas Coste
- Physical Medicine and Rehabilitation, Notre-Dame, Chamalières, France
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CNRS, LaPSCo, Physiological and Psychosocial Stress, university hospital of Clermont-Ferrand, WittyFit, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Hauret
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical research and innovation direction, biostatistics, university hospital of Clermont-Ferrand, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Physical Medicine and Rehabilitation, INRAE, UNH, Université Clermont-Auvergne, university hospital of Clermont-Ferrand, Clermont-Ferrand, France
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Peng SH, Lai YJ, Lai WJ, Li AH, Yen HH, Huang LW, Tang CW. Impact of smoking on one year functional outcomes after thrombectomy for young stroke patients. J Neurointerv Surg 2023; 15:e343-e348. [PMID: 36572522 DOI: 10.1136/jnis-2022-019815] [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] [Received: 11/01/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND The incidence of stroke in young patients (20-50 years old) has increased in recent decades. Unlike the use of good functional outcomes to evaluate prognosis, excellent functional outcomes are a better indicator of return to work among younger patients. The rate of return to work increases with time after stroke. This study investigated the short term (3 months) and long term (1 year) predictors of excellent functional outcomes in young patients after endovascular thrombectomy (EVT). METHODS We included young patients who underwent EVT for acute ischemic stroke (AIS) due to large vessel occlusion within 6 hours after stroke onset between 2015 and 2021. Patients with intracerebral hemorrhage on pretreatment CT were excluded. The associations between clinical, imaging, and procedure variables, and excellent functional outcomes were analyzed using univariate and multivariable logistic regression analyses. An excellent functional outcome was defined as a modified Rankin Scale score of ≤1. RESULTS Of the 361 patients with AIS eligible for EVT, 55 young patients (aged 24-50 years) were included. Of these, 36.4% and 41.8% achieved excellent functional outcomes at 3 and 12 months, respectively. Multivariate analysis revealed that smoking was the independent negative predictor of both 3 month (adjusted OR (aOR) 0.232, 95% CI 0.058 to 0.928; p=0.039) and 12 month (aOR 0.180, 95% CI 0.044 to 0.741; p=0.018) excellent functional outcomes. CONCLUSIONS Current or former smoking habit was an independent negative predictor of both short term and long term excellent functional outcomes in young adults with AIS.
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Affiliation(s)
- Szu-Hsiang Peng
- Division of Medical Imaging, Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Jun Lai
- Division of Medical Imaging, Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wei-Jen Lai
- Division of Medical Imaging, Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ai-Hsien Li
- Department of Cardiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ho-Hsian Yen
- Division of Medical Imaging, Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Lih-Wen Huang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Wei Tang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Institute of Brain Science, Brain Research Center, National Yang-Ming University, Taipei, Taiwan
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3
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Chen NYC, Dong Y, Kua ZZJ. Addressing mood and fatigue in return-to-work programmes after stroke: a systematic review. Front Neurol 2023; 14:1145705. [PMID: 37674875 PMCID: PMC10477595 DOI: 10.3389/fneur.2023.1145705] [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: 01/20/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Return-to-work is a key rehabilitation goal for many working aged stroke survivors, promoting an overall improvement of quality of life, social integration, and emotional wellbeing. Conversely, the failure to return-to-work contributes to a loss of identity, lowered self-esteem, social isolation, poorer quality of life and health outcomes. Return-to-work programmes have largely focused on physical and vocational rehabilitation, while neglecting to include mood and fatigue management. This is despite the knowledge that stroke results in changes in physical, cognitive, and emotional functioning, which all impact one's ability to return to work. The purpose of this systematic review is to conduct a comprehensive and up-to-date search of randomised controlled trials (RCTs) of return-to-work programmes after stroke. The focus is especially on examining components of mood and fatigue if they were included, and to also report on the screening tools used to measure mood and fatigue. Method Searches were performed using 7 electronic databases for RCTs published in English from inception to 4 January 2023. A narrative synthesis of intervention design and outcomes was provided. Results The search yielded 5 RCTs that satisfied the selection criteria (n = 626). Three studies included components of mood and fatigue management in the intervention, of which 2 studies found a higher percentage of subjects in the intervention group returning to work compared to those in the control group. The remaining 2 studies which did not include components of mood and fatigue management did not find any significant differences in return-to-work rates between the intervention and control groups. Screening tools to assess mood or fatigue were included in 3 studies. Conclusion Overall, the findings demonstrated that mood and fatigue are poorly addressed in rehabilitation programmes aimed at improving return-to-work after stroke, despite being a significant predictor of return-to-work. There is limited and inconsistent use of mood and fatigue screening tools. The findings were generally able to provide guidance and recommendations in the development of a stroke rehabilitation programme for return-to-work, highlighting the need to include components addressing and measuring psychological support and fatigue management.
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Affiliation(s)
- Nicole Yun Ching Chen
- Changi General Hospital, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - YanHong Dong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zaylea Zhong Jie Kua
- Changi General Hospital, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Abedi V, Lambert C, Chaudhary D, Rieder E, Avula V, Hwang W, Li J, Zand R. Defining the Age of Young Ischemic Stroke Using Data-Driven Approaches. J Clin Med 2023; 12:jcm12072600. [PMID: 37048683 PMCID: PMC10095415 DOI: 10.3390/jcm12072600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction: The cut-point for defining the age of young ischemic stroke (IS) is clinically and epidemiologically important, yet it is arbitrary and differs across studies. In this study, we leveraged electronic health records (EHRs) and data science techniques to estimate an optimal cut-point for defining the age of young IS. Methods: Patient-level EHRs were extracted from 13 hospitals in Pennsylvania, and used in two parallel approaches. The first approach included ICD9/10, from IS patients to group comorbidities, and computed similarity scores between every patient pair. We determined the optimal age of young IS by analyzing the trend of patient similarity with respect to their clinical profile for different ages of index IS. The second approach used the IS cohort and control (without IS), and built three sets of machine-learning models—generalized linear regression (GLM), random forest (RF), and XGBoost (XGB)—to classify patients for seventeen age groups. After extracting feature importance from the models, we determined the optimal age of young IS by analyzing the pattern of comorbidity with respect to the age of index IS. Both approaches were completed separately for male and female patients. Results: The stroke cohort contained 7555 ISs, and the control included 31,067 patients. In the first approach, the optimal age of young stroke was 53.7 and 51.0 years in female and male patients, respectively. In the second approach, we created 102 models, based on three algorithms, 17 age brackets, and two sexes. The optimal age was 53 (GLM), 52 (RF), and 54 (XGB) for female, and 52 (GLM and RF) and 53 (RF) for male patients. Different age and sex groups exhibited different comorbidity patterns. Discussion: Using a data-driven approach, we determined the age of young stroke to be 54 years for women and 52 years for men in our mainly rural population, in central Pennsylvania. Future validation studies should include more diverse populations.
