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Zha A, Zhang C, Zhu G, Huang X, Anjum S, Talebi Y, Savitz S, Wu H. African American patients have a higher probability of cognitive impairment after incident stroke: An analysis of national electronic health record data. J Stroke Cerebrovasc Dis 2024:107787. [PMID: 38806108 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107787] [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: 11/13/2023] [Revised: 04/26/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Cognitive impairment (CI) and stroke are diseases with significant disparities in race and geography. Post stroke cognitive impairment (PSCI) can be as high as 15-70% but few studies have utilized large administrative or electronic health records (EHR) to evaluate trends in PSCI. We utilized an EHR database to evaluate for disparities in PSCI in a large sample of patients after first recorded stroke to evaluate for disparities in race. METHODS This is a retrospective cohort analysis of Cerner Health Facts® EHR database, which is comprised of EHR data from hundreds of hospitals/clinics in the US from 2009-2018. We evaluated patients ≥40 years of age with a first time ischemic stroke (IS) diagnosis for PSCI using ICD9/10 codes for both conditions. Patients with first stroke in the Cerner database and no pre-existing cognitive impairment were included, we compared hazard ratios for developing PSCI for patient characteristics RESULTS: A total of 150,142 IS patients with follow-up data and no pre-existing evidence of CI were evaluated. Traditional risk factors of age, female sex, kidney injury, hypertension, and hyperlipidemia were associated with PSCI. Only African American stroke survivors had a higher probability of developing PSCI compared to White survivors (HR 1.347, 95% CI (1.270, 1.428)) and this difference was most prominent in the South. Among those to develop PSCI, median time to documentation was 1.8 years in African American survivors. CONCLUSION In a large national database, African American stroke survivors had a higher probability of PSCI five years after stroke than White survivors.
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Affiliation(s)
- Alicia Zha
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030; Department of Neurology, The Ohio State University Wexner Medical Center, Columbus OH, 43210.
| | - Chenguang Zhang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston TX 77030.
| | - Gen Zhu
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston TX 77030.
| | - Xinran Huang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston TX 77030.
| | - Sahar Anjum
- Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030.
| | - Yashar Talebi
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston TX 77030.
| | - Sean Savitz
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030; Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030.
| | - Hulin Wu
- Institute of Stroke and Cerebrovascular Disease, Department of Neurology, University of Texas McGovern Medical School, Houston TX, 77030; Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston TX 77030.
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Ospel JM, Rinkel L, Ganesh A, Demchuk A, Joshi M, Poppe A, McTaggart R, Nogueira R, Menon B, Tymianski M, Hill MD, Goyal M. Influence of Infarct Morphology and Patterns on Cognitive Outcomes After Endovascular Thrombectomy. Stroke 2024; 55:1349-1358. [PMID: 38511330 DOI: 10.1161/strokeaha.123.045825] [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: 11/12/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND To assess the association of qualitative and quantitative infarct characteristics and 3 cognitive outcome tests, namely the Montreal Cognitive Assessment (MOCA) for mild cognitive impairment, the Boston Naming Test for visual confrontation naming, and the Sunnybrook Neglect Assessment Procedure for neglect, in large vessel occlusion stroke. METHODS Secondary observational cohort study using data from the randomized-controlled ESCAPE-NA1 trial (Safety and Efficacy of Nerinetide in Subjects Undergoing Endovascular Thrombectomy for Stroke), in which patients with large vessel occlusion undergoing endovascular treatment were randomized to receive either intravenous Nerinetide or placebo. MOCA, Sunnybrook Neglect Assessment Procedure, and 15-item Boston Naming Test were obtained at 90 days. Total infarct volume, gray matter, and white matter infarct volumes were manually measured on 24-hour follow-up imaging. Infarcts were also visually classified as either involving the gray matter only or both the gray and white matter and scattered versus territorial. Associations of infarct variables and cognitive outcomes were analyzed using multivariable ordinal or binary logistic regression models. RESULTS Of 1105 patients enrolled in ESCAPE-NA1, 1026 patients with visible infarcts on 24-hour follow-up imaging were included. MOCA and Sunnybrook Neglect Assessment Procedure were available for 706 (68.8%) patients and the 15-item Boston Naming Test was available for 682 (66.5%) patients. Total infarct volume was associated with worse MOCA scores (adjusted common odds ratio per 10 mL increase, 1.05 [95% CI, 1.04-1.06]). After adjusting for baseline variables and total infarct volume, mixed gray and white matter involvement (versus gray matter-only adjusted common odds ratio, 1.92 [95% CI, 1.37-2.69]), white matter infarct volume (adjusted common odds ratio per 10 mL increase 1.36 [95% CI, 1.18-1.58]) and territorial (versus scattered) infarct pattern (adjusted common odds ratio, 1.65 [95% CI, 1.15-2.38]) were associated with worse MOCA scores. Results for Sunnybrook Neglect Assessment Procedure and 15-item Boston Naming Test were similar, except for the territorial infarct pattern, which did not reach statistical significance in multivariable analysis. CONCLUSIONS Besides total infarct volume, infarcts that involve the white matter and that show a territorial distribution were associated with worse cognitive outcomes, even after adjusting for total infarct volume.
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Affiliation(s)
- Johanna Maria Ospel
- Departments of Diagnostic Imaging (J.M.O., M.J., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | - Leon Rinkel
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (L.R.)
| | - Aravind Ganesh
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | - Andrew Demchuk
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | - Manish Joshi
- Departments of Diagnostic Imaging (J.M.O., M.J., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | - Alexandre Poppe
- Centre Hospitalier de l'Université de Montréal, QC, Canada (A.P.)
| | - Ryan McTaggart
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (R.N.)
| | - Raul Nogueira
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA (R.N.)
| | - Bijoy Menon
- Departments of Diagnostic Imaging (J.M.O., M.J., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | | | - Michael Douglas Hill
- Departments of Diagnostic Imaging (J.M.O., M.J., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
- Neurosciences (J.M.O., L.R., A.G., A.D., M.J., B.M., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
| | - Mayank Goyal
- Departments of Diagnostic Imaging (J.M.O., M.J., M.D.H., M.G.), Foothills Medical Center, University of Calgary, AB, Canada
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Wang M, Lin Y, Gu F, Xing W, Li B, Jiang X, Liu C, Li D, Li Y, Wu Y, Ta D. Diagnosis of cognitive and motor disorders levels in stroke patients through explainable machine learning based on MRI. Med Phys 2024; 51:1763-1774. [PMID: 37690455 DOI: 10.1002/mp.16683] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/10/2023] [Accepted: 07/29/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Globally, stroke is the third most significant cause of disability. A stroke may produce motor, sensory, perceptual, or cognitive disorders that result in disability and affect the likelihood of recovery, affecting a person's ability to function. Evaluation post-stroke is critical for optimal stroke care. PURPOSE Traditional methods for classifying the clinical disorders of cognitive and motor in stroke patients use assessment and interrogative measures, which are time-consuming, complex, and labor-intensive. In response to the current situation, this study develops an algorithm to automatically classify motor and cognitive disorders in stroke patients by 3D brain MRI to assist physicians in diagnosis. METHODS First, radiomics and fusion features are extracted from the OAx T2 Propeller of 3D brain MRI. Then, we use 14 machine learning models and one model ensemble method to predict Fugl-Meyer and MMSE levels of stroke patients. Next, we evaluate the models using accuracy, recall, f1-score, and area under the curve (AUC). Finally, we employ SHAP to explain the output of the model. RESULTS The best predictive models come from Random Forest (RF) Classifier with fusion features in cognitive classification and Linear Discriminant Analysis (LDA) with radiomics features in motor classification. The highest accuracies are 92.0 and 82.5% for cognitive and motor disorders. CONCLUSIONS MRI brain maps can classify the cognitive and motor disorders of stroke patients. Radiomics features demonstrate its merits. The proposed algorithms with MRI images can efficiently assist physicians in diagnosing the cognitive and motor disorders of stroke patients in clinical practice. Additionally, this lessens labor costs, improves diagnostic effectiveness, and avoids the subjective difference that comes with manual assessment.
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Affiliation(s)
- Meng Wang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yi Lin
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Feifei Gu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenyu Xing
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Boyi Li
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Xue Jiang
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Chengcheng Liu
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Dan Li
- Department of Electronic Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Ying Li
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Dean Ta
- Center for Biomedical Engineering, School of Information Science and Technology, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Blake JA, Long DL, Knight AJ, Goodin BR, Crowe M, Judd SE, Rhodes JD, Roth DL, Clay OJ. Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.26.23297649. [PMID: 37961600 PMCID: PMC10635206 DOI: 10.1101/2023.10.26.23297649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective Cognitive impairment after stroke is common, present up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of two stroke severity ratings and a caregiver-report of post-stroke functioning with longitudinal cognitive outcomes. Methods The analysis was conducted on 157 caregivers and stroke survivor dyads who participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) collected at hospitalization discharge were included as two primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at nine months following stroke were included as a third predictor. Cognition was assessed using a biennial telephone battery, incorporating multiple cognitive assessments to assess learning, memory, and executive functioning. Longitudinal cognitive scores were analyzed up to five years post-stroke, controlling for baseline (pre-stroke) cognitive scores and demographic variables of each stroke survivor collected at CARES baseline. Results Separate mixed models showed significant main effects of GOS (b=0.3280, p=0.0009), mRS (b=-0.2119, p=0.0002), and caregiver-reported impairments (b=-0.0671, p<0.0001) on longitudinal cognitive scores. In a combined model including all three predictors, only caregiver-reported problems significantly predicted cognitive outcomes (b=-0.0480, p<0.0001). Impact These findings underscore the importance of incorporating caregivers feedback in understanding cognitive consequences of stroke.
