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Robledo-Resina IDM, Romero-Morales C, Martín-Casas P, Villafañe JH, Abuín-Porras V. Relationship between Female Sexual Dysfunction and Trunk Stability Post-Stroke: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:324. [PMID: 38399611 PMCID: PMC10890688 DOI: 10.3390/medicina60020324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Stroke can lead to a variety of consequences, the severity and nature of which are contingent upon the affected brain region or lesion type. These consequences manifest with distinct clinical presentations and recovery trajectories. This study aims to investigate the potential correlation between feminine sexual dysfunction and trunk stability among stroke survivors. Materials and Methods: Thirty-eight women (stroke group n = 19 and control group n = 19) were recruited. A cross-sectional observational study was designed. Outcome measures were recorded using the Feminine Sexual Function Index, the National Institute of Health Stroke Score, the Newcastle Stroke-specific Quality of Life Measure Beck Depression Index, the Barthel Index, the Urge-urinary Distress Inventory, and the Trunk Impairment Scale. Spearman's correlation was tested between different factors influencing feminine sexual dysfunction and trunk stability. Results: Statistically significant differences were found in sexual function between the stroke group versus the control group (Z = 88; p = 0.007; rb = 0.51). The correlation showed a relationship between feminine sexual dysfunction and trunk stability (p < 0.05). A relationship between quality of life and sexual dysfunction was also found (p < 0.05). There were no statistically significant results for the association between dependency, severity of stroke, time after stroke type of stroke, and sexual dysfunction (p = 0.378). Conclusions: The results of this study support the existence of a correlation between feminine sexual dysfunction and trunk stability, probably due to trunk and pelvic floor muscle synergy. Multidisciplinary teams assessing sexual dysfunction after stroke should include a physical therapist to assess the physical components that may interfere with feminine sexual health post-stroke.
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Affiliation(s)
- Irene del Mar Robledo-Resina
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (I.d.M.R.-R.); (C.R.-M.)
| | - Carlos Romero-Morales
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (I.d.M.R.-R.); (C.R.-M.)
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (I.d.M.R.-R.); (C.R.-M.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Vanesa Abuín-Porras
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain; (I.d.M.R.-R.); (C.R.-M.)
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Tripathi M, Wankhade L, Mohindra S, Kumar S, Chauhan R. Sexual Dysfunction after Clipping of Ruptured Intracranial Aneurysms. Neurol India 2024; 72:110-116. [PMID: 38443011 DOI: 10.4103/neuroindia.ni_1917_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/25/2021] [Indexed: 03/07/2024]
Abstract
BACKGROUND Sexual dysfunction significantly affects interpersonal relationships and overall quality of life. It remains a matter of concern for risk assessment and counseling in patients with ruptured intracranial aneurysms. OBJECTIVE To assess the sexual dysfunctions in patients undergoing clipping for ruptured intracranial aneurysms and comparative evaluation among different anterior circulation aneurysms. METHOD We prospectively included 40 male patients of ruptured intracranial aneurysms of anterior circulation (age range: 20-60 years; sexually active preoperatively), managed with craniotomy and clipping. We evaluated the sexual outcome in patients with excellent Glasgow outcome score (GOS) five at a minimum one year of follow-up. Patients with GOS-5 status at follow-up were broadly classified into two groups: Anterior communicating artery aneurysm (Acom), and non-Acom) aneurysms. We valued sexual outcome with Subjective Sexual Arousal Scale for Men at follow-up, and compared in the two groups. RESULTS Mean age of patients was 44.78 ± 9.51 years. Besides 20 Acom aneurysms, other groups included 11 middle cerebral artery aneurysms, five internal carotid artery aneurysms, three posterior communicating artery aneurysms, and one distal anterior cerebral artery aneurysm. The mean follow-up was 24.45 ± 13.58 months. Patients with non-Acom aneurysms had an overall better outcome in the sexual performance domain "P = 0.015," mental satisfaction domain "P = 0.009," and sexual assertiveness domain "P = 0.007." However, there was no statistical difference in partner communication domain "P = 0.593," and partner relationship domain "P = 0.378." Overall, the sexual outcome was inferior in patients treated for Acom aneurysms compared to other anterior circulation aneurysms. CONCLUSIONS In cases of aneurysmal subarachnoid hemorrhage, sexual dysfunctions are common even after good clinical outcomes. The study revealed prominent differences in outcomes on the sexual quality of life in patients harboring Acom aneurysms as compared to anterior circulation aneurysms located off-midline.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- National Institute of Health Research (NIHR) Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Lomesh Wankhade