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Affiliation(s)
- Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Clare Lambert
- Department of Neurology, Yale New Haven Hospital, New Haven, CT 06510, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Emily Rieder
- Geisinger Commonwealth, School of Medicine, Scranton, PA 18509, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Wenke Hwang
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA
- Department of Neurology, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence: ; Tel.: +1-(717)-531-1804; Fax: +1-(717)-531-0384
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Broman J, Aarnio K, But A, Marinkovic I, Rodríguez-Pardo J, Kaste M, Tatlisumak T, Putaala J. Association of post-stroke-initiated antidepressants with long-term outcomes in young adults with ischaemic stroke. Ann Med 2022; 54:1757-1766. [PMID: 35786079 PMCID: PMC9258433 DOI: 10.1080/07853890.2022.2089729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE We examined the association between initiation of antidepressants within the first year after ischaemic stroke (IS) in young adults and long-term fatal and non-fatal cardiovascular events, as well as all-cause mortality. PATIENTS AND METHODS The Helsinki Young Stroke Registry (HYSR) includes patients aged 15-49 years with their first-ever IS occurring 1994-2007. From nationwide registers, we obtained data on prescriptions (1993-2011) and outcomes of interest (1994-2011). Time of initiating post-stroke antidepressants (PSADs) was defined as time of the first filled prescription for antidepressants within the first year from IS. To account for non-random assignment of PSADs, we performed propensity score matching and studied the relationship between PSAD initiation and outcomes using Cox regression models with time-varying coefficients. RESULTS Of all patients (n = 888), 206 (23.2%) initiated PSADs within the first year, of which 203 (98.5%) could be matched to 406 non-initiators. In this matched sample of 609 patients, the median follow-up time was 8.1 (interquartile range [IQR] 5.0-12.6) years and 169 (28.9%) patients had any cardiovascular events, 95 (15.8%) had recurrent ischaemic or haemorrhagic strokes and 106 (17.4%) died. Adjusted for sociodemographics and cardiovascular comorbidities, PSAD initiation was associated with recurrent ischaemic or haemorrhagic stroke 5-10 years after IS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 1.32-7.12). No association emerged between PSAD initiation and other outcomes. CONCLUSIONS In young adults, PSAD initiation within the first year after IS was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Future studies are needed to verify the results and to further study the nature of this finding.KEY MESSAGESInitiation of post-stroke antidepressants (PSADs) within the first year after ischaemic stroke (IS) was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term.Patients starting antidepressants after IS should be followed up more closely in case of recurrent events.Future studies are needed to verify the results and to further study the nature of this finding.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ivan Marinkovic
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Markku Kaste
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Martinez-Majander N, Gordin D, Joutsi-Korhonen L, Salopuro T, Adeshara K, Sibolt G, Curtze S, Pirinen J, Liebkind R, Soinne L, Sairanen T, Suihko S, Lehto M, Sinisalo J, Groop PH, Tatlisumak T, Putaala J. Markers of early vascular aging are not associated with cryptogenic ischemic stroke in the young: A case-control study. J Stroke Cerebrovasc Dis 2022; 31:106647. [PMID: 35849915 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106647] [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: 05/16/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to assess the association between covert atherosclerosis, arterial stiffness, and early-onset cryptogenic ischemic stroke (CIS) in a prospective case-control study. METHODS We enrolled 123 young CIS patients (median age 41 years; 42% women) and 123 age- and sex-matched controls. Carotid intima-media thickness (CIMT), Augmentation Index (AIx), central pulse wave velocity (PWV), and subendocardial viability ratio (SEVR) were compared between patients and controls. Conditional logistic regression was used adjusting for age, systolic blood pressure, diastolic blood pressure, current smoking, total cholesterol/high-density lipoprotein cholesterol (Total-C/HDL-C) ratio, and glycated albumin to assess the independent association between CIMT, arterial stiffness and CIS. RESULTS Patients with higher CIMT and PWV were older, more often men and they had more frequently well-documented risk factors, lower HDL and higher Total-C/HDL-C ratio compared to other tertiles. In univariate comparisons, we found no differences between patients and controls regarding CIMT, AIx, or PWV. In the entire cohort, patients had a significantly lower SEVR compared to controls (146.3%, interquartile range [IQR] 125.7-170.3 vs. 158.0%, IQR 141.3-181.0, P=0.010). SEVR was lower also in women compared to their controls (132.0%, IQR 119.4-156.1 vs. 158.7%, IQR 142.0-182.8, P=0.001) but no significant difference appeared between male patients and male controls. However, after adjusting for comorbidities and laboratory values these significant differences were lost (odds ratio [OR] 1.52, 95% confidence interval [CI] 0.47-4.91) in the entire cohort and OR 3.89, 95% CI 0.30-50.80 in women). CONCLUSIONS Higher CIMT and PWV were associated to higher age, male sex, and several well-documented cardiovascular risk factors. However, in this study we could not prove that either covert atherosclerosis or arterial stiffness contribute to pathogenesis of early-onset CIS.
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Affiliation(s)
- Nicolas Martinez-Majander
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland.
| | - Daniel Gordin
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Lotta Joutsi-Korhonen
- Department of Clinical Chemistry, HUSLAB, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Titta Salopuro
- Department of Clinical Chemistry, HUSLAB, HUS Diagnostic Centre, Helsinki University Hospital, Helsinki, Finland
| | - Krishna Adeshara
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Clinical and Molecular Metabolism, Faculty of Medicine Research Programs, University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Jani Pirinen
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland; HUS Helsinki University Hospital, Porvoo Hospital Area, Internal Medicine, Finland; Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Finland
| | - Ron Liebkind
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Lauri Soinne
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Tiina Sairanen
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
| | - Satu Suihko
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Per-Henrik Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Finland
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7
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Hahn M, Gröschel S, Hayani E, Brockmann MA, Muthuraman M, Gröschel K, Uphaus T. Sex Disparities in Re-Employment in Stroke Patients With Large Vessel Occlusion Undergoing Mechanical Thrombectomy. Stroke 2022; 53:2528-2537. [PMID: 35443786 DOI: 10.1161/strokeaha.121.037386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strokes in the working-age population represent a relevant share of ischemic strokes and re-employment is a major factor for well-being in these patients. Income differences by sex have been suspected a barrier for women in returning to paid work following ischemic stroke. We aim to identify predictors of (not) returning to paid work in patients with large vessel occlusion treated with mechanical thrombectomy (MT) to identify potential areas of targeted vocational rehabilitation. METHODS From 6635 patients enrolled in the German Stroke Registry Endovascular Treatment between 2015 and 2019, data of 606 patients of the working population who survived large vessel occlusion at least 90 days past MT were compared based on employment status at day 90 follow-up. Univariate analysis, multiple logistic regression and analyses of area under the curve were performed to identify predictors of re-employment. RESULTS We report 35.6% of patients being re-employed 3 months following MT (median age 54.0 years; 36.1% of men, 34.5% of women [P=0.722]). We identified independent negative predictors against re-employment being female sex (odds ratio [OR], 0.427 [95% CI, 0.229-0.794]; P=0.007), higher National Institutes of Health Stroke Scale (NIHSS) score 24 hours after MT (OR, 0.775 [95% CI, 0.705-0.852]; P<0.001), large vessel occlusion due to large-artery atherosclerosis (OR, 0.558 [95% CI, 0.312-0.997]; P=0.049) and longer hospital stay (OR, 0.930 [95% CI, 0.868-0.998]; P=0.043). Positive predictors favoring re-employment were excellent functional outcome (modified Rankin Scale score of 0-1) at 90 day follow-up (OR, 11.335 [95% CI, 4.864-26.415]; P<0.001) and combined treatment with intravenous thrombolysis (OR, 1.904 [95% CI, 1.046-3.466]; P=0.035). Multiple regression modeling increased predictive power of re-employment status significantly over prediction by best single functional outcome parameter (National Institutes of Health Stroke Scale 24 hours after MT ≤5; R2: 0.582 versus 0.432; area under the receiver operating characteristic curve: 0.887 versus 0.835, P<0.001). CONCLUSIONS There is more to re-employment after MT than functional outcome alone. In particular, attention should be paid to possible systemic barriers deterring women from resuming paid work. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03356392.
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Affiliation(s)
- Marianne Hahn
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
| | - Sonja Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
| | - Eyad Hayani
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.A.B.)
| | - Muthuraman Muthuraman
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
| | - Klaus Gröschel
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
| | - Timo Uphaus
- Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany. (M.H., S.G., E.H., M.M., K.G., T.U.)
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8
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Nawaz B, Fromm A, Øygarden H, Eide GE, Saeed S, Meijer R, Bots ML, Sand KM, Thomassen L, Næss H, Waje-Andreassen U. Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study. Eur Stroke J 2022; 6:374-384. [PMID: 35342817 PMCID: PMC8948509 DOI: 10.1177/23969873211059472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/20/2021] [Indexed: 01/05/2023] Open
Abstract
Objectives: We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up. Methods: Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven vascular areas by electrocardiogram (ECG), ankle–arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied. Results: Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients (p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients (p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls. Conclusion: Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death.
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Affiliation(s)
- Beenish Nawaz
- Department of Clinical Medicine 1, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Øygarden
- Department of Neurology, Sørlandet Hospital, Kristiansand, Norway.,Department of Health and Nursing Sciences, Univeristy of Agder, Kristiansand, Norway
| | - Geir E Eide
- Centre of Clinical Research, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sahrai Saeed
- Department of Cardiology, Haukeland University Hospital, Bergen, Norway
| | - Rudy Meijer
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kristin M Sand
- Department of Medicine, Sørlandet Hospital, Flekkefjord, Norway.,The Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Thomassen
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Næss
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,SESAM, Centre for Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
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9
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Stewart CE, Branyan TE, Sampath D, Sohrabji F. Sex Differences in the Long-Term Consequences of Stroke. Curr Top Behav Neurosci 2022; 62:287-308. [PMID: 35332459 DOI: 10.1007/7854_2022_311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Stroke is the fifth leading cause of death and as healthcare intervention improves, the number of stroke survivors has also increased. Furthermore, there exists a subgroup of younger adults, who suffer stroke and survive. Given the overall improved survival rate, bettering our understanding of long-term stroke outcomes is critical. In this review we will explore the causes and challenges of known long-term consequences of stroke and if present, their corresponding sex differences in both old and young survivors. We have separated these long-term post-stroke consequences into three categories: mobility and muscle weakness, memory and cognitive deficits, and mental health and mood. Lastly, we discuss the potential of common preclinical stroke models to contribute to our understanding of long-term outcomes following stroke.
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Affiliation(s)
- Courtney E Stewart
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA
| | - Taylor E Branyan
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA.,Texas A&M Institute for Neuroscience, College Station, TX, USA
| | - Dayalan Sampath
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA
| | - Farida Sohrabji
- Women's Health in Neuroscience Program, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, Bryan, TX, USA. .,Texas A&M Institute for Neuroscience, College Station, TX, USA.