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Zhang Z, Lim MJR. Incident Dementia After Spontaneous Intracerebral Hemorrhage. J Alzheimers Dis 2024; 99:41-51. [PMID: 38640161 DOI: 10.3233/jad-240111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Post-stroke cognitive impairment and dementia (PSCID) is a complication that affects long-term functional outcomes after stroke. Studies on dementia after long-term follow-up in stroke have focused predominantly on ischemic stroke, which may be different from the development of dementia after spontaneous intracerebral hemorrhage (ICH). In this review, we summarize the existing data and hypotheses on the development of dementia after spontaneous ICH, review the management of post-ICH dementia, and suggest areas for future research. Dementia after spontaneous ICH has a cumulative incidence of up to 32.0-37.4% at 5 years post-ICH. Although the pathophysiology of post-ICH dementia has not been fully understood, two main theoretical frameworks can be considered: 1) the triggering role of ICH (both primary and secondary brain injury) in precipitating cognitive decline and dementia; and 2) the contributory role of pre-existing brain pathology (including small vessel disease and neurodegenerative pathology), reduced cognitive reserve, and genetic factors predisposing to cognitive dysfunction. These pathophysiological pathways may have synergistic effects that converge on dysfunction of the neurovascular unit and disruptions in functional connectivity leading to dementia post-ICH. Management of post-ICH dementia may include screening and monitoring, cognitive therapy, and pharmacotherapy. Non-invasive brain stimulation is an emerging therapeutic modality under investigation for safety and efficacy. Our review highlights that there remains a paucity of data and standardized reporting on incident dementia after spontaneous ICH. Further research is imperative for determining the incidence, risk factors, and pathophysiology of post-ICH dementia, in order to identify new therapies for the treatment of this debilitating condition.
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Affiliation(s)
- Zheting Zhang
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Angelucci F, Veverova K, Katonová A, Vyhnalek M, Hort J. Serum PAI-1/BDNF Ratio Is Increased in Alzheimer's Disease and Correlates with Disease Severity. ACS OMEGA 2023; 8:36025-36031. [PMID: 37810633 PMCID: PMC10552510 DOI: 10.1021/acsomega.3c04076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 07/27/2023] [Indexed: 10/10/2023]
Abstract
We previously demonstrated that serum levels of plasminogen activator inhibitor-1 (PAI-1), which inhibits both the tissue plasminogen activator (tPA) and plasmin activity, are increased in patients with Alzheimer's disease. tPA/plasmin not only prevents the accumulation of β-amyloid in the brain but also is involved in the synthesis of the brain-derived neurotrophic factor (BDNF), a neurotrophin whose levels are reduced in Alzheimer. In the present study, we compared BDNF serum levels in Alzheimer patients with dementia to those in Alzheimer patients with amnestic mild cognitive impairment and to cognitively healthy controls. Moreover, we examined whether the PAI-1/BDNF ratio correlates with disease severity, as measured by Mini-Mental State Examination. Our results showed that BDNF serum levels are lower (13.7% less) and PAI-1 levels are higher in Alzheimer patients with dementia than in Alzheimer patients with amnestic mild cognitive impairment patients (23% more) or controls (36% more). Furthermore, the PAI-1/BDNF ratio was significantly increased in Alzheimer patients as compared to amnestic mild cognitive impairment (36.4% more) and controls (40% more). Lastly, the PAI-1/BDNF ratio negatively correlated with the Mini-Mental score. Our results suggest that increased PAI-1 levels in Alzheimer, by impairing the production of the BDNF, are implicated in disease progression. They also indicate that the PAI-1/BDNF ratio could be used as a marker of Alzheimer. In support of this hypothesis, a strong negative correlation between the PAI-1/BDNF ratio and the Mini-Mental score was observed.
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Affiliation(s)
- Francesco Angelucci
- Memory
Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague 150 06, Czech Republic
- International
Clinical Research Centre, St. Anne’s
University Hospital, Brno 602 00,Czech Republic
| | - Katerina Veverova
- Memory
Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague 150 06, Czech Republic
| | - Alžbeta Katonová
- Memory
Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague 150 06, Czech Republic
| | - Martin Vyhnalek
- Memory
Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague 150 06, Czech Republic
| | - Jakub Hort
- Memory
Clinic, Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague 150 06, Czech Republic
- International
Clinical Research Centre, St. Anne’s
University Hospital, Brno 602 00,Czech Republic
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Pluta R. The Dual Role of Autophagy in Postischemic Brain Neurodegeneration of Alzheimer's Disease Proteinopathy. Int J Mol Sci 2023; 24:13793. [PMID: 37762096 PMCID: PMC10530906 DOI: 10.3390/ijms241813793] [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: 08/16/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Autophagy is a self-defense and self-degrading intracellular system involved in the recycling and elimination of the payload of cytoplasmic redundant components, aggregated or misfolded proteins and intracellular pathogens to maintain cell homeostasis and physiological function. Autophagy is activated in response to metabolic stress or starvation to maintain homeostasis in cells by updating organelles and dysfunctional proteins. In neurodegenerative diseases, such as cerebral ischemia, autophagy is disturbed, e.g., as a result of the pathological accumulation of proteins associated with Alzheimer's disease and their structural changes. Postischemic brain neurodegeneration, such as Alzheimer's disease, is characterized by the accumulation of amyloid and tau protein. After cerebral ischemia, autophagy was found to be activated in neuronal, glial and vascular cells. Some studies have shown the protective properties of autophagy in postischemic brain, while other studies have shown completely opposite properties. Thus, autophagy is now presented as a double-edged sword with possible therapeutic potential in brain ischemia. The exact role and regulatory pathways of autophagy that are involved in cerebral ischemia have not been conclusively elucidated. This review aims to provide a comprehensive look at the advances in the study of autophagy behavior in neuronal, glial and vascular cells for ischemic brain injury. In addition, the importance of autophagy in neurodegeneration after cerebral ischemia has been highlighted. The review also presents the possibility of modulating the autophagy machinery through various compounds on the development of neurodegeneration after cerebral ischemia.
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Affiliation(s)
- Ryszard Pluta
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland
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Pluta R, Miziak B, Czuczwar SJ. Apitherapy in Post-Ischemic Brain Neurodegeneration of Alzheimer's Disease Proteinopathy: Focus on Honey and Its Flavonoids and Phenolic Acids. Molecules 2023; 28:5624. [PMID: 37570596 PMCID: PMC10420307 DOI: 10.3390/molecules28155624] [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: 06/30/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Neurodegeneration of the brain after ischemia is a major cause of severe, long-term disability, dementia, and mortality, which is a global problem. These phenomena are attributed to excitotoxicity, changes in the blood-brain barrier, neuroinflammation, oxidative stress, vasoconstriction, cerebral amyloid angiopathy, amyloid plaques, neurofibrillary tangles, and ultimately neuronal death. In addition, genetic factors such as post-ischemic changes in genetic programming in the expression of amyloid protein precursor, β-secretase, presenilin-1 and -2, and tau protein play an important role in the irreversible progression of post-ischemic neurodegeneration. Since current treatment is aimed at preventing symptoms such as dementia and disability, the search for causative therapy that would be helpful in preventing and treating post-ischemic neurodegeneration of Alzheimer's disease proteinopathy is ongoing. Numerous studies have shown that the high contents of flavonoids and phenolic acids in honey have antioxidant, anti-inflammatory, anti-apoptotic, anti-amyloid, anti-tau protein, anticholinesterase, serotonergic, and AMPAK activities, influencing signal transmission and neuroprotective effects. Notably, in many preclinical studies, flavonoids and phenolic acids, the main components of honey, were also effective when administered after ischemia, suggesting their possible use in promoting recovery in stroke patients. This review provides new insight into honey's potential to prevent brain ischemia as well as to ameliorate damage in advanced post-ischemic brain neurodegeneration.
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Affiliation(s)
- Ryszard Pluta
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland; (B.M.); (S.J.C.)
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Wang L, Yang L, Liu H, Pu J, Li Y, Tang L, Chen Q, Pu F, Bai D. C-Reactive Protein Levels and Cognitive Decline following Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:1082. [PMID: 37509012 PMCID: PMC10377587 DOI: 10.3390/brainsci13071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Cognitive decline (CD) is devastating with a high incidence in patients after stroke. Although some studies have explored underlying associations between C-reactive protein (CRP) levels and cognitive decline after stroke, consistent results have not been obtained. Therefore, this meta-analysis aimed to explore whether or not higher levels of C-reactive proteins were associated with an increased risk of cognitive decline after stroke. To this end, PubMed, Embase, the Cochrane Library, and Web of Science were searched for eligible studies, and pooled effect sizes from eligible studies were calculated using random effect models. Furthermore, subgroups were established and meta-regression analyses were performed to explain the causes of heterogeneity. Eventually, nine studies with 3893 participants were included. Our statistical results suggested that the concentrations of peripheral CRP may be significantly increased for CD patients after stroke, compared to those of non-CD patients. Subgroup analyses showed that CRP was higher in CD than that in non-CD patients when the mini-mental state examination was used. A higher level of CRP in the acute phase of ischemic stroke may suggest an increased risk of CD after stroke. However, these results should be cautiously interpreted because of the limited sample sizes and the diversity of potential confounders in the studies included in this meta-analysis.