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajeev Chauhan
- Department of Anesthesiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Contrada M, Cerasa A, Pucci C, Ciancarelli I, Pioggia G, Tonin P, Calabrò RS. Talking about Sexuality in Stroke Individuals: The New Era of Sexual Rehabilitation. J Clin Med 2023; 12:3988. [PMID: 37373681 PMCID: PMC10299413 DOI: 10.3390/jcm12123988] [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: 02/27/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
One of the largest causes of mortality and disability worldwide is stroke. In the last twenty years significant objectives have been achieved in the early and chronic treatment of motor and cognitive dysfunctions, increasing the quality of life in patients and their caregivers. However, there is an unresolved clinical issue that remains: sexual dysfunctions. Multiple etiologies, including organic (such as lesion localization, premorbid medical problems, and drugs) and psychosocial (such as fear of recurrences, loss of self-esteem, role shifts, anxiety, and depression), are associated with sexual deficits. In this perspective review, we reported the last piece of evidence about this crucial topic which drastically affects the quality of life of these patients. Indeed, although patients may often not disclose their sexual concerns, literature demonstrates that they seek help concerning this issue. On the other side, clinicians working in the rehabilitation field are not always comfortable or prepared to deal with sexuality and sexual function in neurological patients. A new phase of the training course should be launched including different physicians, nurses, rehabilitation specialists, and social workers, to learn how to deal with topics related to sexuality. As a result, professional sexual counselors should now become a structured part of stroke settings and rehabilitation with new effective tools (i.e., PLISSIT model; TDF program) for improving quality of life.
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Affiliation(s)
| | - Antonio Cerasa
- S. Anna Institute, Via Siris 11, 88900 Crotone, Italy
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
| | - Paolo Tonin
- S. Anna Institute, Via Siris 11, 88900 Crotone, Italy
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Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21:4. [PMID: 36653785 PMCID: PMC9850784 DOI: 10.1186/s12955-023-02090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults. METHODS Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included. RESULTS A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work. CONCLUSION Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).
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Affiliation(s)
- Elena Gurková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Lenka Štureková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Petra Mandysová
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Daniel Šaňák
- grid.10979.360000 0001 1245 3953Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
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Sapuppo D, Bernhardt J, Carvalho LB, Churilov L, Thijs V. Self-evaluation of personal needs by community-living young stroke survivors using an online English language questionnaire. Disabil Rehabil 2022; 45:1830-1835. [PMID: 35617487 DOI: 10.1080/09638288.2022.2076935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Identifying personal needs of young stroke survivors is crucial for their recovery. PURPOSE Identify factors, burden, and significance of unmet needs of young community-living stroke survivors. MATERIALS AND METHODS We used online advertising and word-of-mouth snowballing to recruit participants for an English language online questionnaire constructed for this purpose. Eligible participants aged 18-55 at time of stroke. Needs were classified into seven domains: Healthcare Experience, Impairments from Stroke, Everyday Activities, Work/Study, Finances, Relationships, and Social Participation. Random-effects logistic regression was used to determine the probability of unmet needs and X2 test to determine significance of distribution across domains. RESULTS Out of 137 responses recorded: 32 did not meet inclusion criteria, 29 duplicates identified were discarded, and 76 eligible participants were analysed. Respondents were median 37 (IQR 32-47) years at time of stroke, and median 3 (1-5) years since stroke. Fifty-eight (76%) females. Modified Rankin Scale median score of 1 (1-3). Of 48 identified potential needs, 25 (IQR 19-30) were rated unmet. Twenty (IQR 15-25) considered of high significance. Unmet needs most frequently occurred in the domains: Impairments from Stroke, Finances, and Social Participation. CONCLUSIONS There is high burden of unmet needs in community-living young stroke survivors which are spread disproportionately across the identified domains.IMPLICATIONS FOR REHABILITATIONIdentifying personal needs of young stroke survivors is crucial for their recovery.Impairments after Stroke, Finances, and Social Participation were often selected as being high burden unmet needs for community-living young people after stroke.Employing a post-stroke checklist to guide exploration of needs in young stroke may better capture which needs are unmet.