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10
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Chaudhary D, Anyaehie M, Demiraj F, Bavishi S, Shahjouei S, Li J, Abedi V, Zand R. Comparison of Long-Term Outcomes and Associated Factors between Younger and Older Rural Ischemic Stroke Patients. J Clin Med 2022; 11:jcm11051430. [PMID: 35268521 PMCID: PMC8911514 DOI: 10.3390/jcm11051430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: The rise of ischemic stroke among young adults has stressed the need to understand their risk profiles and outcomes better. This study aimed to examine the five-year ischemic stroke recurrence and survival probability among young patients in rural Pennsylvania. Methods: This retrospective cohort study included first-time ischemic stroke patients from the Geisinger Health System between September 2003 and May 2014. The outcomes included all-cause mortality and ischemic stroke recurrence at five years. Kaplan-Meier estimator, cumulative incidence function, Cox proportional hazards model, and Cause-specific hazard model were used to examine the association of independent variables with the outcomes. Results: A total of 4459 first-time ischemic stroke patients were included in the study, with 664 (14.9%) patients in the 18−55 age group and 3795 (85.1%) patients in the >55 age group. In the 18−55 age group, the five-year survival probability was 87.2%, and the cumulative incidence of recurrence was 8%. Patients in the 18−55 age group had significantly lower hazard for all-cause mortality (HR = 0.37, 95% CI 0.29−0.46, p < 0.001), and non-significant hazard for five-year recurrence (HR = 0.81, 95% CI 0.58−1.12, p = 0.193) compared to the >55 age group. Chronic kidney disease was found to be associated with increased mortality in the 18−55 age group. Conclusion: In our rural population, younger ischemic stroke patients were at the same risk of long-term ischemic stroke recurrence as the older ischemic stroke patients. Identifying the factors and optimizing adequate long-term secondary prevention may reduce the risk of poor outcomes among younger ischemic stroke patients.
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Affiliation(s)
- Durgesh Chaudhary
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
| | - Michelle Anyaehie
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, PA 18510, USA;
| | - Francis Demiraj
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL 33314, USA;
| | - Shreya Bavishi
- Cell and Molecular Biology Department, Tulane University, New Orleans, LA 70118, USA;
| | - Shima Shahjouei
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA;
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Ramin Zand
- Department of Neurology, Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (D.C.); (S.S.)
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence:
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11
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Mayer-Suess L, Geiger M, Dejakum B, Boehme C, Domig LM, Komarek S, Toell T, Kiechl S, Knoflach M. Sex-differences in psychosocial sequelae after spontaneous cervical artery dissection. Sci Rep 2022; 12:611. [PMID: 35022509 PMCID: PMC8755839 DOI: 10.1038/s41598-021-04686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Short- to mid-term functional outcome in spontaneous cervical artery dissection is favorable, but the concomitant psychosocial impact is underreported. We aimed to determine these possible sequelae, with a special focus on sex differences, in our cohort of spontaneous cervical artery dissection subjects. During a standardized prospective in-house follow-up visit we, among other values, evaluated functional outcome (modified Rankin Scale [mRS]), psychosocial measures (return to work-, divorce rate) and health-related quality of life (WHO-QoL-BREF and SF-36-questionnaires). 145 patients participated in the long-term prospective follow-up. Median follow-up time was 6.5 years and excellent functional outcome (mRS ≤ 1) was achieved in 89.0% subjects. 87.6% returned to work and 17.6% married patients had a divorce during follow-up. Even though relevant baseline-/discharge characteristics and functional outcome did not differ between the sexes, women were less likely to return to work compared to men (79.7% vs. 93.8%; P = 0.010) and divorce rate was considerably higher in women (30.2% vs. 9.2%; P = 0.022). Health related quality of life did not differ significantly between the sexes, but women consistently reported lower values. Even though functional outcome is beneficial in most patients, measures to prevent poor psychosocial outcome should be considered in the long-term care of patients with spontaneous cervical artery dissection, especially women.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Moritz Geiger
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lena M Domig
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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12
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Tatlisumak T, Putaala J. General Stroke Management and Stroke Units. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00055-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Saeed S, Waje-Andreassen U, Naess H, Fromm A, Nilsson PM. The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study. J Clin Hypertens (Greenwich) 2021; 23:1922-1929. [PMID: 34492149 PMCID: PMC8678672 DOI: 10.1111/jch.14361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
The impact of age and 24‐h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima‐media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle‐aged (45–60 years, n = 292). Arterial stiffness was measured by carotid‐femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24‐h ABPM was recorded. The middle‐aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high‐density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R2 = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R2 = 0.21, p = .01) in the middle‐aged group. In the middle‐aged group, 24‐h pulse pressure had a significant association with PWV (β = 0.18, R2 = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R2 = 0.16, p = .065). 24‐h diastolic BP was associated with higher cIMT in the middle‐aged group (β = 0.24, p < .001, R2 = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle‐aged patients. 24‐h pulse pressure was associated with arterial stiffness, and 24‐h diastolic BP was associated with cIMT only in middle‐aged patients.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmö, Sweden
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14
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Samuelsson H, Viken J, Redfors P, Holmegaard L, Blomstrand C, Jern C, Jood K. Cognitive function is an important determinant of employment amongst young ischaemic stroke survivors with good physical recovery. Eur J Neurol 2021; 28:3692-3701. [PMID: 34242459 DOI: 10.1111/ene.15014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE This cross-sectional cohort study aims at investigating young ischaemic stroke survivors with good physical recovery 7 years post-stroke in order to analyze the relation between late cognitive ability and employment. METHODS Consecutive ischaemic stroke survivors participating in the Sahlgrenska Academy Study on Ischemic Stroke, <55 years of age at stroke onset, and with no or minimal persisting neurological deficits corresponding to a score ≤2 on the National Institutes of Health Stroke Scale at long-term follow-up 7 years post-stroke were included. At this follow-up, the participants were assessed with respect to general cognitive function, processing speed, executive functions, cardiovascular risk factors, self-reported employment, cognitive difficulties, fatigue, depressive symptoms, anxiety and physical function. RESULTS Seven years post-stroke 112/142 (79%) had part-time or full-time work and 30/142 (21%) had full-time disability pension or sick leave. Compared to those with full-time disability pension or sick leave, participants with current employment demonstrated significantly better performance with respect to general cognitive function and processing speed, and significantly lower self-ratings for cognitive difficulties, physical limitations, fatigue and depressed mood. Multivariable logistic regression selected self-rated memory (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.61-4.21), processing speed (OR 3.50, 95% CI 1.67-7.33) and self-rated communication skills (OR 3.46, 95% CI 1.75-6.85) as most important correlates (area under the curve 0.83-0.87) of having current employment. CONCLUSION This study indicates that cognitive dysfunction is an important contributor to long-term work disability amongst young stroke survivors with good physical recovery.
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Affiliation(s)
- Hans Samuelsson
- Department of Psychology, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jo Viken
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lukas Holmegaard
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Broman J, Aarnio K, But A, Marinkovic I, Rodríguez-Pardo J, Kaste M, Tatlisumak T, Putaala J. Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study. J Neurol 2021; 269:956-965. [PMID: 34165628 PMCID: PMC8782780 DOI: 10.1007/s00415-021-10678-4] [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] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Objective Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods Helsinki Young Stroke Registry includes patients aged 15–49 years with first-ever IS, 1994–2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1 year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100 days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48–4.31) and during later follow-up among those with silent infarcts (2.04; 1.27–3.28), prior use of antidepressants (2.09; 1.26–3.46) and moderate versus mild stroke (2.06; 1.18–3.58). The relative difference in the hazard rate for moderate–severe limb paresis persisted both within the first 100 days (3.84, 2.12–6.97) and during later follow-up (4.54; 2.51–8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11–1.97) as well as lower (1.78; 1.25–2.54) and upper white-collar workers (2.00; 1.24–3.23) compared to blue-collar workers. Conclusion One-fourth of young adults started PSADs within 1 year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10678-4.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland.
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ivan Marinkovic
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | | | - Markku Kaste
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
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16
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Evaluating High-Functioning Young Stroke Survivors with Cognitive Complaints. Can J Neurol Sci 2021; 49:368-372. [PMID: 34134793 DOI: 10.1017/cjn.2021.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Montreal Cognitive Assessment (MoCA) is a commonly used cognitive outcome in stroke trials. However, it may be insufficiently sensitive to detect impairment in high-functioning stroke survivors. The National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB), a 30-min comprehensive tablet-based cognitive assessment, may be a better choice to characterize cognitive issues in this cohort. METHODS We compared MoCA and NIHTB-CB performance in young stroke survivors (18-55 years) with excellent functional outcomes (modified Rankin Scale 0-1) reporting subjective cognitive complaints to that of age-matched healthy controls. We recruited 53 stroke survivors and 53 controls. We performed a sensitivity analysis in those participants with normal MoCA scores (≥26). RESULTS Median MoCA scores were not significantly different between stroke survivors (27.0 vs. 28.0) and healthy controls. Mean T scores for NIHTB-CB fluid (44.9 vs. 54.2), crystallized (53.8 vs. 60.0), and total cognition (49.1 vs. 58.4) components were significantly lower in stroke survivors compared to healthy controls (p < 0.001 for all). In participants scoring within normal range (≥26) on the MoCA, NIHTB-CB scores for all components remained significantly lower in stroke survivors. CONCLUSIONS In young stroke survivors with excellent functional outcomes and subjective cognitive complaints, the NIHTB-CB, but not the MoCA, was able to detect differences in cognitive performance between stroke survivors and healthy controls. The NIHTB-CB may be a suitable outcome measure for cognition in clinical trials examining higher-functioning young stroke survivors.