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Affiliation(s)
- Likun Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lining Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Haiyan Liu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Juncai Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yi Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lu Tang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qing Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Fang Pu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Dingqun Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Zewde Y, Alem A, Seeger SK. Magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors: A facility-based cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-2852302. [PMID: 37292631 PMCID: PMC10246265 DOI: 10.21203/rs.3.rs-2852302/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Stroke is emerging as a public health threat in sub-Saharan African countries including Ethiopia. Even though cognitive impairment is increasingly being recognized as a major cause of disability among stroke survivors there is a paucity of information on the magnitude of stroke-related cognitive dysfunction in Ethiopia. Thus, we assessed the magnitude and predictors of post-stroke cognitive impairment among Ethiopian stroke survivors. Methods A facility-based cross-sectional study was employed to assess the magnitude and predictor of post-stroke cognitive impairment among adult stroke survivors who came for follow-up at least 3 months after the last stoke episode from February to June 2021 in three outpatient neurology clinics in Addis Ababa, Ethiopia. We used the Montreal Cognitive Assessment Scale-Basic (MOCA-B), modified Rankin Scale (mRS), and Patient Health Questionnaire-9 (PHQ-9) to assess post-stroke cognition, functional recovery, and depression, respectively. Data were entered and analyzed using SPSS software version 25. A binary logistic regression model was employed to identify the predictors of post-stroke cognitive impairment. A p-value of 0.05 was considered statistically significant. Results Of the 79 stroke survivors approached, 67 were included. The mean (SD) age was 52.1 (12.7) years. Over half (59.7%) of the survivors were males and most (67.2%) were urban residents. The median stroke duration was 3 years ranging from 1 to 4 years. Almost half (41.8%) of stroke survivors had cognitive impairment. Increased age (AOR=0.24, 95% CI=0.07,0.83), lower education (AOR=4.02, 95% CI=1.13,14.32), and poor function recovery (mRS 33) (AOR=0.27, 95% CI=0.08-0.81) were predictors significantly associated with post-stroke cognitive impairment. Conclusion Nearly one in two stroke survivors had cognitive impairment. The major predictors associated with cognitive decline were age above 45 years, low literacy, and poor recovery in physical function. Although causality cannot be inferred, physical rehabilitation and better education are essential in building cognitive resilience among stroke survivors.
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Boutros CF, Khazaal W, Taliani M, Sadier NS, Salameh P, Hosseini H. Factors associated with cognitive impairment at 3, 6, and 12 months after the first stroke among Lebanese survivors. Brain Behav 2023; 13:e2837. [PMID: 36495111 PMCID: PMC9847618 DOI: 10.1002/brb3.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/10/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This study aimed to calculate the rate of post-stroke cognitive impairment (PSCI) by evaluating the cognitive domains among Lebanese stroke survivors at 3, 6, and 12 months post-stroke, and to identify the contributing factors including pre- and post-stroke related factors. METHODS A multicenter longitudinal prospective study was conducted in 10 hospitals from Beirut and Mount Lebanon for a 15-month period. Mini-Mental State Examination (MMSE), modified Rankin Scale (mRS), Short Form Health Survey (SF12), National Institutes of Health Stroke Scale (NIHSS), and Hospital Anxiety and Depression Scale (HADS) were used to assess cognitive function, disability degree, Quality of Life (QoL), stroke severity, and levels of anxiety and depression, respectively. Then, univariate and multivariable analyses were performed to identify the predictors of PSCI. RESULTS Low MMSE scores were found among survivors during the first 3 months post-stroke (74.8%) of whom 53.7% presented with an MMSE ≤ 17, followed by 46.7% in the 6 months, and 37.6% at 12 months post-stroke. Follow-up comparisons showed a significant increase of MMSE scores over time (p < .001), indicating a 37% improvement of the cognitive function over time. The most affected cognitive domain was the attention and concentration at the three time points. Independent factors that were positively associated with low MMSE scores were as follows: sedentary behavior ≥ 12 h/day (AOR = 3.062, p = .033), involvement of the left hemisphere (AOR = 2.710, p = .006), HADS ≥ 11 (AOR = 2.536, p = .049), and high NIHSS scores (AOR = 3, p = .009). Age was the main predictor in the three time periods (AOR ≈ 3, p < .05). Inversely, female gender (AOR = 0.09, p = .027), high educational level (AOR = 0.2, p < .02), employment post-stroke (AOR = 0.3, p = .023), high Physical Component Summary (PCS) of Quality of Life (QoL) (AOR = 0.8, p < .001), and the use of anti-diabetic treatment post-stroke (AOR = 0.17, p = .016) improved MMSE scores to > 23. CONCLUSION The risk of PSCI among Lebanese stroke survivors was high especially in the acute phase, depending on various determinants. Health care providers are invited to implement an emergency rehabilitation program for an appropriate successful management of the risk factors in order to reduce stroke burden and to improve overall cognitive performance.
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Affiliation(s)
- Celina F Boutros
- Institut Mondor de Recherche Biomédicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Walaa Khazaal
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Najwane Said Sadier
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Pascale Salameh
- Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.,Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomédicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France.,Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,Neurology Department, Hôpital Henri Mondor, AP-HP, Créteil, France
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12
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Akada K, Koyama N, Miura Y, Takahashi K, Aoshima K. Nationwide Database Analysis of Risk Factors Associated with Decreased Activities of Daily Living in Patients with Alzheimer's Disease. J Alzheimers Dis 2023; 94:1465-1475. [PMID: 37393499 DOI: 10.3233/jad-230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
BACKGROUND Preserving activities of daily living (ADL) is the key issue for Alzheimer's disease (AD) patients and their caregivers. OBJECTIVE To clarify the ADL level of AD patients at diagnosis and the risk factors associated with decreased ADL during long-term care (≤3 years). METHODS Medical records of AD patients in a Japanese health insurance claims database were analyzed retrospectively to determine ADL using the Barthel Index (BI) and identify the risk factors associated with decreased ADL. RESULTS A total of 16,799 AD patients (mean age at diagnosis: 83.6 years, 61.5% female) were analyzed. Female patients were older (84.6 versus 81.9 years; p < 0.001) and had lower BI (46.8 versus 57.6; p < 0.001) and body mass index (BMI) (21.0 versus 21.7 kg/m2; p < 0.001) than male patients at diagnosis. Disability (BI≤60) increased at age≥80 years and was significantly higher in females. Complete disability was most frequent for bathing and grooming. Risk factors for decreased ADL were determined separately by sex through comparing the ADL-preserved and ADL-decreased groups using propensity score matching by age and BI and multivariable logistic regression analysis. In males, decreased ADL was significantly associated with BMI < 21.5 kg/m2, stroke, and hip fracture, and inversely associated with hyperlipidemia. In females, decreased ADL was significantly associated with BMI < 21.5 kg/m2 and vertebral and hip fractures, and inversely associated with lower back pain. CONCLUSION AD patients with low BMI, stroke, and fractures had increased risks of decreased ADL; such patients should be identified early and managed appropriately, including rehabilitation to preserve ADL.
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Affiliation(s)
- Keishi Akada
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Tokyo, Japan
| | - Noriyuki Koyama
- Government Relations Strategy Department, Eisai Co. Ltd., Tokyo, Japan
| | - Yuji Miura
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Tokyo, Japan
| | - Kentaro Takahashi
- Human Biology Integration Foundation, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
| | - Ken Aoshima
- Microbes & Host Defense Domain, Deep Human Biology Learning, Eisai Co. Ltd., Ibaraki, Japan
- School of Integrative and Global Majors, University of Tsukuba, Ibaraki, Japan
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13
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Hong CT, Lee HH, Chung CC, Chiu WT, Lee TY, Chen DYT, Huang LK, Hu CJ, Chan L. Poststroke Cognitive Impairment: A Longitudinal Follow-Up and Pre/Poststroke Mini-Mental State Examination Comparison. Curr Alzheimer Res 2022; 19:716-723. [PMID: 35927922 DOI: 10.2174/1567205019666220802151945] [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: 03/10/2022] [Revised: 04/14/2022] [Accepted: 05/07/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Poststroke cognitive impairment (PSCI) is a prevalent cause of disability in people with stroke. PSCI results from either lesion-dependent loss of cognitive function or augmentation of Alzheimer's pathology due to vascular insufficiency. The lack of prestroke cognitive assessments limits the clear understanding of the impact of PSCI on cognition. OBJECTIVE The present study aims to make a direct comparison of longitudinal cognitive assessment results to clarify the impact of ischemic stroke on PSCI and assess the cognitive decline in PSCI compared to people with Alzheimer's disease (AD). METHODS All study participants had their Mini-Mental State Examination (MMSE) at the chronic poststroke stage (≥6 months after stroke), which was compared with prestroke or acute poststroke (<6 months after stroke) MMSE to investigate the two aspects of PSCI. A group of patients with AD was used to reference the speed of neurodegenerative cognitive deterioration. Repeated measures analysis of variance was used to compare the longitudinal change of MMSE. RESULTS MMSE score between acute and chronic poststroke revealed a 1.8 ± 6.49 decline per year (n=76), which was not significantly different from the AD patients who underwent cholinesterase inhibitors treatment (-1.11 ± 2.61, p=0.35, n=232). MMSE score between prestroke and chronic poststroke (n=33) revealed a significant decline (-6.52 ± 6.86, p < 0.001). In addition, their cognitive deterioration was significantly associated with sex, age, and stroke over the white matter or basal ganglia. CONCLUSION Ischemic stroke substantially affects cognition with an average six-point drop in MMSE. The rate of cognitive decline in PSCI was similar to AD, and those with white matter or basal ganglia infarct were at greater risk of PSCI.
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Affiliation(s)
- Chien-Tai Hong
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsun-Hua Lee
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chen-Chih Chung
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Ting Chiu
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ting-Yi Lee
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - David Yen-Ting Chen
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Kai Huang
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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14
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Tynterova A, Perepelitsa S, Golubev A. Personalized Neurophysiological and Neuropsychological Assessment of Patients with Left and Right Hemispheric Damage in Acute Ischemic Stroke. Brain Sci 2022; 12:brainsci12050554. [PMID: 35624940 PMCID: PMC9139366 DOI: 10.3390/brainsci12050554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/23/2022] [Indexed: 02/04/2023] Open
Abstract
The leading factors of post-stroke disability are motor disorders and cognitive dysfunctions. The aim of the study was to identify and provide a rationale for the variable early cognitive dysfunction in right and left hemispheric damage in patients with acute stroke. The study included 80 patients diagnosed with ischemic stroke. All patients were assessed for cognitive status, depression, fatigue and anxiety. For objectification, the method of evoked potentials (P300) and neuroimaging were used. Our findings revealed distinguishing features of cognitive dysfunction and identified a combination of the most informative markers characteristic of right and left hemispheric damage in patients with acute ischemic stroke. In patients with damage to the left hemisphere, a predominance of dysregulation syndrome (decrease in executive function and attention) was revealed, accompanied by various disorders such as severe anxiety and fatigue. The causes of this cognitive dysfunction may be directly related to stroke (damage to subcortical structures), as well as to a preexisting reduction in higher mental functions associated with age and vascular conditions. Cognitive impairments in patients with lesions of the right hemisphere were characterized by polymorphism and observed in the mental praxis, speech (with predominant semantic component) and abstract thinking domains. They are closely linked to each other and are more related to the lateralization of the lesion and preexisting neurodegeneration than to the localization of the ischemic lesion. The study of P300-evoked potentials is a good tool for confirming cognitive dysfunction. The latent period of the P300 wave is more sensitive to neurodegeneration, while the amplitude factor characterizes vascular pathology to a greater extent. The results of the study provide a rationale for a comprehensive assessment of lateralization, stroke localization, underlying diseases, neurophysiological parameters and identified cognitive impairments when developing a plan of rehabilitation and neuropsychological measures aimed at cognitive and emotional recovery of patients both in the acute phase of ischemic stroke and when selecting further personalized rehabilitation programs.