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Affiliation(s)
- David Sapuppo
- Neurology Department, Austin Health, Melbourne, Australia
| | - Julie Bernhardt
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Lilian B Carvalho
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Leonid Churilov
- Department of Medicine (Austin Health) and Melbourne Brain Centre at Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Australia
| | - Vincent Thijs
- Neurology Department, Austin Health, Melbourne, Australia.,Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
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Zhao S, Wu W, Wu P, Ding C, Xiao B, Xu Z, Hu Y, Shen M, Feng L. Significant Increase of Erectile Dysfunction in Men With Post-stroke: A Comprehensive Review. Front Neurol 2021; 12:671738. [PMID: 34393971 PMCID: PMC8355431 DOI: 10.3389/fneur.2021.671738] [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: 03/05/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Men with erectile dysfunction (ED) are considered to be at risk from stroke events. Conversely, post-stroke patients are also at high risk of ED, whereas a quantitative result from all the relevant studies has not been previously addressed. Therefore, we have performed a comprehensive review and meta-analysis on this issue. This study was registered on PROSPERO (ID No. CRD42021226618). Twenty studies with a total of 3,382 stroke events were included, of which six studies were included for quantitative analysis, and the remaining 14 studies were calculated for the ratio of ED. Synthetic results from four eligible studies providing the ED cases showed that stroke patients were associated with a significantly higher risk of ED than the general population [pooled relative risk (RR) = 3.32, 95% confidence interval (CI): 1.25–8.82, P = 0.016]. Men with stroke were also found to be associated with a significant decline in International Index of Erectile Function −5 (IIEF-5) score as compared with the healthy controls [three studies, standard mean differences (SMD) = −1.8, 95% CI: −2.94 to −0.67, P = 0.002]. The prevalence of ED in post-stroke patients among 14 studies ranged from 32.1 to 77.8%, which was dramatically higher than that of the general population. The result of the GRADE-pro revealed that the quality of the evidence in this study was moderate. The present study has confirmed the high prevalence of ED in men with stroke. ED in stroke patients is a result of both neurological and psychological factors. Rehabilitative interventions rather than phosphodiesterase-5 (PDE-5) inhibitors are recommended to improve the erectile function for those survivors with ED.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Weizhou Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Panxing Wu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Chao Ding
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Bingxiang Xiao
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Zhengbao Xu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Yan Hu
- Department of Obstetrics and Gynecology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Maolei Shen
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Lu Feng
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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8
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Auger LP, Aubertin M, Grondin M, Auger C, Filiatrault J, Rochette A. Assessment methods in sexual rehabilitation after stroke: a scoping review for rehabilitation professionals. Disabil Rehabil 2021; 44:4126-4148. [PMID: 33689511 DOI: 10.1080/09638288.2021.1889047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim was to identify and describe the assessment methods used by rehabilitation professionals to evaluate sexuality for individuals post-stroke, as well as the domains of sexuality addressed. METHODS Seven databases were selected for this scoping review. Articles needed to meet these inclusion criteria: published studies with a sample of ≥ 50% stroke clients and describing a quantitative or qualitative assessment method that could be used by rehabilitation professionals. This study was conducted following the PRISMA guidelines and domains of sexuality were categorized using the ICF core set for stroke. RESULTS Of the 2447 articles reviewed, the 96 that met the selection criteria identified a total of 116 assessment methods classified as standardized assessment tools (n = 62), original questionnaires (n = 28), semi-structured interviews (n = 16) or structured interviews (n = 10). Sexual functions were predominantly assessed using standardized tools, while intimate relationships and partner's perspective were generally addressed more by original questionnaires and qualitative methods. A stepwise approach combining relevant assessment methods is presented. CONCLUSIONS Individually, these diverse assessment methods addressed a limited scope of relevant domains. Future research should combine quantitative and qualitative methods to encompass most domains of sexuality of concern to post-stroke individuals.IMPLICATIONS FOR REHABILITATIONMost of the studies reviewed here used quantitative methods to assess sexuality, rather than qualitative methods, and mostly used standardized assessment tools.Few assessment methods covered all domains related to sexuality.Qualitative methods and standardized assessment tools were shown to be complementary, therefore emphasizing the added value of mixed methods in assessing sexuality after a stroke.Among the methods that were reviewed, certain would be more suitable for the identification of the need to address sexuality (e.g., Life Satisfaction Checklist-11) and others to assess more thoroughly sexuality (e.g., Change in Sexual Functioning Questionnaire (CSFQ-14)).