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17
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Liang C, Van Laar Veth AJ, Li Q, Zheng D, Hackett ML. Effect of mood on long-term disability in younger stroke survivors: results from the Psychosocial Outcomes In StrokE (POISE) study. Top Stroke Rehabil 2021; 29:286-294. [PMID: 34018471 DOI: 10.1080/10749357.2021.1922802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background & Purpose: Anxiety and depression are common among stroke survivors, and their effect on long-term outcome remains unknown in those under 65 years of age. We investigated the association between early anxiety/depression after stroke and 12-month disability, and whether this is modified by sex.Methods: The Psychosocial Outcomes In StrokE (POISE) study was a prospective observational cohort study that recruited 441 younger (< 65 years) stroke survivors ≤28 days of acute stroke. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and disability using the World Health Organization Disability Assessment Scale version II (WHODAS-II). Associations between baseline anxiety/depression, and disability at 12-months was tested using analysis of covariance. Subgroup analysis was conducted using interaction term.Results: 92 (25%) had anxiety and 53 (14%) depression at baseline. Multivariable models showed significant association between baseline anxiety and 12-month disability (WHODAS-II score 15.24 vs. 11.49, p < .05). Those with anxiety had more impairment in 'cognition' (WHODAS-II score 18.26 vs. 8.71, p < .001), 'getting along' (WHODAS-II score 11.87 vs. 7.42, p < .05) and 'participation' (WHODAS-II score 22.37 vs. 15.92, p < .005) WHODAS-II. No significant relationship was found between baseline depression and long-term disability. There was no differential effect of anxiety by sex found in this study.Conclusions: Post-stroke anxiety has an adverse effect on disability at one year among young stroke survivors.
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Affiliation(s)
- C Liang
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - A J Van Laar Veth
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Q Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - D Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Translational Australian Clinical Toxicology program, Biomedical Informatics in Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
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18
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Priya DI, Aghoram R, Narayan SK. Neuropsychiatric symptoms among young stroke survivors-frequency, patterns, and associated factors. Neurol Sci 2021; 42:5021-5027. [PMID: 33733388 DOI: 10.1007/s10072-021-05178-2] [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] [Received: 08/28/2020] [Accepted: 03/13/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although neuropsychiatric symptoms are reported in stroke survivors, details of its prevalence and patterns among young stroke subjects are sparse. METHODS In a hospital-based cross-sectional study in India, we recruited 150 young stroke subjects (aged < 45 years) and their caregivers > 3 months from ictus. Neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory-12 (NPI-12) and self-reported depression with the Centre for Epidemiological Studies - Depression (CES-D) scale. Descriptive statistics were used. Multivariate analysis was performed to identify associated factors. All statistical analyses were carried out using STATA ver. 14.2, StataCorp, TX, USA. RESULTS Eighty-four (56%; 95% CI: 47.7-64.1%) had ≥ 1 symptoms on the NPI-12 over median time from stroke of 2 years (IQR 2). Self-reported depression was seen in 71 (47.3%). Post-stroke epilepsy was associated with presence of at least one neuropsychiatric symptom. Dementia was associated with increased odds; and having spouse as principal caregiver with reduced odds, of self-reported depression. Multiple infarcts on imaging were associated with self-reported depression (OR: 3.29; 95%CI: 1.31-8.27) and presence of any neuropsychiatric symptom (OR: 3.55; 95% CI: 1.42-8.88). CONCLUSION Young stroke survivors frequently have neuropsychiatric symptoms with depression being most common. Presence of multiple infarcts on imaging was associated with self-reported depression and presence of any neuropsychiatric symptom.
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Affiliation(s)
- Done Indira Priya
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, D. Nagar, Pondicherry, 605006, India
| | - Rajeswari Aghoram
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, D. Nagar, Pondicherry, 605006, India.
| | - Sunil K Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, D. Nagar, Pondicherry, 605006, India
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Abstract
PURPOSE OF REVIEW This article reviews current knowledge on epidemiology, risk factors and causes, diagnostic considerations, management, and prognosis of ischemic stroke in young adults (those 55 years old and younger). RECENT FINDINGS The incidence of ischemic stroke in young adults has been increasing since the 1980s, which has occurred in parallel with increasing prevalence of vascular risk factors and substance abuse among the younger population. Young adults have a considerably wider range of risk factors than older patients, including age-specific factors such as pregnancy/puerperium and oral contraceptive use. Behavioral risk factors such as low physical activity, excess alcohol consumption, and smoking are factors as well. More than 150 identified causes of early-onset ischemic stroke exist, including rare monogenic disorders. Several recent advances have been made in diagnosis and management of stroke in young adults, including molecular characterization of monogenic vasculitis due to deficiency of adenosine deaminase 2 and transcatheter closure of patent foramen ovale for secondary prevention. Compared with the background population of the same age and sex, long-term mortality in patients remains fourfold higher with cardiovascular causes underlying most of the deaths. The cumulative rate of recurrent stroke extends up to 15% at 10 years. Patients with atherosclerosis, high-risk sources of cardioembolism, and small vessel disease underlying their stroke seem to have the worst prognosis regarding survival and recurrent vascular events. Young stroke survivors also often have other adverse outcomes in the long term, including epilepsy, pain, cognitive problems, and depression. SUMMARY Systematic identification of risk factors and causes and the motivation of patients for long-term prevention and lifestyle changes are of utmost importance to improve the prognosis of early-onset ischemic stroke.
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20
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Saeed S, Tadic M, Putaala J. The prevalence and Covariates of Stroke in Khyber Pakhtunkhwa; From a European Perspective. Pak J Med Sci 2020; 37:1-3. [PMID: 33437241 PMCID: PMC7794126 DOI: 10.12669/pjms.37.1.3815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sahrai Saeed
- Sahrai Saeed MD, PhD, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marijana Tadic
- Marijana Tadic MD, PhD, University Hospital "Dr. Dragisa Misovic - Dedinje" Department of Cardiology, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Jukka Putaala
- Jukka Putaala MD, PhD. Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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21
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Yahya T, Jilani MH, Khan SU, Mszar R, Hassan SZ, Blaha MJ, Blankstein R, Virani SS, Johansen MC, Vahidy F, Cainzos-Achirica M, Nasir K. Stroke in young adults: Current trends, opportunities for prevention and pathways forward. Am J Prev Cardiol 2020; 3:100085. [PMID: 34327465 PMCID: PMC8315351 DOI: 10.1016/j.ajpc.2020.100085] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and loss of productivity, all of which have vast personal, social and economic implications. These concerning trends among young adults are likely due to increasing trends in the prevalence of modifiable risk factors amongst this population including hypertension, hyperlipidemia, obesity and diabetes, highlighting the importance of early detection and aggressive prevention strategies in the general population at early ages. In parallel and compounding to the issue, troublesome trends are evident regarding increasing rates of substance abuse among young adults. Higher rates of strokes have been noted particularly among young African Americans, indicating the need for tailored prevention and social efforts targeting this and other vulnerable groups, including the primordial prevention of risk factors in the first place, reducing stroke rates in the presence of prevalent risk factors such as hypertension, and improving outcomes through enhanced healthcare access. In this narrative review we aim to emphasize the importance of stroke in young adults as a growing public health issue and increase awareness among clinicians and the public health sector. For this purpose, we summarize the available data on stroke in young adults and discuss the underlying epidemiology, etiology, risk factors, prognosis and opportunities for timely prevention of stroke specifically at young ages. Furthermore, this review highlights the gaps in knowledge and proposes future directions moving forward.
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Affiliation(s)
- Tamer Yahya
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | | | - Safi U. Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Syed Zawahir Hassan
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Michael J. Blaha
- Ciccarone Center of the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Ron Blankstein
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Salim S. Virani
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | | | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention & Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
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22
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Zhang Q, Liu Y, Jiang M, Liu Y, Gu S, Tong H, Liu H. Temporal Trends in the Risk Factors and Clinical Characteristics of Ischemic Stroke in Young Adults. J Stroke Cerebrovasc Dis 2020; 29:104914. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023] Open
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23
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Aguilera-Pena MP, Cardenas-Cruz AF, Baracaldo I, Garcia-Cifuentes E, Ocampo-Navia MI, Coral EJ. Ischemic stroke in young adults in Bogota, Colombia: a cross-sectional study. Neurol Sci 2020; 42:639-645. [PMID: 32651858 DOI: 10.1007/s10072-020-04584-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND There has been an increase in the incidence of ischemic stroke in young adults. It is believed that it is due to the increase in traditional cardiovascular risk factors. This change has affected the quality of life of young adults. AIMS To describe the most common etiologies and risk factors in patients aged ≤ 50 who had ischemic stroke between 2011 and 2018. METHODOLOGY A cross-sectional study of patients under 50 years who had ischemic stroke between 2011 and 2018 who were evaluated at a comprehensive center in Bogotá, Colombia. We carried out a descriptive analysis of comorbidities, the Trial of Org for Acute Stroke (TOAST), the National Institute of Health Stroke Scale (NIHSS), and the modified Rankin Scale (mRS). RESULTS A total of 152 patients were included, out of which 50.66% were men. The most frequent traditional risk factors were smoking history (19%), history of high blood pressure (18%), presence of cardiovascular disease (17%), and history of migraine (15%). The most common etiological subgroups were those classified as "other determined etiologies" (33.5%) and "undetermined etiology" (33.5%), while the most common etiology was carotid or vertebral artery dissection (23%). CONCLUSION This study demonstrates the need to make a deep evaluation of the past medical history, laboratory tests, and new risk factors in young adults. On the other hand, modifiable cardiovascular risk factors top the list, showing the need to implement health promotion strategies for young adults.