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Affiliation(s)
- Anastasia Tynterova
- Immanuel Kant Baltic Federal University, 14 Alexander Nevsky St., 236041 Kaliningrad, Kaliningrad Oblast, Russia;
- Correspondence:
| | - Svetlana Perepelitsa
- Immanuel Kant Baltic Federal University, 14 Alexander Nevsky St., 236041 Kaliningrad, Kaliningrad Oblast, Russia;
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., Build. 2, 107031 Moscow, Moskovskaya Oblast, Russia;
| | - Arкady Golubev
- V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, 25 Petrovka Str., Build. 2, 107031 Moscow, Moskovskaya Oblast, Russia;
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15
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Kuan YC, Lin LF, Wang CY, Hu CC, Liang PJ, Lee SC. Association Between Turning Mobility and Cognitive Function in Chronic Poststroke. Front Neurol 2022; 13:772377. [PMID: 35280264 PMCID: PMC8904417 DOI: 10.3389/fneur.2022.772377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Turning difficulties are common in patients with stroke. The detrimental effects of dual tasks on turning indicate a correlation between turning and cognition. Cognitive impairment is prevalent after stroke, and stroke patients with mild cognitive impairment had a poorer turning performance than did stroke patients with intact cognitive abilities. Therefore, we investigated the association between turning mobility and cognitive function in patients with chronic poststroke. Ninety patients with chronic stroke (>6 months post-stroke) were recruited. Angular velocity was assessed using wearable sensors during 180° walking turns and 360° turning on the spot from both sides. Global cognition and distinct cognitive domains were assessed using the Mini-Mental State Examination. In patients with stroke, turning mobility was significantly associated with global cognitive function and distinct cognitive domains, such as visuospatial ability and language. The balance function and lower limbs strength were mediators of the association between cognition and turning. The association highlights the complexity of the turning movement and dynamic motor and cognitive coordination necessary to safely complete a turn. However, our findings should be regarded as preliminary, and a thorough neuropsychological assessment to provide a valid description of distinct cognitive domains is required.
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Affiliation(s)
- Yi-Chun Kuan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Li-Fong Lin
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang-Ho Hospital, New Taipei City, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Chia-Chen Hu
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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16
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Xie G, Tang X, Luo W, Xu Y, Li D, Wang Z, Yuan C, Xia Y, Zhou X, Tian M, Yuan Z, Wang T, Liao J. Electro-acupuncture for post-stroke cognitive impairment: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e28774. [PMID: 35212273 PMCID: PMC8878786 DOI: 10.1097/md.0000000000028774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND A considerable number of stroke survivors suffered from cognitive impairment, and more than one third of stroke survivors are affected at 3 and 12 months after the stroke. Although the published systematic reviews suggest that acupuncture can help improve post-stroke cognitive dysfunction, the power of the results is low due to study limitations. Therefore, this review is necessary to analyze the effect of acupuncture on cognitive impairment after stroke and to provide evidence for cognitive impairment in stroke. METHODS This study will be carried out in strict accordance with the Cochrane Handbook for Systematic Reviews of Interventions. According to the pre-established search strategy (PICOS framework), all the literature will be obtained from online databases including Cochrane Central Register of Controlled Trials in the Cochrane Library, Medline (via PubMed), EMBASE (via embase.com), CINAHL (via EBSCOhost), China National Knowledge Infrastructure database, WanFang Database, Chinese Science and Technology Periodical Database, and Sino-Med Database from inception until December 31, 2021 with no language limitations. Two reviewers will screen the records and include quality studies according to inclusion criteria independently. The data needed will be extracted independently by 2 authors according to a table of data extraction. Any inconsistencies in literature screening and data collection will be resolved to reach a consensus via discussion with a third author. Risk of bias for each study will be assessed using risk of bias tool. RevMan5.3 will be used to analyze the data. Heterogeneity will be identified and measured by Chi2. Subgroup analyses and sensitivity analysis will be carried out. Grading of Recommendations Assessment, Development and Evaluation will be used to evaluate the evidence for each outcome. CONCLUSION The results of this study will provide a theoretical basis for the clinical use of electro-acupuncture to treat cognitive dysfunction after stroke. UNIQUE INPLASY NUMBER INPLASY202210038.
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Affiliation(s)
- Guanli Xie
- Yunnan University of Chinese Medicine, Kunming, Yunnan, China
| | - Xiaoxia Tang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Wen Luo
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Yanfei Xu
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Deguang Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Zhe Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Changfei Yuan
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Yibo Xia
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Xiaohan Zhou
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Miao Tian
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Zhifa Yuan
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Tao Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Jianglong Liao
- Kunming Municipal Hospital of Traditional Chinese Medicine & Kunming Combination of Chinese and Western Medicine Minimally Invasive Spine Technology Center, Kunming, Yunnan, China
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Zhang Y, Feng Y, Zuo J, Shi J, Zhang S, Yang Y, Xie S, Chen Z. Elevated Serum Amyloid A Is Associated With Cognitive Impairment in Ischemic Stroke Patients. Front Neurol 2022; 12:789204. [PMID: 35111127 PMCID: PMC8801533 DOI: 10.3389/fneur.2021.789204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeThe impact of serum amyloid A on cognitive impairment after ischemic stroke is unclear. We aimed to investigate the association between serum amyloid A (SAA) levels and post-stroke cognitive impairment (PSCI) at 3 months after ischemic stroke.MethodsOne hundred and ninety-eight patients were enrolled prospectively from June 2020 to April 2021. The SAA concentrations were measured using a commercially available enzyme-linked immunosorbent assay kit after admission. Cognitive function was assessed using the Montreal Cognitive Assessment score at 3 months after the symptom onset. We defined a Montreal Cognitive Assessment score <25 as cognitive impairment.ResultsDuring 3-month follow-up, 80 patients (40.4%) were diagnosed as having PSCI. As compared with patients with cognitively normal ischemic stroke, those with PSCI were older, more likely to have diabetes and white matter lesions, and had a higher baseline National Institutes of Health stroke score and SAA levels. After adjustment for age, the National Institutes of Health stroke score and other covariates, the OR for the highest quartile of SAA compared with the lowest quartile was 5.72 (95% CI, 2.17–15.04, P = 0.001) for PSCI. Also, ordinal logistic regression analysis showed that higher SAA concentrations were associated with increased risk of PSCI severity (OR, 4.31; 95% CI, 1.81–10.33, P = 0.001). Similar results were found when the SAA levels were analyzed as a continuous variable.ConclusionsThis present study demonstrated that increased SAA levels might be associated with PSCI at 3 months after ischemic stroke.
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Affiliation(s)
- Yun Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
- *Correspondence: Zhonglun Chen
| | - Yue Feng
- Department of Medical Laboratory, Mianyang Central Hospital, Mianyang, China
| | - Jiacai Zuo
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Jian Shi
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Shanshan Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Yao Yang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Shu Xie
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Zhonglun Chen
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
- Yun Zhang
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The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke. J Int Neuropsychol Soc 2022; 28:35-47. [PMID: 33785079 DOI: 10.1017/s1355617721000187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. METHOD Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 - Revised (SCL-90-R). RESULTS In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3-7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). CONCLUSION Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.
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Lee R, Choi H, Park KY, Kim JM, Seok JW. Prediction of post-stroke cognitive impairment using brain FDG PET: deep learning-based approach. Eur J Nucl Med Mol Imaging 2021; 49:1254-1262. [PMID: 34599654 DOI: 10.1007/s00259-021-05556-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Post-stroke cognitive impairment can affect up to one third of stroke survivors. Since cognitive function greatly contributes to patients' quality of life, an objective quantitative biomarker for early prediction of dementia after stroke is required. We developed a deep-learning (DL)-based signature using positron emission tomography (PET) to objectively evaluate cognitive decline in patients with stroke. METHODS We built a DL model that differentiated Alzheimer's disease (AD) from normal controls (NC) using brain fluorodeoxyglucose (FDG) PET from the Alzheimer's Disease Neuroimaging Initiative database. The model was directly transferred to a prospectively enrolled cohort of patients with stroke to differentiate patients with dementia from those without dementia. The accuracy of the model was evaluated by the area under the curve values of receiver operating characteristic curves (AUC-ROC). We visualized the distribution of DL-based features and brain regions that the model weighted for classification. Correlations between cognitive signature from the DL model and clinical variables were evaluated, and survival analysis for post-stroke dementia was performed in patients with stroke. RESULTS The classification of AD vs. NC subjects was performed with AUC-ROC of 0.94 (95% confidence interval [CI], 0.89-0.98). The transferred model discriminated stroke patients with dementia (AUC-ROC = 0.75). The score of cognitive decline signature using FDG PET was positively correlated with age, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio and negatively correlated with body mass index in patients with stroke. We found that the cognitive decline score was an independent risk factor for dementia following stroke (hazard ratio, 10.90; 95% CI, 3.59-33.09; P < 0.0001) after adjustment for other key variables. CONCLUSION The DL-based cognitive signature using FDG PET was successfully transferred to an independent stroke cohort. It is suggested that DL-based cognitive evaluation using FDG PET could be utilized as an objective biomarker for cognitive dysfunction in patients with cerebrovascular diseases.