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Affiliation(s)
- Louis-Pierre Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Mélanie Aubertin
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Myrian Grondin
- Marguerite-d'Youville Library, Université de Montréal, Montreal, Canada
| | - Claudine Auger
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Johanne Filiatrault
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Montreal Geriatric University Institute Research Center, Montreal, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
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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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Risk Factors, Depression, and Drugs Influencing Sexual Activity in Individuals With and Without Stroke. Rehabil Nurs 2020; 45:23-29. [PMID: 29794569 DOI: 10.1097/rnj.0000000000000145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the study was to analyze factors affecting sexual activity in individuals with and without stroke, ages 40-59 years, in a national, cross-sectional, population-based sample derived from the National Health and Nutrition Examination Survey (NHANES). DESIGN Descriptive, cross-sectional survey. METHODS Data were obtained from the NHANES (2011-2012) data set from individuals (N = 3,649) completing items related to cardiovascular risk factors, drugs, and sexual activity. Data were analyzed using chi-square, t tests, and logistic regression. FINDINGS Overall, number of drugs, smoking, and depression significantly predicted sexual activity. When comparing sexually active to not sexually active, those with stroke had significantly less sexual activity (t = 2.822, p = .005) and reduced sexual activity per week or month (χ = 16.275, p = .005, df = 4). Those taking angiotensin-converting enzyme inhibitors and statins had reduced sexual activity. CONCLUSIONS/CLINICAL RELEVANCE Findings illustrate the importance of risk factor modification and nurses engaging in sexual assessment, education, and counseling to support sexual quality of life in younger individuals with stroke.
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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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Female Sexual Dysfunction as a Warning Sign of Chronic Disease Development. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00229-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol 2019; 17:790-801. [PMID: 30129475 DOI: 10.1016/s1474-4422(18)30233-3] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023]
Abstract
Epidemiological evidence suggests that the incidence of ischaemic stroke in young adults (18-50 years) has increased substantially. These patients have a long life expectancy after stroke, and the costs of long-term care pose huge challenges to health-care systems. Although the current recommendations for treatment of young and old (>50 years) patients with stroke are similar, the optimal management of young adult patients with stroke is unknown. They are usually not included in trials, and specific subanalyses limited to young adult patients with stroke are usually not done, owing to lower incidence of stroke and lower prevalence of vascular risk factors in young adults. Progress has been made in identifying patients with a considerable risk of stroke occurrence, such as those with patent foramen ovale. Future prevention studies might result in a decrease in the incidence of stroke and its sequelae in young adults. The development of guidelines specifically devoted to the management of stroke in young adults will be an important step in achieving this aim.
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Abstract
PROBLEM The sequelae of a stroke can negatively affect sex and intimacy for survivors and their partners. PURPOSE This clinical article offers practical evidence-based recommendations for nurses to use in advising couples who may be experiencing sexual problems due to decreased desire, erectile dysfunction, vaginal dryness, paraparesis, pain, spasticity, fatigue, aphasia, concrete thinking, emotional lability, shame, embarrassment, fear, depression, or neurogenic bladder. KEY FINDINGS AND CLINICAL RELEVANCE Recent research and clinical articles show that intimacy and sexual concerns are often ignored by the rehabilitation team, yet research shows that couples want information to assist them to maintain their sexual relationships. Using the PLISSIT model to address sexual concerns, nurses can facilitate discussions to aid couples toward improved sexual function and quality of life.
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Affiliation(s)
- Donald D Kautz
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, NC, USA
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Epprecht L, Messerli M, Samuel R, Seule M, Weber J, Fournier JY, Surbeck W. Sexual Dysfunction After Good-Grade Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2017; 111:e449-e453. [PMID: 29288108 DOI: 10.1016/j.wneu.2017.12.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the consequences of aneurysmal subarachnoid hemorrhage (aSAH) on sexual pleasure in patients with an otherwise favorable neurologic outcome. METHODS Anonymous, standardized questionnaires concerning sexual function, including the International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), and a statement on subjective change in sexual pleasure after aSAH, were completed by 33 patients treated at the Cantonal Hospital St Gallen between 2005 and 2013. All had favorable neurologic outcomes (Glasgow Outcome Scale score 4 or 5). RESULTS Ten patients (31.3%) reported a subjective worsening of sexual pleasure after aSAH. Sexual dysfunction according to FSFI criteria affected 9 of the 19 female patients (47.4%). All 19 women had a hypoactive sexual desire disorder. Erectile dysfunction was present in 7 of the 14 male patients (50%). Patients with World Federation of Neurosurgical Societies (WFNS) grade 2 aSAH were significantly more likely to report a subjective worsening of sexual experience after hemorrhage than those with WFNS grade 1. CONCLUSIONS This is the first known evaluation of sexual health following aSAH with otherwise favorable neurologic outcomes, and confirms that sexual dysfunction is common in this population. Sexual health should be explored during follow-up with these patients.