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Affiliation(s)
| | | | - Ivan Baracaldo
- Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Elkin Garcia-Cifuentes
- Pontificia Universidad Javeriana, Bogotá, Colombia.,Instituto de Envejecimiento, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Elza Juliana Coral
- Pontificia Universidad Javeriana, Bogotá, Colombia.,Hospital Universitario San Ignacio, Bogotá, Colombia
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24
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Association of increased arterial stiffness with diastolic dysfunction in ischemic stroke patients: the Norwegian Stroke in the Young Study. J Hypertens 2020; 38:467-473. [DOI: 10.1097/hjh.0000000000002297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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25
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Kapoor A, Scott C, Lanctot KL, Herrmann N, Murray BJ, Thorpe KE, Lien K, Sicard M, Swartz RH. Symptoms of depression and cognitive impairment in young adults after stroke/transient ischemic attack. Psychiatry Res 2019; 279:361-363. [PMID: 31272664 DOI: 10.1016/j.psychres.2019.06.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 01/29/2023]
Abstract
Depression and cognitive complaints are common after stroke; these issues have been studied in older populations, but not in the young. Two hundred and seventy four eligible stroke and TIA patients consented to participate and complete the Center for Epidemiologic Studies Depression Scale, and National Institute of Neurological Disorders and Stroke - Canadian Stroke Network 30-min neuropsychological battery; 57 (21%) were ≤ 50 years of age. Younger patients reported greater symptoms of depression and less executive dysfunction than older patients. This study highlights age differences in post-stroke depression symptoms and cognitive impairment, and emphasizes the need for screening across ages.
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Affiliation(s)
- Arunima Kapoor
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Courtney Scott
- Department of Medicine (Neurology), Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Krista L Lanctot
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michelle Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada.
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26
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Left ventricular myocardial dysfunction in young and middle-aged ischemic stroke patients. J Hypertens 2019; 37:538-545. [DOI: 10.1097/hjh.0000000000001925] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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27
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Bhatt N, Malik AM, Chaturvedi S. Stroke in young adults: Five new things. Neurol Clin Pract 2018; 8:501-506. [PMID: 30588380 PMCID: PMC6294527 DOI: 10.1212/cpj.0000000000000522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/17/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population. RECENT FINDINGS Recent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available. SUMMARY Stroke in young adults is a rapidly growing problem with deep public health implications. There are many areas in this field, which require further research.
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Affiliation(s)
- Nirav Bhatt
- Division of Vascular Neurology (NB, AMM, SC), Department of Neurology, University of Miami Miller School of Medicine, and Miami VA Hospital (SC), FL
| | - Amer M Malik
- Division of Vascular Neurology (NB, AMM, SC), Department of Neurology, University of Miami Miller School of Medicine, and Miami VA Hospital (SC), FL
| | - Seemant Chaturvedi
- Division of Vascular Neurology (NB, AMM, SC), Department of Neurology, University of Miami Miller School of Medicine, and Miami VA Hospital (SC), FL
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28
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Covariables and types of abnormal left ventricular geometry in nonelderly ischemic stroke survivors. J Hypertens 2018; 36:1858-1864. [DOI: 10.1097/hjh.0000000000001772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Oftedal Å, Gerdts E, Waje-Andreassen U, Fromm A, Naess H, Linde A, Saeed S. Prevalence and covariates of uncontrolled hypertension in ischemic stroke survivors: the Norwegian stroke in the young study. Blood Press 2018; 27:173-180. [DOI: 10.1080/08037051.2018.1425827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Åshild Oftedal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anja Linde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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30
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Edwards JD, Kapoor A, Linkewich E, Swartz RH. Return to work after young stroke: A systematic review. Int J Stroke 2017; 13:243-256. [PMID: 29189108 DOI: 10.1177/1747493017743059] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The incidence of stroke in young adults is increasing. While many young survivors are able to achieve a good physical recovery, subtle dysfunction in other domains, such as cognition, often persists, and could affect return to work. However, reported estimates of return to work and factors affecting vocational outcome post-stroke vary greatly. Aims The aims of this systematic review were to determine the frequency of return to work at different time points after stroke and identify predictors of return to work. Summary of review Two electronic databases (Medline and Embase) were systematically searched for articles according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 6473 records were screened, 68 were assessed for eligibility, and 29 met all inclusion criteria (working-age adults with stroke, return to work evaluated as an outcome, follow-up duration reported, and publication within the past 20 years). Return to work increased with time, with median frequency increasing from 41% between 0 and 6 months, 53% at 1 year, 56% at 1.5 years to 66% between 2 and 4 years post-stroke. Greater independence in activities of daily living, fewer neurological deficits, and better cognitive ability were the most common predictors of return to work. Conclusion This review highlights the need to examine return to work in relation to time from stroke and assess cognition in working age and young stroke survivors. The full range of factors affecting return to work has not yet been explored and further evaluations of return to work interventions are warranted.
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Affiliation(s)
- Jodi D Edwards
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,3 Institute for Clinical Evaluative Sciences, Toronto, Canada.,4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Arunima Kapoor
- 5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Elizabeth Linkewich
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
| | - Richard H Swartz
- 1 Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, Canada.,2 Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, Canada.,5 71545 Sunnybrook HSC , Toronto, Canada.,6 University of Toronto, Toronto, Canada
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31
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Abstract
OPINION STATEMENT Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended. A thorough history is performed, including a detailed family history with specific annotations on each family member. A thorough physical examination is necessary including a careful evaluation of the patient's general appearance, noting any joint laxity, and/or abnormalities of the skin, eyes, and heart. Findings across multiple organ systems in the patient and/or their family may indicate a genetic etiology. After an initial head CT rules out hemorrhagic stroke, additional testing should include a brain MRI, neck and cerebral vascular imaging (e.g., CTA for head and neck), transthoracic echocardiogram with a bubble study, telemetry monitoring, basic risk factor blood work (e.g., lipid panel, hemoglobin A1c, TSH, ESR, CRP, RPR, HIV, and toxicology screen), and, when appropriate, sickle screen and pregnancy test. There should be a low threshold to obtain blood cultures or a lumbar puncture. The acute treatment of ischemic stroke in young adult patients does not differ from treatment of older adults, using intravenous alteplase within 4.5 h, assuming no contraindications. In suspected proximal large artery occlusive disease, interventional clot extraction procedures should be employed in patients deemed eligible. Long-term secondary prevention strategies aimed to reduce recurrent stroke risk by targeting and modifying vascular risk factors should be instituted. The mainstay of preventative therapy is aspirin for most etiologies; however, for atrial fibrillation, anticoagulation is recommended. Statin therapy is another pharmacologic intervention recommended in most stroke patients. Other measures employed are blood pressure reduction, smoking cessation, optimal glucose control in diabetic patients, the initiation of a healthy diet and regular exercise, and lastly, substance abuse counseling in appropriate patients.
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Affiliation(s)
- Christopher A Stack
- Department of Neurology, University of Maryland Medical Center, 16 South Eutaw Street Suite 300, Baltimore, MD, 21201, USA
| | - John W Cole
- Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, 12th Floor, Bressler Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
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32
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Putaala J, Martinez-Majander N, Saeed S, Yesilot N, Jäkälä P, Nerg O, Tsivgoulis G, Numminen H, Gordin D, von Sarnowski B, Waje-Andreassen U, Ylikotila P, Roine RO, Zedde M, Huhtakangas J, Fonseca C, Redfors P, de Leeuw FE, Pezzini A, Kõrv J, Schneider S, Tanislav C, Enzinger C, Jatuzis D, Siegerink B, Martínez-Sánchez P, Grau AJ, Palm F, Groop PH, Lanthier S, Ten Cate H, Pussinen P, Paju S, Sinisalo J, Lehto M, Lindgren A, Ferro J, Kittner S, Fazekas F, Gerdts E, Tatlisumak T. Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome (SECRETO): Rationale and design. Eur Stroke J 2017; 2:116-125. [PMID: 31008307 PMCID: PMC6453214 DOI: 10.1177/2396987317703210] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Worldwide, about 1.3 million annual ischaemic strokes (IS) occur in adults aged <50 years. Of these early-onset strokes, up to 50% can be regarded as cryptogenic or associated with conditions with poorly documented causality like patent foramen ovale and coagulopathies. KEY HYPOTHESES/AIMS (1) Investigate transient triggers and clinical/sub-clinical chronic risk factors associated with cryptogenic IS in the young; (2) use cardiac imaging methods exceeding state-of-the-art to reveal novel sources for embolism; (3) search for covert thrombosis and haemostasis abnormalities; (4) discover new disease pathways using next-generation sequencing and RNA gene expression studies; (5) determine patient prognosis by use of phenotypic and genetic data; and (6) adapt systems medicine approach to investigate complex risk-factor interactions. DESIGN Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Etiology, Triggers, and Outcome (SECRETO; NCT01934725) is a prospective multi-centre case-control study enrolling patients aged 18-49 years hospitalised due to first-ever imaging-proven IS of undetermined etiology. Patients are examined according to a standardised protocol and followed up for 10 years. Patients are 1:1 age- and sex-matched to stroke-free controls. Key study elements include centralised reading of echocardiography, electrocardiography, and neurovascular imaging, as well as blood samples for genetic, gene-expression, thrombosis and haemostasis and biomarker analysis. We aim to have 600 patient-control pairs enrolled by the end of 2018. SUMMARY SECRETO is aiming to establish novel mechanisms and prognosis of cryptogenic IS in the young and will provide new directions for therapy development for these patients. First results are anticipated in 2019.