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Affiliation(s)
- Reeree Lee
- Department of Nuclear Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 06974, Republic of Korea.
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ju Won Seok
- Department of Nuclear Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 224-1, Heukseok-dong, Dongjak-gu, Seoul, 06974, Republic of Korea.
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20
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Potter T, Lioutas VA, Tano M, Pan A, Meeks J, Woo D, Seshadri S, Selim M, Vahidy F. Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review of Current Evidence and Knowledge Gaps. Front Neurol 2021; 12:716632. [PMID: 34512528 PMCID: PMC8429504 DOI: 10.3389/fneur.2021.716632] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/02/2021] [Indexed: 01/21/2023] Open
Abstract
Background: Cognitive impairment (CI) is commonly observed after intracerebral hemorrhage (ICH). While a growing number of studies have explored this association, several evidence gaps persist. This review seeks to investigate the relationship between CI and ICH. Methods: A two-stage systematic review of research articles, clinical trials, and case series was performed. Initial search used the keywords [“Intracerebral hemorrhage” OR “ICH”] AND [“Cognitive Impairment” OR “Dementia OR “Cognitive Decline”] within the PubMed (last accessed November 3rd, 2020) and ScienceDirect (last accessed October 27th, 2020) databases, without publication date limits. Articles that addressed CI and spontaneous ICH were accepted if CI was assessed after ICH. Articles were rejected if they did not independently address an adult human population or spontaneous ICH, didn't link CI to ICH, were an unrelated document type, or were not written in English. A secondary snowball literature search was performed using reviews identified by the initial search. The Agency for Healthcare research and Quality's assessment tool was used to evaluate bias within studies. Rates of CI and contributory factors were investigated. Results: Search yielded 32 articles that collectively included 22,631 patients. Present evidence indicates a high rate of post-ICH CI (65–84%) in the acute phase (<4 weeks) which is relatively lower at 3 (17.3–40.2%) and 6 months (19–63.3%). Longer term follow-up (≥1 year) demonstrates a gradual increase in CI. Advanced age, female sex, and prior stroke were associated with higher rates of CI. Associations between post-ICH CI and cerebral microbleeds, superficial siderosis, and ICH volume also exist. Pre-ICH cognitive assessment was missing in 28% of included studies. The Mini Mental State Evaluation (44%) and Montreal Cognitive Assessment (16%) were the most common cognitive assessments, albeit with variable thresholds and definitions. Studies rarely (<10%) addressed racial and ethnic disparities. Discussion: Current findings suggest a dynamic course of post-ICH cognitive impairment that may depend on genetic, sociodemographic and clinical factors. Methodological heterogeneity prevented meta-analysis, limiting results. There is a need for the methodologies and time points of post-ICH cognitive assessments to be harmonized across diverse clinical and demographic populations.
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Affiliation(s)
- Thomas Potter
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | | | - Mauricio Tano
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States.,Department of Nuclear Engineering, Texas A&M University, College Station, TX, United States
| | - Alan Pan
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | - Jennifer Meeks
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Magdy Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Farhaan Vahidy
- Center for Outcomes Research, Houston Methodist Research Institute, Houston Methodist, Houston, TX, United States.,Neurological Institute, Houston Methodist, Houston, TX, United States
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21
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Aamodt EB, Schellhorn T, Stage E, Sanjay AB, Logan PE, Svaldi DO, Apostolova LG, Saltvedt I, Beyer MK. Predicting the Emergence of Major Neurocognitive Disorder Within Three Months After a Stroke. Front Aging Neurosci 2021; 13:705889. [PMID: 34489676 PMCID: PMC8418065 DOI: 10.3389/fnagi.2021.705889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/26/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Neurocognitive disorder (NCD) is common after stroke, with major NCD appearing in about 10% of survivors of a first-ever stroke. We aimed to classify clinical- and imaging factors related to rapid development of major NCD 3 months after a stroke, so as to examine the optimal composition of factors for predicting rapid development of the disorder. We hypothesized that the prediction would mainly be driven by neurodegenerative as opposed to vascular brain changes. Methods: Stroke survivors from five Norwegian hospitals were included from the "Norwegian COgnitive Impairment After STroke" (Nor-COAST) study. A support vector machine (SVM) classifier was trained to distinguish between patients who developed major NCD 3 months after the stroke and those who did not. Potential predictor factors were based on previous literature and included both vascular and neurodegenerative factors from clinical and structural magnetic resonance imaging findings. Cortical thickness was obtained via FreeSurfer segmentations, and volumes of white matter hyperintensities (WMH) and stroke lesions were semi-automatically gathered using FSL BIANCA and ITK-SNAP, respectively. The predictive value of the classifier was measured, compared between classifier models and cross-validated. Results: Findings from 227 stroke survivors [age = 71.7 (11.3), males = (56.4%), stroke severity NIHSS = 3.8 (4.8)] were included. The best predictive accuracy (AUC = 0.876) was achieved by an SVM classifier with 19 features. The model with the fewest number of features that achieved statistically comparable accuracy (AUC = 0.850) was the 8-feature model. These features ranked by their weighting were; stroke lesion volume, WMH volume, left occipital and temporal cortical thickness, right cingulate cortical thickness, stroke severity (NIHSS), antiplatelet medication intake, and education. Conclusion: The rapid (<3 months) development of major NCD after stroke is possible to predict with an 87.6% accuracy and seems dependent on both neurodegenerative and vascular factors, as well as aspects of the stroke itself. In contrast to previous literature, we also found that vascular changes are more important than neurodegenerative ones. Although possible to predict with relatively high accuracy, our findings indicate that the development of rapid onset post-stroke NCD may be more complex than earlier suggested.
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Affiliation(s)
- Eva Birgitte Aamodt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Till Schellhorn
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Edwin Stage
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Apoorva Bharthur Sanjay
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Paige E Logan
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Diana Otero Svaldi
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Liana G Apostolova
- Department of Neurology, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Mona Kristiansen Beyer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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22
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Tian D, Gao Q, Lin J, Chang Z, Wang Y, Shi Y, Su R, Han Z, Ma D. Uncovering the mechanism of the Shenzhi Jiannao formula against vascular dementia using a combined network pharmacology approach and molecular biology. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 90:153637. [PMID: 34273705 DOI: 10.1016/j.phymed.2021.153637] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Shenzhi Jiannao formula (SZJNF) is a herbal prescription which is used for detoxification, dredging collaterals, and activating blood circulation and Qi flow in traditional Chinese medicine. SZJNF is a clinical effective prescription for the treatment of vascular dementia (VD) first formulated based on the classical theory of traditional Chinese medicine, but its anti-VD mechanism remains ambiguous. PURPOSE The aim of this study was to elucidate the multi-target mechanisms of SZJNF against VD using a network pharmacology approach and verify its effects through biological experiments. STUDY DESIGN AND METHODS We utilized network pharmacology-based prediction and molecular docking techniques to uncover the potential micro-mechanism of SZJNF against VD. We identified active components and potential targets, and performed network analysis, functional annotation, and pathway enrichment analysis. Subsequently, glutamate-induced PC12 cells and VD rats were used to verify the molecular mechanisms of SZJNF. RESULTS Seventeen active compounds were identified in SZJNF rat plasma; moreover, 773 predicted targets and 1544 VD-related targets were found. Various networks, including the PPI, herb-compound-target, and compound-target-pathway network were constructed. A total of 188 shared targets were identified by network topological analysis, which were closely associated to the anti-VD effects of SZJNF. They were also enriched in various biological processes through hypoxia reaction, promotion of cell proliferation, inhibition of apoptosis, neuroactive ligand-receptor interaction, and calcium signaling pathway, as evaluated by the analysis of advanced functions and pathways. SZJNF components docked well with the key targets. Treatment with SZJNF promoted cell proliferation, ameliorated apoptosis and oxidative stress injury, and improved neurological and cognitive abilities. CONCLUSION This study comprehensively demonstrated the multi-target mechanisms of SZJNF in VD using network pharmacology and molecular biology experiments. This provides evidence for further mechanistic studies and for the development of SZJNF as a potential treatment for patients with VD.
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Affiliation(s)
- Danfeng Tian
- Beijing University of Chinese Medicine, Beijing, China
| | - Qiang Gao
- Beijing University of Chinese Medicine, Beijing, China
| | - Jingfeng Lin
- Beijing University of Chinese Medicine, Beijing, China
| | - Ze Chang
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuchun Wang
- Beijing University of Chinese Medicine, Beijing, China
| | - Yuanyuan Shi
- Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang), Shenzhen, China; School of Life Sciences, Beijing University of Chinese Medicine, Beijing, China
| | - Rui Su
- Department of Academic Research, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Zhenyun Han
- Shenzhen Hospital of Beijing University of Chinese Medicine (Longgang), Shenzhen, China.
| | - Dayong Ma
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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23
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Rost NS, Meschia JF, Gottesman R, Wruck L, Helmer K, Greenberg SM. Cognitive Impairment and Dementia After Stroke: Design and Rationale for the DISCOVERY Study. Stroke 2021; 52:e499-e516. [PMID: 34039035 PMCID: PMC8316324 DOI: 10.1161/strokeaha.120.031611] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Stroke is a leading cause of the adult disability epidemic in the United States, with a major contribution from poststroke cognitive impairment and dementia (PSCID), the rates of which are disproportionally high among the health disparity populations. Despite the PSCID's overwhelming impact on public health, a knowledge gap exists with regard to the complex interaction between the acute stroke event and highly prevalent preexisting brain pathology related to cerebrovascular and Alzheimer disease or related dementia. Understanding the factors that modulate PSCID risk in relation to index stroke event is critically important for developing personalized prognostication of PSCID, targeted interventions to prevent it, and for informing future clinical trial design. The DISCOVERY study (Determinants of Incident Stroke Cognitive Outcomes and Vascular Effects on Recovery), a collaborative network of thirty clinical performance clinical sites with access to acute stroke populations and the expertise and capacity for systematic assessment of PSCID will address this critical challenge. DISCOVERY is a prospective, multicenter, observational, nested-cohort study of 8000 nondemented ischemic and hemorrhagic stroke patients enrolled at the time of index stroke and followed for a minimum of 2 years, with serial cognitive evaluations and assessments of functional outcome, with subsets undergoing research magnetic resonance imaging and positron emission tomography and comprehensive genetic/genomic and fluid biomarker testing. The overall scientific objective of this study is to elucidate mechanisms of brain resilience and susceptibility to PSCID in diverse US populations based on complex interplay between life-course exposure to multiple vascular risk factors, preexisting burden of microvascular and neurodegenerative pathology, the effect of strategic acute stroke lesions, and the mediating effect of genomic and epigenomic variation.