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Affiliation(s)
- Lorenz Epprecht
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Otorhinolaryngology Head and Heck Surgery, University Hospital Zurich, Zürich, Switzerland
| | - Michael Messerli
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Robin Samuel
- Integrative Research Unit on Social and Individual Development, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Martin Seule
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Johannes Weber
- Department of Radiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Jean-Yves Fournier
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Werner Surbeck
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland.
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16
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Grenier-Genest A, Gérard M, Courtois F. Stroke and sexual functioning: A literature review. NeuroRehabilitation 2017; 41:293-315. [DOI: 10.3233/nre-001481] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Marina Gérard
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, QC, Canada
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17
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Dusenbury W, Palm Johansen P, Mosack V, Steinke EE. Determinants of sexual function and dysfunction in men and women with stroke: A systematic review. Int J Clin Pract 2017; 71. [PMID: 28594462 DOI: 10.1111/ijcp.12969] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/05/2017] [Indexed: 11/28/2022] Open
Abstract
AIM The aim of this systematic review was to examine determinants of sexual function and dysfunction in men and women poststroke, and to evaluate effectiveness of interventions. METHODS A systematic review was conducted using the databases of PubMed, Medline, CINAHL, Cochrane, and Psychinfo, for studies published between January, 2000 and October, 2016. Included were original research, adult ≥18 years, English language, and experimental and non-experimental designs. Excluded were studies of stroke caused by sexual activity, stroke triggered unusual behaviours, and changes in sexual orientation. Studies were evaluated for quality using The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Of 19 studies reviewed, 13 were descriptive, three case-controlled and three intervention/randomised controlled trials (RCTs) designs. RESULTS Participants across studies were predominantly men (90%), with moderate erectile dysfunction (ED), and mild depression. Changes in sexual activity, sexual dissatisfaction and sexual dysfunction were common, including decreased libido, orgasmic problems and ED, significantly worse from pre to poststroke. Results for side of hemiparesis and sexual dysfunction were inconclusive. Sexual rehabilitation interventions differed, but resulted in improved sexual satisfaction, sexual activity frequency and erectile function in two studies. CONCLUSIONS Sexual dysfunction commonly occurred poststroke, continuing for months or as long as 2 years. Intervention studies were limited, with only two RCTs, thus, firm conclusions cannot be made. Few studies included women or younger stroke patients, indicating the need for further RCTs with larger and more diverse samples.
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Affiliation(s)
- Wendy Dusenbury
- School of Nursing, Wichita State University, Wichita, KS, USA
| | - Pernille Palm Johansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Victoria Mosack
- School of Nursing, Wichita State University, Wichita, KS, USA
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18
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Grenier Genest A, Courtois F. Les accidents vasculaires cérébraux et leur impact sur la sexualité. SEXOLOGIES 2017. [DOI: 10.1016/j.sexol.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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19
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Yoon JG, Zarayeneh N, Suh SC. Interrelationship between the general characteristics of Korean stroke patients and the variables of the sexual functions: random forest and boosting algorithm. J Phys Ther Sci 2017; 29:613-617. [PMID: 28533595 PMCID: PMC5430258 DOI: 10.1589/jpts.29.613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/19/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to examine patient preferences for counseling related to sexuality post-stroke in Korea. [Subjects and Methods] A survey was conducted on 200 stroke patients. Among the 200 submitted questionnaires, 156 responded but 147 cases are available. The questionnaire is composed of 27 questions such as 8 independent variables related to the general characteristics of the patients, 7 dependent variables in conjunction with sexual intercourse and changed muscle tone, 6 questions regarding to changed sexual function, and 6 questions about a changed motor and a sensory function after stroke. To analyze the factors related to a sexual function after a stroke, we used the random forest, boosting algorithm and MANOVA. [Results] The most important variable in variable group 1 is VAR1, and then VAR22, VAR23, VAR26, VAR27, VAR25, VAR21 and VAR 24 respectively. The most important variable in variable group 2 is VAR22, and then VAR26, VAR23, VAR25, VAR1, VAR27, VAR21 and VAR 24. Finally, for variable group 3, VAR1 has the most important percentage, and we have the order as VAR26, VAR23, VAR27, VAR22, VAR25, VAR21 and VAR 24 among the rest of variables. The result of variable importance in boosting algorithm is somehow the same as that of random forest. [Conclusion] As a result of our analysis, we figured out that duration of illness, age, and education level are important factors of sexual functions for Korean Stroke patients.