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Affiliation(s)
- Jukka Putaala
- Department of Neurology, Helsinki
University Hospital, Finland
| | | | - Sahrai Saeed
- Department of Clinical Science,
University of Bergen, Norway
| | - Nilufer Yesilot
- Department of Neurology, Istanbul
Faculty of Medicine, Istanbul University, Turkey
| | - Pekka Jäkälä
- Neuro Center, Kuopio University
Hospital, Finland
| | - Ossi Nerg
- Neuro Center, Kuopio University
Hospital, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, National
and Kapodistrian University of Athens, Attikon University Hospital, Greece
| | - Heikki Numminen
- Department of Neuroscience and
Rehabilitation, Tampere University Hospital, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics,
Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki,
Finland
| | | | | | - Pauli Ylikotila
- Division of Clinical Neurosciences,
Turku University Hospital, University of Turku, Finland
| | - Risto O Roine
- Division of Clinical Neurosciences,
Turku University Hospital, University of Turku, Finland
| | | | | | - Catarina Fonseca
- Department of Neurosciences
(Neurology), Hospital de Santa Maria, University of Lisbon, Portugal
| | - Petra Redfors
- Department of Clinical Neuroscience,
Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of
Gothenburg, Sweden
- Department of Neurology, Sahlgrenska
University Hospital, Sweden
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders
Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud
University Medical Center, The Netherlands
| | - Alessandro Pezzini
- Department of Clinical and
Experimental Sciences, Neurology Clinic, University of Brescia, Italy
| | - Janika Kõrv
- Department of Neurology and
Neurosurgery, University of Tartu, Estonia
| | | | | | - Christian Enzinger
- Division of Neuroradiology, Vascular
and Interventional Radiology, Medical University of Graz, Austria
| | - Dalius Jatuzis
- Department of Neurology and
Neurosurgery, Center for Neurology, Vilnius University, Lithuania
| | - Bob Siegerink
- Centre for Stroke Research Berlin,
Charité Universitätsmedizin Berlin, Germany
| | - Patricia Martínez-Sánchez
- Department of Neurology and Stroke
Centre, IdiPAZ Health Research Institute, La Paz University Hospital, Autonoma of
Madrid University, Spain
| | - Armin J Grau
- Department of Neurology, Klinikum
Ludwigshafen, Germany
| | | | - Per-Henrik Groop
- Folkhälsan Institute of Genetics,
Folkhälsan Research Center, Biomedicum Helsinki, University of Helsinki,
Finland
| | - Sylvain Lanthier
- Division of Neurology and Research
Centre, Centre Hospitalier de l'Université de Montréal (CHUM), Canada
| | - Hugo Ten Cate
- Department of Internal Medicine,
Cardiovascular Research Institute Maastricht, The Netherlands
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Finland
| | - Susanna Paju
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and
Lung Center, Helsinki University Hospital, Finland
| | - Mika Lehto
- Department of Cardiology, Heart and
Lung Center, Helsinki University Hospital, Finland
| | - Arne Lindgren
- Department of Clinical Sciences Lund,
Neurology, Lund University, Sweden
- Department of Neurology and
Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - José Ferro
- Department of Neurosciences
(Neurology), Hospital de Santa Maria, University of Lisbon, Portugal
| | - Steven Kittner
- Department of Neurology, Baltimore
Veterans Administration Hospital, USA
- University of Maryland, USA
| | - Franz Fazekas
- Department of Neurology, Medical
University of Graz, Austria
| | - Eva Gerdts
- Department of Clinical Science,
University of Bergen, Norway
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki
University Hospital, Finland
- Department of Clinical Neuroscience,
Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of
Gothenburg, Sweden
- Department of Neurology, Sahlgrenska
University Hospital, Sweden
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van der Kemp J, Kruithof WJ, Nijboer TCW, van Bennekom CAM, van Heugten C, Visser-Meily JMA. Return to work after mild-to-moderate stroke: work satisfaction and predictive factors. Neuropsychol Rehabil 2017; 29:638-653. [DOI: 10.1080/09602011.2017.1313746] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Jet van der Kemp
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Willeke J. Kruithof
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Tanja C. W. Nijboer
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, the Netherlands
| | - Coen A. M. van Bennekom
- Department of Research and Development, Heliomare Rehabilitation Centre, Wijk aan Zee, the Netherlands
- Coronel Institute of Occupational Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, the Netherlands
| | - Johanna M. A. Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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34
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Pirinen J, Putaala J, Aarnio K, Aro AL, Mustanoja S, Sinisalo J, Kaste M, Haapaniemi E, Tatlisumak T, Lehto M. Twelve-lead electrocardiogram and mortality in young adults after ischaemic stroke. Eur Stroke J 2017; 2:77-86. [PMID: 31008304 DOI: 10.1177/2396987316684706] [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: 09/22/2016] [Accepted: 11/27/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Ischaemic stroke at young age carries an increased risk for mortality in comparison to the general population, but factors associated with mortality have been poorly studied. We studied the role of electrocardiogram in mortality risk stratification in young stroke patients. Patients and methods The Helsinki Young Stroke Registry encompasses 1008 patients aged <50 years with ischaemic stroke. We included 690 patients for this electrocardiogram substudy. Our endpoints were all-cause and cardiovascular mortality. Cox regression models - adjusted for clinical and demographic characteristics - were used to identify the electrocardiogram parameters associated with these endpoints. Results At a mean follow-up of 8.8 years, cumulative all-cause and cardiovascular mortality were 16.1 and 9.1%, respectively. Factors associated with both endpoints included diabetes (type 1 for all-cause, type 2 for cardiovascular mortality), heavy drinking, malignancy, as well as stroke severity and aetiology. Of the electrocardiogram parameters, higher heart rate (hazard ratio 1.35 per 10/min, 95% confidence interval 1.21-1.49), a shorter P-wave (hazard ratio 0.78 per 10 ms decrement, 0.64-0.92) and longer QTc interval (1.09 per 10 ms, 1.03-1.16) were associated with increased all-cause mortality. Only a higher heart rate (1.42 per 10/min, 1.24-1.60) was associated with death from cardiovascular causes. Conclusions A higher heart rate during the subacute phase after stroke is associated with an elevated risk of all-cause and cardiovascular mortality in young adults. A longer QTc interval is associated only with higher all-cause mortality. P-wave characteristics and their possible association with mortality need further studies.
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Affiliation(s)
- Jani Pirinen
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Aarnio
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Aapo L Aro
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Satu Mustanoja
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Kaste
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Elena Haapaniemi
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Clinical Neurosciences, Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mika Lehto
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Li CJZ, Du XX, Yang K, Song LP, Li PK, Wang Q, Sun R, Lin XL, Lu HY, Zhang T. Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients. Neural Regen Res 2017; 11:1766-1772. [PMID: 28123417 PMCID: PMC5204229 DOI: 10.4103/1673-5374.194746] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke (59.6%) was the primary stroke type found in the young group, while ischemic stroke (60.0%) was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction (such as friendship) improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.