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Affiliation(s)
- Natalia S. Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | | | | | | | - Karl Helmer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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24
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Impacts of stroke and cognitive impairment on activities of daily living in the Taiwan longitudinal study on aging. Sci Rep 2021; 11:12199. [PMID: 34108582 PMCID: PMC8190118 DOI: 10.1038/s41598-021-91838-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke and cognitive impairment are common in older population. They often occur together and their combined effects significantly increase disability in both basic (BADLs) and instrumental (IADLs) activities of daily living. We investigated the individual and combined impacts of stroke and cognitive impairment on BADLs and IADLs. A total of 3331 community-dwelling older adults were enrolled from the Taiwan longitudinal study on aging in 2011. Both BADLs and IADLs were analyzed. Combination of stroke and cognitive impairment increased severity of ADL disabilities, but similar prevalence, similar numbers of summed BADL and IADL tasks with disability, and similar levels of difficulty for each BADL and IADL task were found between the stroke group and cognitive impairment group. The former had more difficult in dressing while the latter had more difficult in using the telephone, transport, and managing finances. A hierarchy of ADLs was also observed in all groups. ADL skill training supplemented with cognitive and physical interventions should focus on secondary prevention of dementia and improve motor functional capacity to reduce loss of ADLs.
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25
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Menon RN, Varghese F, Paplikar A, Mekala S, Alladi S, Sharma M, Aralikatte Onkarappa S, Gollahalli D, Dutt A, Ghosh A, Dhaliwal RS, Hooda R, Iyer GK, Justus S, Kandukuri R, Kaul S, Banu Khan A, Nandi R, Narayanan J, Nehra A, Vasantha PM, Pauranik A, Mathew R, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Padmavathy Narayana S, Varma RP, Verma M, Vishwanath Y. Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society. Dement Geriatr Cogn Disord 2021; 49:355-364. [PMID: 33412549 DOI: 10.1159/000512393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. METHODS Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. RESULTS Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of -0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI. CONCLUSIONS The ICMR-NCTB is a "first of its kind" approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.
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Affiliation(s)
- Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India,
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shailaja Mekala
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | - Divyaraj Gollahalli
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Aparna Dutt
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India.,Duttanagar Mental Health Centre, Neuropsychology & Clinical Psychology Unit, Duttanagar, Kolkata, India
| | - Amitabha Ghosh
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Roopa Hooda
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Indian Institute of Public Health, Hyderabad, India
| | - Sunitha Justus
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rajmohan Kandukuri
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Arfa Banu Khan
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Ranita Nandi
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Ashima Nehra
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Padma M Vasantha
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | | | - Robert Mathew
- Department of Neurology, Sree Mookambika Institute of Medical Sciences, Tamil Nadu, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Manjari Tripathi
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Sylaja Padmavathy Narayana
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
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26
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Serotonin Levels and Cognitive Recovery in Patients with Subacute Stroke after Rehabilitation Treatment. Brain Sci 2021; 11:brainsci11050642. [PMID: 34063444 PMCID: PMC8156601 DOI: 10.3390/brainsci11050642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Post-stroke depression and cognitive impairment are common conditions affecting patients after stroke. Serotonin is a neurotransmitter involved in modulating, among others, mood, cognition, learning, and memory. Sub-optimal serotonin activity may be in part responsible for cognitive deficits seen in depression. In this pilot study serotonin levels were evaluated in 29 patients with sub-acute stroke before and after a rehabilitation treatment (consisting of a program of upper limb robotic rehabilitation in addition to conventional physical therapy treatment). We employed the Back Depression Inventory scale to evaluate symptoms of depression, and specific tools to evaluate cognitive functions. We found a significant reduction of the serotonin levels after rehabilitation in the whole group (T0: 85.9 ± 92.4 ng/mL; T1: 61.9 ± 58.4 ng/mL; p = 0.0018), as well as in the subgroup of patients untreated with Selective Serotonin Reuptake Inhibitors (SRRI), (mean serotonin at T0: 154.0 ± 102.3 ng/mL; mean serotonin at T1: 92.9. ± 68.7 ng/mL at T1; p = 0.005). We also found a correlation with cognitive assessment: in particular, the change from baseline of the serotonin (ΔSerotonin) was correlated with the changes from baseline of the Rey’s Figure (ΔROCF) (r = 0.535; p < 0.05), the Tower of London (ΔToL) (subscore point: r = 0.621; p < 0.005; subscore time: r = −0.619; p < 0.005) meaning that a serotonin levels decrease is associated with a worsening of cognitive functions. Considering patients treated and untreated with SSRIs separately, in patients treated with SSRIs (n = 16) we found only a positive correlation between ∆Serotonin and ∆ToL (subscore point: r= 0.587; p = 0.045), whereas in patients untreated with SSRIs (n = 13) we found a positive correlations between ΔSerotonin and ΔROCF (r = 0.700; p = 0.036), ∆Stroop (subscore time: r = 0.750; p = 0.020) and ∆Tol (subscore point: r = 0.740; p = 0.023) and a negative correlation between ΔSerotonin and ∆Tol (subscore time: r= −0.833; p = 0.005). These results suggest that variation of serotonin levels should be monitored in patients during a rehabilitation program, not only for their relationship with depression symptoms, but also for the correlation with cognitive performance.
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27
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Eschweiler M, Bohr L, Kessler J, Fink GR, Kalbe E, Onur OA. Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study. NeuroRehabilitation 2021; 48:97-108. [PMID: 33386825 DOI: 10.3233/nre-201583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.
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Affiliation(s)
- Mareike Eschweiler
- Medical Faculty and University Hospital Cologne, Department of Medical Psychology, Neuropsychology & Gender Studies and Center for Neuropsychological Diagnostic and Intervention (CeNDI), Kerpener Str. 62, Cologne, Germany.,Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany.,University Cologne, Medical Faculty, study program clinical and experimental neuroscience, Josef-Stelzmann-Str. 20, Germany.,Neurological Rehabilitation Center Godeshoehe e.V., Department of Therapeutic Science, Waldstr. 2-10, Bonn, Germany
| | - Lara Bohr
- Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany.,University Cologne, Medical Faculty, study program clinical and experimental neuroscience, Josef-Stelzmann-Str. 20, Germany
| | - Josef Kessler
- Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany
| | - Gereon R Fink
- Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany.,Research Center Jülich, Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Leo-Brandt-Straße, Jülich, Germany
| | - Elke Kalbe
- Medical Faculty and University Hospital Cologne, Department of Medical Psychology, Neuropsychology & Gender Studies and Center for Neuropsychological Diagnostic and Intervention (CeNDI), Kerpener Str. 62, Cologne, Germany
| | - Oezguer A Onur
- Medical Faculty and University Hospital Cologne, Department of Neurology, Kerpener Str. 62, Cologne, Germany.,Research Center Jülich, Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Leo-Brandt-Straße, Jülich, Germany
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28
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Xu Y, Yi L, Lin Y, Peng S, Wang W, Lin W, Chen P, Zhang W, Deng Y, Guo S, Shi L, Wang Y, Molloy DW, O'Caoimh R. Screening for Cognitive Impairment After Stroke: Validation of the Chinese Version of the Quick Mild Cognitive Impairment Screen. Front Neurol 2021; 12:608188. [PMID: 33763012 PMCID: PMC7982853 DOI: 10.3389/fneur.2021.608188] [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: 09/30/2020] [Accepted: 02/11/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Screening for post-stroke cognitive impairment (PSCI) is necessary because stroke increases the incidence of and accelerates premorbid cognitive decline. The Quick Mild Cognitive Impairment (Qmci) screen is a short, reliable and accurate cognitive screening instrument but is not yet validated in PSCI. We compared the diagnostic accuracy of a Chinese version of the Qmci screen (Qmci-CN) compared with the widely-used Chinese versions of the Montreal Cognitive Assessment (MoCA-CN) and Mini-Mental State Examination (MMSE-CN). Methods: We recruited 34 patients who had recovered from a stroke in rehabilitation unit clinics in 2 university hospitals in China: 11 with post-stroke dementia (PSD), 15 with post-stroke cognitive impairment no dementia (PSCIND), and 8 with normal cognition (NC). Classification was made based on clinician assessment supported by a neuropsychological battery, independent of the screening test scores. The Qmci-CN, MoCA-CN, and MMSE-CN screens were administered randomly by a trained rater, blind to the diagnosis. Results: The mean age of the sample was 63 ± 13 years and 61.8% were male. The Qmci-CN had statistically similar diagnostic accuracy in differentiating PSD from NC, an area under the curve (AUC) of 0.94 compared to 0.99 for the MoCA-CN (p = 0.237) and 0.99 for the MMSE-CN (p = 0.293). The Qmci-CN (AUC 0.91), MoCA-CN (AUC 0.94), and MMSE-CN (AUC 0.79) also had statistically similar accuracy in separating PSD from PSCIND. The MoCA-CN more accurately distinguished between PSCIND and normal cognition than the Qmci-CN (p = 0.015). Compared to the MoCA-CN, the administration times of the Qmci-CN (329s vs. 611s, respectively, p < 0.0001) and MMSE-CN (280 vs. 611s, respectively, p < 0.0001) were significantly shorter. Conclusion: The Qmci-CN is accurate in identifying PSD and separating PSD from PSCIND in patients post-stroke following rehabilitation and is comparable to the widely-used MoCA-CN, albeit with a significantly shorter administration time. The Qmci-CN had relatively poor accuracy in identifying PSCIND from NC and hence may lack accuracy for certain subgroups. However, given the small sample size, the study is under-powered to show superiority of one instrument over another. Further study is needed to confirm these findings in a larger sample size and in other settings (countries and languages).