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Affiliation(s)
- Jung-Gyu Yoon
- Department of Physical Therapy, Namseoul University, Republic of Korea
| | - Neda Zarayeneh
- Department of Computer Science, Texas A&M University-Commerce, USA
| | - Sang C Suh
- Department of Computer Science, Texas A&M University-Commerce, USA
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20
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The Challenge of Altered Sexual Function in Stroke Survivors Undergoing Rehabilitation. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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21
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Richards A, Dean R, Burgess GH, Caird H. Sexuality after stroke: an exploration of current professional approaches, barriers to providing support and future directions. Disabil Rehabil 2016; 38:1471-82. [DOI: 10.3109/09638288.2015.1106595] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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23
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Autonomic symptoms in hypertensive patients with post-acute minor ischemic stroke. Clin Neurol Neurosurg 2015; 139:188-91. [PMID: 26513431 DOI: 10.1016/j.clineuro.2015.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/09/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most studies regarding autonomic dysfunction in ischemic stroke are limited to heart rate and blood pressure changes during the acute phase. However, there are few data on quantitative assessment of autonomic symptoms. We sought to assess autonomic symptoms in hypertensive ischemic stroke patients. METHODS In 100 hypertensive patients (45 with symptomatic ischemic stroke (6 months after stroke onset) and 55 without stroke), we assessed autonomic symptoms using the Scale for Outcomes in Parkinson disease-Autonomic (SCOPA-AUT). RESULTS The age (mean ± standard deviation) for the stroke group was 66 ± 12 and 63 ± 15 for the without stroke group (P=0.8). Orthostatic hypotension occurred in 3.6% of the stroke group and 4.4% in the group without stroke. The total SCOPA-AUT score was higher in the stroke group compared with the group without stroke (P=0.001). Domain scores for gastrointestinal (P=0.001), urinary (P=0.005) and cardiovascular (P=0.001) were higher in the stroke group. No differences were found when comparing the total SCOPA-AUT scores for stroke subtypes (P=0.168) and for lateralization (P=0.6). SCOPA AUT scores were correlated with depression scores (P=0.001) but not with stroke severity (P=0.2). CONCLUSION Autonomic symptoms, especially, gastrointestinal, urinary and cardiovascular function, were significantly increased in hypertensive patients with minor ischemic stroke. Symptoms were associated with depression but not with the characteristic of the stroke.
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Abstract
Strokes are the second leading cause of death and the third leading cause of disability worldwide. Thanks in part to better and more available diagnosis, treatment, and rehabilitation, the vast majority of stroke patients tend to survive strokes, particularly in the industrialized world. Motor disability and cognitive changes such as aphasia and visuospatial disorders are most often considered among the major contributors to stroke burden. This chapter discusses disorders of sexual functions as another frequent sequel of strokes. Strokes generally induce hyposexuality, but in some instances they may be followed by hypersexuality. There is some evidence suggesting that lesions of either hemisphere affect sexual activities, but for different reasons: aphasia and depression after left-hemisphere lesions, a deficit in arousal and perhaps visuospatial disorders after right-hemisphere lesions. Psychologic, psychosocial, and physical factors, as well as medications, play an important role. A better understanding of the psychosocial and physiologic mechanisms underlying sexual functioning can provide insight into improving sexual activity and therefore quality of life in patients affected by strokes and other brain lesions.
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25
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Atrial Fibrillation in the Young: A Neurologist's Nightmare. Neurol Res Int 2015; 2015:374352. [PMID: 25922764 PMCID: PMC4398952 DOI: 10.1155/2015/374352] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 11/17/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice with prevalence in excess of 33 million worldwide. Although often asymptomatic and until recently considered a "benign" arrhythmia, it is now appreciated that thromboembolism resulting from AF results in significant morbidity and mortality predominantly due to stroke. Although an arrhythmia more commonly affecting the elderly, AF can also occur in the young. This review focuses on the impact of AF in the younger population and discusses the dilemmas of managing younger patients with AF.
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26
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Calabrò RS. Post-stroke sexual dysfunction at a young age: time to act! Eur J Neurol 2014; 21:e48. [DOI: 10.1111/ene.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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27
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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: 219] [Impact Index Per Article: 21.9] [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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