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Affiliation(s)
- Chao-Jin-Zi Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiao-Xia Du
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Kun Yang
- Department of Neurology, Xi'an Gaoxin Hospital, Xi'an, Shaanxi Province, China
| | - Lu-Ping Song
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Peng-Kun Li
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Room of Medical Records, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Qiang Wang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Rong Sun
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Xiao-Ling Lin
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Hong-Yu Lu
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Tong Zhang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China; Department of Neurological Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
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36
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Markostamou I, Ioannidis A, Dandi E, Mandyla MA, Nousiopoulou E, Simeonidou C, Spandou E, Tata DA. Maternal separation prior to neonatal hypoxia-ischemia: Impact on emotional aspects of behavior and markers of synaptic plasticity in hippocampus. Int J Dev Neurosci 2016; 52:1-12. [PMID: 27165447 DOI: 10.1016/j.ijdevneu.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 12/20/2022] Open
Abstract
Exposure to early-life stress is associated with long-term alterations in brain and behavior, and may aggravate the outcome of neurological insults. This study aimed at investigating the possible interaction between maternal separation, a model of early stress, and subsequent neonatal hypoxia-ischemia on emotional behavior and markers of synaptic plasticity in hippocampus. Therefore, rat pups (N=60) were maternally separated for a prolonged (MS 180min) or a brief (MS 15min) period during the first six postnatal days, while a control group was left undisturbed. Hypoxia-ischemia was applied to a subgroup of each rearing condition on postnatal day 7. Emotional behavior was examined at three months of age and included assessments of anxiety (elevated plus maze), depression-like behavior (forced swimming) and spontaneous exploration (open field). Synaptic plasticity was evaluated based on BDNF and synaptophysin expression in CA3 and dentate gyrus hippocampal regions. We found that neonatal hypoxia-ischemia caused increased levels of anxiety, depression-like behavior and locomotor activity (ambulation). Higher anxiety levels were also seen in maternally separated rats (MS180min) compared to non-maternally separated rats, but prolonged maternal separation prior to HI did not potentiate the HI-associated effect. No differences among the three rearing conditions were found regarding depression-like behavior or ambulation. Immunohistochemical evaluation of synaptophysin revealed that both prolonged maternal separation (MS180min) and neonatal hypoxia-ischemia significantly reduced its expression in the CA3 and dentate gyrus. Decreases in synaptophysin expression in these areas were not exacerbated in rats that were maternally separated for a prolonged period prior to HI. Regarding BDNF expression, we found a significant decrease in immunoreactivity only in the hypoxic-ischemic rats that were subjected to the prolonged maternal separation paradigm. The above findings suggest that early-life stress prior to neonatal hypoxia-ischemia leads to significant alterations in synaptic plasticity of the dorsal hippocampus during adulthood, but does not exacerbate HI-related changes in emotional behavior.
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Affiliation(s)
- Ioanna Markostamou
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anestis Ioannidis
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evgenia Dandi
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria-Aikaterini Mandyla
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Nousiopoulou
- Laboratory of Experimental Neurology & Neuroimmunology, B' Department of Neurology, AHEPA University Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantina Simeonidou
- Laboratory of Experimental Physiology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Spandou
- Laboratory of Experimental Physiology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Despina A Tata
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Maaijwee NAMM, Tendolkar I, Rutten-Jacobs LCA, Arntz RM, Schaapsmeerders P, Dorresteijn LD, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Long-term depressive symptoms and anxiety after transient ischaemic attack or ischaemic stroke in young adults. Eur J Neurol 2016; 23:1262-8. [PMID: 27094933 DOI: 10.1111/ene.13009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Few studies exist on long-term post-stroke depressive symptoms and anxiety in young adults, although these young patients have a particular interest in their long-term prognosis, given their usually long life expectancy and being in the midst of an active social, working and family life. The aims of this study were to investigate the prevalence of depressive symptoms and anxiety and their association with clinical and demographic variables and with functional outcome after stroke in young adults. METHODS AND RESULTS Long-term prevalence of depressive symptoms and anxiety was calculated in 511 patients with a transient ischaemic attack or ischaemic stroke, aged 18-50 years, using the Hospital Anxiety and Depression scale, compared with 147 controls. Functional outcome was assessed with the modified Rankin Score (mRS) and the Instrumental Activities of Daily Living scale (IADL). 16.8% of patients had depressive symptoms and 23.0% had anxiety, versus 6.1% (P = 0.001) and 12.2% (P < 0.001) in controls. In ischaemic stroke patients, depressive symptoms and anxiety were associated with poor functional outcome (mRS > 2 or IADL < 8). CONCLUSION Even a decade after stroke at young age, depressive symptoms and anxiety were prevalent and associated with poor functional outcome. Therefore, even in the long term, treating physicians should be aware of the long-term presence of these symptoms as their recognition may be the first step in improving long-term functional independence.
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Affiliation(s)
- N A M M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - R M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L D Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - H C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - F-E de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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38
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Atherosclerosis in Trial of Org 10172 in Acute Stroke Treatment Subtypes among Young and Middle-Aged Stroke Patients: The Norwegian Stroke in the Young Study. J Stroke Cerebrovasc Dis 2016; 25:825-30. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/09/2015] [Accepted: 12/14/2015] [Indexed: 01/10/2023] Open
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39
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Calvet D. Infarctus cérébral du sujet jeune. Rev Med Interne 2016; 37:19-24. [DOI: 10.1016/j.revmed.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/16/2022]
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40
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Koivunen RJ, Harno H, Tatlisumak T, Putaala J. Depression, anxiety, and cognitive functioning after intracerebral hemorrhage. Acta Neurol Scand 2015; 132:179-84. [PMID: 25639837 DOI: 10.1111/ane.12367] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Post-stroke depression (PSD) is an important complication of stroke. We studied long-term PSD after intracerebral hemorrhage (ICH) at young age, as well as anxiety, and cognitive functioning of the survivors. METHODS We gathered clinical and imaging data of 336 young ICH patients between age 16 and 49 treated in the Helsinki University Central Hospital. After a median follow-up of 9.7 (7.0-12.0) years, we interviewed 130 survivors with structural questionnaires including Beck Depression Inventory II (BDI-II), Hospital Anxiety and Depression Scale (HADS), Pain Anxiety Symptoms Scale (PASS), Brief Pain Inventory (BPI), and Montreal Cognitive Assessment (MoCA). Univariate and multivariate analysis was performed to identify factors associated with PSD (BDI-II score >13). Degree of disability was measured by modified Rankin Scale score (mRS). RESULTS PSD was present among 30 (23.1%) and anxiety among 52 (40.0%) patients (HADS score >6). Higher degree of disability was associated with symptoms of depression (higher BDI-II scores, P = 0.001), emotional distress (higher HADS scores, P = 0.004), and pain (higher PASS scores, P = 0.008, and higher BPI scores, P = 0.003). The only baseline factor identified to associate with PSD was hydrocephalus (P = 0.014). Median PASS score was 9 (IQR 0-25), median BPI score was 5 (0-23), and median MoCA score was 26 (22-28) hinting to normal or mild cognitive dysfunction. Antidepressants were used by 9.2%. CONCLUSIONS One of four survivors of ICH at young age suffers long-term PSD. Higher degree of disability predicted occurrence of PSD. Treatment of depression appears as an unmet need in young ICH survivors.
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Affiliation(s)
- R.-J. Koivunen
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - H. Harno
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - T. Tatlisumak
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - J. Putaala
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
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41
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Synhaeve NE, Schaapsmeerders P, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, Dorresteijn LD, de Kort PL, van Dijk EJ, Kessels RP, de Leeuw FE. Cognitive performance and poor long-term functional outcome after young stroke. Neurology 2015; 85:776-82. [DOI: 10.1212/wnl.0000000000001882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/04/2015] [Indexed: 01/24/2023] Open
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42
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Donker-Cools BHPM, Wind H, Frings-Dresen MHW. Prognostic factors of return to work after traumatic or non-traumatic acquired brain injury. Disabil Rehabil 2015; 38:733-741. [PMID: 26138021 DOI: 10.3109/09638288.2015.1061608] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate and to determine evidence of prognostic factors for return to work (RTW) after acquired brain injury (ABI). METHOD A systematic literature search was conducted in PubMed (2008-2014), applying terms for ABI and RTW. In addition, studies published after 2003 of a previous review on the same topic were added. The methodological quality of the included studies was assessed and evidence was classified. RESULTS Twenty-seven studies were included. There is strong evidence that a high education level is positively associated with RTW after traumatic ABI; a low education level, unemployment and length of stay in rehabilitation are negatively associated, and a clear tendency has been deduced from the studies that conscious state in the Emergency Department is not associated with RTW. After non-traumatic ABI, there is strong evidence that independence in activities of daily living is positively associated with RTW and aetiology of stroke is not. CONCLUSIONS This study confirms earlier findings that after both traumatic and non-traumatic ABI injury related factors in the Emergency Department are not associated with RTW. In addition, it provides further evidence that personal factors after traumatic ABI and activity-related factors after non-traumatic ABI are strongly associated with RTW. Implications for Rehabilitation We found strong evidence for a significant association between RTW and personal factors (education level, unemployment) after traumatic ABI, and activities of daily living (ADL) after non-traumatic ABI. We advise to focus on work-related activities during the RTW process besides ADL-training and pay attention to and support patients at risk for not returning to work.
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Affiliation(s)
- Birgit H P M Donker-Cools
- a Academic Medical Center, Coronel Institute of Occupational Health, University of Amsterdam , Amsterdam , The Netherlands and.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
| | - Haije Wind
- a Academic Medical Center, Coronel Institute of Occupational Health, University of Amsterdam , Amsterdam , The Netherlands and.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
| | - Monique H W Frings-Dresen
- a Academic Medical Center, Coronel Institute of Occupational Health, University of Amsterdam , Amsterdam , The Netherlands and.,b Research Center for Insurance Medicine , Amsterdam , The Netherlands
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43
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Goeggel Simonetti B, Mono ML, Huynh-Do U, Michel P, Odier C, Sztajzel R, Lyrer P, Engelter ST, Bonati L, Gensicke H, Traenka C, Tettenborn B, Weder B, Fischer U, Galimanis A, Jung S, Luedi R, De Marchis GM, Weck A, Cereda CW, Baumgartner R, Bassetti CL, Mattle HP, Nedeltchev K, Arnold M. Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS). J Neurol 2015; 262:2025-32. [PMID: 26067218 DOI: 10.1007/s00415-015-7805-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60% men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73%. Stroke aetiology was mostly cardioembolism (32%) and of other defined origin (24%), including cervicocerebral artery dissection (17%). Fabry disease was diagnosed in 2 patients (0.3%). Aetiology remained unknown in 20%. Outcome at 3 months was favourable (mRS 0-1) in 61% and fatal in 2.9%. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7%. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.