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Affiliation(s)
- Yangfan Xu
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lingrong Yi
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yangyang Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suiying Peng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiming Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wujian Lin
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peize Chen
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weichao Zhang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yujie Deng
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Suimin Guo
- Center for Child Health and Mental Health, Shenzhen Children's Hospital, Shenzhen, China
| | - Le Shi
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarr's Hospital, Cork, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
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Cognitive Impairment After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 148:141-162. [PMID: 33482414 DOI: 10.1016/j.wneu.2021.01.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The present systematic review and meta-analysis analyzes the available clinical literature on post-intracerebral hemorrhage (ICH) cognitive impairment. METHODS We conducted a systematic review with meta-analysis following PRISMA guidelines. A search of bibliographic databases up to July 31, 2020 yielded 2155 studies. Twenty articles were included in our final qualitative systematic review and 18 articles in quantitative meta-analysis. RESULTS Based on analysis of data from 18 studies (3270 patients), we found prevalence of post-ICH cognitive impairment to be 46% (confidence interval, 35.9-55.9), with a follow-up duration ranging from 8 days to 4 years. The estimated pooled prevalence of cognitive decline decreased over longitudinal follow-up, from 55% (range, 37.7%-71.15%) within 6 months of ICH to 35% (range, 27%-42.7%) with >6 months to 4 years follow-up after ICH. The modalities used to evaluate cognitive performance after ICH in studies varied widely, ranging from global cognitive measures to domain-specific testing. The cognitive domain most commonly affected included nonverbal IQ, information processing speed, executive function, memory, language, and visuoconstructive abilities. Prognostic factors for poor cognitive performance included severity of cortical atrophy, age, lobar ICH location, and higher number of hemorrhages at baseline. CONCLUSIONS The prevalence of post-ICH cognitive impairment is high. Despite the heterogeneity among studies, the present study identified cognitive domains most commonly affected and predictors of cognitive impairment after ICH. In future, prospective cohort studies with larger sample sizes and standardized cognitive domains testing could more accurately determine prevalence and prognostic factors of post-ICH cognitive decline.
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Kuvås KR, Saltvedt I, Aam S, Thingstad P, Ellekjær H, Askim T. The Risk of Selection Bias in a Clinical Multi-Center Cohort Study. Results from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) Study. Clin Epidemiol 2020; 12:1327-1336. [PMID: 33293871 PMCID: PMC7718873 DOI: 10.2147/clep.s276631] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/30/2020] [Indexed: 01/13/2023] Open
Abstract
Purpose The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study aimed to estimate the prevalence and incidence of neurocognitive disorder in an unselected stroke cohort. The aim of the present study was to investigate whether selection bias occurred by comparing baseline characteristics from participants with non-participants in Nor-COAST. Patients and Methods Nor-COAST is a prospective cohort multi-center study, recruiting participants from five Norwegian hospitals. Patients with the diagnosis of acute stroke were screened for inclusion. Baseline data from the participants recruited between May 2015 and March 2017 were compared to corresponding data from those not participating in Nor-COAST but registered in the Norwegian Stroke Registry. Regression analysis was used to assess whether age, stroke severity, sex and stroke subtype were independently associated with inclusion in the study. Results Out of 2505 available patients, 815 (32.5%) were included in Nor-COAST. There were no differences between participants and non-participants with respect to age (mean (SD) age 73.5 (11.7) versus 74.2 (14.5) years) or sex (44.8% versus 46.9% women). A significantly larger proportion of the participants were independent prior to stroke (87% versus 78%), had mild strokes (69% versus 55%) and suffered from cerebral infarction (90% versus 84%). The regression analysis showed decreased odds ratio (OR) of being included for those with higher degree of pre-stroke dependency (OR 0.895, 95% CI 0.825 to 0.971, p=0.007) and a more severe stroke (OR 0.952, 95% CI 0.939 to 0.966, p<0.001). Conclusion The participants in Nor-COAST had a better pre-stroke health condition and milder strokes compared to non-participants. However, the participants should be regarded as representative of the majority of the stroke population which suffers from mild strokes. Nevertheless, baseline information for non-participants should be available also in future clinical studies to make it easier to identify which part of the stroke population the results can be generalized to.
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Affiliation(s)
- Karen Rosmo Kuvås
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Health and Social Services, City of Trondheim, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway.,Department of Stroke, Clinic of Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Ponomarenko M, Sharypova E, Drachkova I, Chadaeva I, Arkova O, Podkolodnaya O, Ponomarenko P, Kolchanov N, Savinkova L. Unannotated single nucleotide polymorphisms in the TATA box of erythropoiesis genes show in vitro positive involvements in cognitive and mental disorders. BMC MEDICAL GENETICS 2020; 21:165. [PMID: 33092544 PMCID: PMC7579878 DOI: 10.1186/s12881-020-01106-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hemoglobin is a tetramer consisting of two α-chains and two β-chains of globin. Hereditary aberrations in the synthesis of one of the globin chains are at the root of thalassemia, one of the most prevalent monogenic diseases worldwide. In humans, in addition to α- and β-globins, embryonic zeta-globin and fetal γ-globin are expressed. Immediately after birth, the expression of fetal Aγ- and Gγ-globin ceases, and then adult β-globin is mostly expressed. It has been shown that in addition to erythroid cells, hemoglobin is widely expressed in nonerythroid cells including neurons of the cortex, hippocampus, and cerebellum in rodents; embryonic and adult brain neurons in mice; and mesencephalic dopaminergic brain cells in humans, mice, and rats. Lately, there is growing evidence that different forms of anemia (changes in the number and quality of blood cells) may be involved in (or may accompany) the pathogenesis of various cognitive and mental disorders, such as Alzheimer's and Parkinson's diseases, depression of various severity levels, bipolar disorders, and schizophrenia. Higher hemoglobin concentrations in the blood may lead to hyperviscosity, hypovolemia, and lung diseases, which may cause brain hypoxia and anomalies of brain function, which may also result in cognitive deficits. METHODS In this study, a search for unannotated single-nucleotide polymorphisms (SNPs) of erythroid genes was initially performed using our previously created and published SNP-TATA_Z-tester, which is a Web service for computational analysis of a given SNP for in silico estimation of its influence on the affinity of TATA-binding protein (TBP) for TATA and TATA-like sequences. The obtained predictions were finally verified in vitro by an electrophoretic mobility shift assay (EMSA). RESULTS On the basis of these experimental in vitro results and literature data, we studied TATA box SNPs influencing both human erythropoiesis and cognitive abilities. For instance, TBP-TATA affinity in the HbZ promoter decreases 6.6-fold as a result of a substitution in the TATA box (rs113180943), thereby possibly disrupting stage-dependent events of "switching" of hemoglobin genes and thus causing erythroblastosis. Therefore, rs113180943 may be a candidate marker of severe hemoglobinopathies with comorbid cognitive and mental disorders associated with cerebral blood flow disturbances. CONCLUSIONS The literature data and experimental and computations results suggest that the uncovered candidate SNP markers of erythropoiesis anomalies may also be studied in cohorts of patients with cognitive and/or mental disorders with comorbid erythropoiesis diseases in comparison to conventionally healthy volunteers. Research into the regulatory mechanisms by which the identified SNP markers contribute to the development of hemoglobinopathies and of the associated cognitive deficits will allow physicians not only to take timely and adequate measures against hemoglobinopathies but also to implement strategies preventing cognitive and mental disorders.
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Affiliation(s)
- Mikhail Ponomarenko
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia. .,Novosibirsk State University, 1 Pirogova Street, Novosibirsk, 630090, Russia.
| | - Ekaterina Sharypova
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Irina Drachkova
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Irina Chadaeva
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Olga Arkova
- Institute of Gene Biology Russian Academy of Sciences, 34/5 Vavilova Street, Moscow, 119334, Russia
| | - Olga Podkolodnaya
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Petr Ponomarenko
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Nikolay Kolchanov
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
| | - Ludmila Savinkova
- Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences, 10 Lavrentyev Ave, Novosibirsk, 630090, Russia
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Hestad K, Engedal K, Horndalsveen P, Strand BH. Blood Pressure in Different Dementia Disorders, Mild Cognitive Impairment, and Subjective Cognitive Decline. Front Aging Neurosci 2020; 12:257. [PMID: 33110409 PMCID: PMC7488384 DOI: 10.3389/fnagi.2020.00257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/24/2020] [Indexed: 01/01/2023] Open
Abstract
The aim of the study was to investigate whether blood pressure (BP) differed among people with different dementia diagnoses, mild cognitive impairment, and subjective cognitive decline and whether BP differences were observed across age and sex. Our study population comprised clinical data from 6,236 patients (53.5% women) aged 45–97 years (Mean = 73.9, SD = 9.6) referred to dementia assessment in 42 outpatient clinics across Norway during 2009–2019. Patients with the following diagnoses were included: Subjective cognitive decline (SCD), Mild cognitive impairment (MCI), dementia due to Alzheimer’s disease (AD), Vascular dementia (VaD), mixed AD and VaD, and dementia in Parkinson’s disease/Lewy body disease (PDD/LBD). For all diagnostic groups, SBP increased with age until about 80 years, after which it trended downward, whereas DBP declined after 60 years of age for all diagnostic groups. Patients aged 65 years and younger with SCD had lower SBP compared to AD patients at the same age, but SBP increased rapidly with increasing age, resulting in a substantially higher SBP at 80 + years compared with all other diagnostic groups. No other differences in SBP or diastolic blood pressure (DBP) were found among patients with the different dementia diagnosis. Neither SBP nor DBP differed between MCI and AD groups. An interaction between age and gender was found for SBP at younger ages, as women started out with a lower pressure than men did but ended up with higher SBP.