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Affiliation(s)
- Barbara Goeggel Simonetti
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
| | - Marie-Luise Mono
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Uyen Huynh-Do
- Department of Nephrology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Patrik Michel
- Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Celine Odier
- Neurology Service, Centre Hospitalier Universitaire Vaudois, Lausanne University, Lausanne, Switzerland
| | - Roman Sztajzel
- Department of Neurology, University Hospital Geneva, Geneva, Switzerland
| | - Philippe Lyrer
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Stefan T Engelter
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Leo Bonati
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Henrik Gensicke
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | | | - Barbara Tettenborn
- Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Bruno Weder
- Department of Neurology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Aekaterini Galimanis
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Rudolf Luedi
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Gian Marco De Marchis
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Anja Weck
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Carlo W Cereda
- Department of Neurology, Neurocenter (EOC) of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | | | - Claudio L Bassetti
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
| | - Krassen Nedeltchev
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.,Department of Neurology, Cantonal Hospital Aargau, Aarau, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital, University of Bern, Freiburgstrasse 10, 3010, Bern, Switzerland.
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Waje-Andreassen U, Naess H, Thomassen L, Maroy TH, Mazengia KY, Eide GE, Vedeler CA. Biomarkers Related to Carotid Intima-Media Thickness and Plaques in Long-Term Survivors of Ischemic Stroke. Transl Stroke Res 2015; 6:276-83. [PMID: 25948070 PMCID: PMC4485696 DOI: 10.1007/s12975-015-0403-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/28/2015] [Accepted: 04/28/2015] [Indexed: 12/31/2022]
Abstract
Lifestyle risk factors, inflammation and genetics play a role in the development of atherosclerosis. We therefore studied Fc gamma receptor (FcγR) polymorphisms, interleukin (IL)-10 polymorphisms and other biomarkers related to carotid intima-media thickness (cIMT) in patients with ischemic stroke at a young age. Patients were evaluated 12 years after stroke occurrence. Patients (n = 232) 49 years of age or younger with an index stroke between 1988 and 1997 were retrospectively selected. Blood samples were taken at a first follow-up 6 years after the stroke. At a second follow-up, additional arterial events were registered for 140 patients, new blood samples were taken, and measurements of cIMT and blood pressure (BP) were performed. Unadjusted logistic regression analysis showed that cIMT ≥1 mm was associated with age, male gender, additional arterial events, BP, cholesterol, sedimentation rate, haemoglobin, triglycerides, creatinine, glycolysed haemoglobin (HbA1c) and FcγRIIIB-NaII/NaII. Adjusted backward stepwise logistic regression showed significance for age (odds ratio (OR) 1.13, 95 % confidence interval (CI) 1.04 to1.23, p = 0.003), male gender (OR 4.07, 95 % CI 1.15 to 14.5, p = 0.030), HbA1c (OR 6.65, 95 % CI 1.21 to 36.5, p = 0.029) and FcγRIIIB-NaII/NaII (OR 3.94, 95 % CI 1.08 to 14.3, p = 0.037). In this long-term follow-up study of patients with ischemic stroke at a young age, FcγRIIIB-NaII/NaII was identified as a possible contributing factor for cIMT ≥1 mm together with known risk factors, such as age, male gender, systolic BP, additional arterial events and HbA1c.
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Affiliation(s)
- Ulrike Waje-Andreassen
- Department of Neurology, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway,
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Early vascular aging in young and middle-aged ischemic stroke patients: the Norwegian Stroke in the Young Study. PLoS One 2014; 9:e112814. [PMID: 25405619 PMCID: PMC4236076 DOI: 10.1371/journal.pone.0112814] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/15/2014] [Indexed: 12/21/2022] Open
Abstract
Background Ischemic stroke survivors have high risk of cardiovascular morbidity and mortality even at young age, suggesting that early arterial aging is common among such patients. Methods We measured aortic stiffness by carotid-femoral pulse wave velocity (PWV) in 205 patients (69% men) aged 15–60 years with acute ischemic stroke in the prospective Norwegian Stroke in the Young Study. High for age carotid-femoral PWV was identified in the reference normogram. Results Patients were on average 49±10 years old, 34% had a history of hypertension and 37% had metabolic syndrome (MetS). In the total study population, higher PWV was associated with history of hypertension (β = 0.18), higher age (β = 0.34), systolic blood pressure (BP) (β = 0.28) and serum creatinine (β = 0.18) and lower high-density lipoprotein (HDL) cholesterol (β = –0.10, all p<0.01) in multivariate linear regression analysis (multiple R2 = 0.42, p<0.001). High for age PWV was found in 18% of patients. In univariate analyses, known hypertension was associated with a 6-fold, MetS with a 4-fold and presence of carotid plaque with a 3.7-fold higher risk for high for age PWV (all p<0.01). In multiple logistic regression analysis higher systolic BP (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.02–1.06; p<0.01), history of hypertension (OR 3.59; 95% CI 1.52–8.51; p<0.01), low HDL cholesterol (OR 3.03; 95% CI 1.00–9.09; p = 0.05) and higher serum creatinine (OR 1.04; 95% CI 1.01–1.06; p<0.01) were associated with high for age PWV. Conclusions Higher PWV is common in younger and middle-aged ischemic stroke patients and associated with a clustering of classical cardiovascular risk factors. ClinicalTrials.gov NCT01597453
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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Aarnio K, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, Putaala J. Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults. Stroke 2014; 45:2670-6. [DOI: 10.1161/strokeaha.114.005648] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Karoliina Aarnio
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Elena Haapaniemi
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Susanna Melkas
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Kaste
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Naess H, Gjerde G, Waje-Andreassen U. Ischemic stroke in patients older and younger than 80 years. Acta Neurol Scand 2014; 129:399-404. [PMID: 24256324 DOI: 10.1111/ane.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare short-term outcome and long-term mortality in old and younger patients with ischemic stroke. We hypothesized that short-term outcomes in patients≥80 and <80 years with no neurological worsening are similar. METHODS The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Short-term outcome was determined by the NIHSS score 7 days after stroke onset. Neurological worsening was defined as NIHSS score worsening >3 points. Risk factors, prior diseases, complications, and long-term mortality were registered. RESULTS The study includes 592 patients≥80 years and 1275 patients<80 years. High NIHSS score on admission and day 7, neurological worsening, and complications were significantly more frequent among patients≥80 years. In patients with no neurological worsening, improvement in NIHSS score on day 7 was not associated with age≥80 years (P=0.75). Long-term mortality was associated with the number of risk factors in both age groups (P<0.05). CONCLUSION Avoiding neurological worsening may have a large potential for reducing the difference in short-term outcome between old and young stroke patients by preventing treatable complications including pneumonia. Risk factor burden is important for long-term survival in both stroke patients≥80 years and <80 years.
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Affiliation(s)
- H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - G. Gjerde
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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Jönsson AC, Delavaran H, Iwarsson S, Ståhl A, Norrving B, Lindgren A. Functional Status and Patient-Reported Outcome 10 Years After Stroke. Stroke 2014; 45:1784-90. [DOI: 10.1161/strokeaha.114.005164] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ann-Cathrin Jönsson
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Hossein Delavaran
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Susanne Iwarsson
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Agneta Ståhl
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Bo Norrving
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
| | - Arne Lindgren
- From the Department of Health Sciences (A.-C.J., S.I.), Department of Clinical Sciences, Lund, Neurology (H.D., B.N., A.L.), and Department of Technology and Society (A.S.), Lund University, Lund, Sweden; and Department of Neurology, Skåne University Hospital, Lund, Sweden (H.D., B.N., A.L.)
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Maaijwee NAMM, Rutten-Jacobs LCA, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10:315-25. [PMID: 24776923 DOI: 10.1038/nrneurol.2014.72] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Contrary to trends in most other diseases, the average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among 'young' individuals (under 50 years of age). This Review provides a critical overview of the risk factors and aetiology of young ischaemic stroke and addresses its long-term prognosis, including cardiovascular risk, functional outcome and psychosocial consequences. We highlight the diminishing role of 'rare' risk factors in the pathophysiology of young stroke in light of the rising prevalence of 'traditional' vascular risk factors in younger age groups. Long-term prognosis is of particular interest to young patients, because of their long life expectancy and major responsibilities during a demanding phase of life. The prognosis of young stroke is not as favourable as previously thought, with respect either to mortality or cardiovascular disease or to psychosocial consequences. Therefore, secondary stroke prevention is probably a life-long endeavour in most young stroke survivors. Due to under-representation of young patients in past trials, new randomized trials focusing on this age group are needed to confirm the benefits of long-term secondary preventive medication. The high prevalence of poor functional outcome and psychosocial problems warrants further study to optimize treatment and rehabilitation for these young patients.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Loes C A Rutten-Jacobs
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
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