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Affiliation(s)
- Knut Hestad
- Department of Health- and Nursing Science, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Department of Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Horndalsveen
- Department of Old Age Psychiatry, Innlandet Hospital Trust, Ottestad, Norway
| | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold County Hospital Trust, Tønsberg, Norway.,Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Hagberg G, Ihle-Hansen H, Fure B, Thommessen B, Ihle-Hansen H, Øksengård AR, Beyer MK, Wyller TB, Müller EG, Pendlebury ST, Selnes P. No evidence for amyloid pathology as a key mediator of neurodegeneration post-stroke - a seven-year follow-up study. BMC Neurol 2020; 20:174. [PMID: 32384876 PMCID: PMC7206753 DOI: 10.1186/s12883-020-01753-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/29/2020] [Indexed: 12/24/2022] Open
Abstract
Background Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol (18F-Flut) positron emission tomography (PET), is common in seven-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18F-Flut-PET uptake after 7 years correlates with amyloid-β peptide (Aβ42) levels in cerebrospinal fluid (CSF) at 1 year, and with measures of neurodegeneration and cognition at 7 years post-stroke. Methods 208 patients with first-ever stroke or transient Ischemic Attack (TIA) without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or normal. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At 7 years, patients were offered 18F-Flut-PET, and amyloid-positivity was assessed visually and semi-quantitatively. The associations between 18F-Flut-PET standardized uptake value ratios (SUVr) and measures of neurodegeneration (medial temporal lobe atrophy (MTLA), global cortical atrophy (GCA)) and cognition (Mini-Mental State Exam (MMSE), Trail-making test A (TMT-A)) and CSF Aβ42 levels were assessed using linear regression. Results In total, 111 patients completed 7-year follow-up, and 26 patients agreed to PET imaging, of whom 13 had CSF biomarkers from 1 year. Thirteen out of 26 patients were diagnosed with CI 7 years post-stroke, but only one had visually assessed amyloid positivity. CSF Aβ42 levels at 1 year, MTA grade, GCA scale, MMSE score or TMT-A at 7 years did not correlate with 18F-Flut-PET SUVr in this cohort. Conclusions Amyloid binding was not common in 7-year stroke survivors diagnosed with CI. Quantitatively assessed, cortical amyloid deposition did not correlate with other measures related to neurodegeneration or cognition. Therefore, amyloid pathology may not be a key mediator of neurodegeneration 7 years post-stroke. Trial registration Clinicaltrials.gov (NCT00506818). July 23, 2007. Inclusion from February 2007, randomization and intervention from May 2007 and trial registration in July 2007.
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Affiliation(s)
- Guri Hagberg
- Bærum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hege Ihle-Hansen
- Bærum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Brynjar Fure
- Department of Neurology, Department of Internal Medicine, Central Hospital Karlstad and Faculty of Medicine, Örebro University, Örebro, Sweden
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Oslo, Norway
| | - Håkon Ihle-Hansen
- Bærum Hospital, Vestre Viken Hospital Trust, N-3004, Drammen, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Mona K Beyer
- Division of Radiology, Nuclear Medicine Oslo University Hospital, Oslo, Norway
| | - Torgeir B Wyller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Ebba Gløersen Müller
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Per Selnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Akershus University Hospital, Oslo, Norway
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Hagberg G, Fure B, Thommessen B, Ihle-Hansen H, Øksengård AR, Nygård S, Pendlebury ST, Beyer MK, Wyller TB, Ihle-Hansen H. Predictors for Favorable Cognitive Outcome Post-Stroke: A-Seven-Year Follow-Up Study. Dement Geriatr Cogn Disord 2020; 48:45-55. [PMID: 31461703 DOI: 10.1159/000501850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Knowledge of the burden and development of post-stroke cognitive impairments (CIs) in the long-term after the first event is limited. We aimed to assess the prevalence of mild CI (MCI) and dementia 7 years after first-ever stroke or transient ischemic attack (TIA), to subclassify the impairments, and to identify predictors for a favorable cognitive outcome. MATERIALS AND METHODS During 2007 and 2008, 208 patients with first-ever stroke or TIA without preexisting CI were included. After 1 and 7 years, survivors were invited to a follow-up. Transitions of cognitive status from 1 to 7 years were recorded based on the 3 categories dementia, MCI, or none. Etiologic subclassification was based on clinical cognitive profile, magnetic resonance imaging (MRI) findings, and biomarkers at both time points. Favorable outcome was defined as normal cognitive function or MCI after 7 years with exclusion of those who had progression from normal to MCI. RESULTS Eighty patients died during follow-up, 12 patients refused further participation. After 7 years, 109 completed follow-up of whom 40 (37%) were diagnosed with MCI and 24 (22%) with dementia. Of the 64 patients diagnosed with CI, 9 were subclassified with degenerative cognitive disease, 13 with vascular disease, and 42 had mixed cognitive disease. In all, 65 patients (60%) had a favorable outcome. In multivariable logistic regression analysis, lower age and lower medial temporal lobe atrophy (MTLA) grade on MRI at 12 months were independently associated with a favorable outcome, adjusted OR (95% CI), 0.94 (0.86-0.92), and 0.55 (0.35-0.85), respectively. CONCLUSIONS Sixty percent of stroke survivors have a favorable cognitive outcome. Lower age and lower MTLA grade on MRI were associated with favorable outcome.
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Affiliation(s)
- Guri Hagberg
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway,
| | - Brynjar Fure
- Department of Internal Medicine, Karlstad Central Hospital and Institute of Public Health, University of Tromsoe, Tromsoe, Norway
| | - Bente Thommessen
- Department of Neurology, Akershus University Hospital, Akershus, Norway
| | - Håkon Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne-Rita Øksengård
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway
| | - Ståle Nygård
- Bioinformatics Core Facility, Institute for Cancer Research, Oslo University Hospital and Department of Informatics, University of Oslo, Oslo, Norway
| | - Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Mona K Beyer
- Department of Radiology and Nuclear Medicine and Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege Ihle-Hansen
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Li J, Wang J, Wu B, Xu H, Wu X, Zhou L, Deng B. Association Between Early Cognitive Impairment and Midterm Functional Outcomes Among Chinese Acute Ischemic Stroke Patients: A Longitudinal Study. Front Neurol 2020; 11:20. [PMID: 32174878 PMCID: PMC7054458 DOI: 10.3389/fneur.2020.00020] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/08/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Cognitive decline is common after stroke. The influence of early cognitive impairment on midterm functional outcomes among Chinese acute ischemic stroke (AIS) patients has not been fully studied. The aim of the study was to assess the association between early cognitive impairment and midterm functional outcomes among Chinese AIS patients. Methods: A longitudinal survey focusing on Chinese AIS patients was conducted in three stroke centers in Shanghai, China (July to December 2016). A total of 185 eligible patients were interviewed at acute stage and at 1, 3, and 6 months after onset. Patients' functional outcomes were measured by modified Rankin Scale (mRS) and Barthel Index (BI) at each time point. Cognitive function was assessed using Montreal Cognitive Assessment, Changsha version (MoCA-CS), within 7 days after stroke onset. Covariates included patient's demographic characteristics, socioeconomic status, clinical characteristics of stroke, vascular risk factors, receiving rehabilitation after discharge from acute hospital, and recurrence. Generalized linear mixed models and general linear mixed models were applied. Results: The prevalence of cognitive impairment at acute stage of stroke among these patients was 88.1%. The risk of disability (mRS 2–5) of all patients after stroke decreased over time (OR = 0.491, 95% CI = 0.401–0.603). The risk of disability among those with cognitive impairment increased compared with those with normal cognition (OR = 7.384, 95% CI = 1.041–52.407). The BI score of all patients increased over time after controlling for covariates (β = 1.51, p < 0.01). The BI score of those with cognitive impairment was lower than that with normal cognition over the follow-up period after controlling for other covariates (β = −8.11, p < 0.05). Conclusions: This study showed that early cognitive impairment was associated with higher risk of disability and poor activity of daily living (ADL) among Chinese AIS patients. Further studies are needed to examine the linkage between multi-domain cognitive impairment and long-term disability and ADL among stroke survivors by using neuropsychological test batteries.
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Affiliation(s)
- Juan Li
- Naval Military Medical University School of Nursing, Shanghai, China
| | - Jing Wang
- Fudan University School of Nursing, Shanghai, China
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY, United States
| | - Hanzhang Xu
- Duke University School of Nursing, Durham, NC, United States.,Duke University School of Medicine, Durham, NC, United States
| | - Xiongfeng Wu
- Stroke Center, Changhai Hospital Affiliated to Naval Military Medical University, Shanghai, China
| | - Lanshu Zhou
- Naval Military Medical University School of Nursing, Shanghai, China
| | - Benqiang Deng
- Stroke Center, Changhai Hospital Affiliated to Naval Military Medical University, Shanghai, China
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Baccaro A, Wang YP, Brunoni AR, Candido M, Conforto AB, da Costa Leite C, Lotufo PA, Benseñor IM, Goulart AC. Does stroke laterality predict major depression and cognitive impairment after stroke? Two-year prospective evaluation in the EMMA study. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109639. [PMID: 31075348 DOI: 10.1016/j.pnpbp.2019.109639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022]
Abstract
Depression and cognitive impairment are common conditions following stroke. We aimed to evaluate stroke laterality as predictor of post-stroke depression (PSD) and cognitive impairment (PCI) in a stroke cohort. Major depression (Patient Health Questionnaire-9, score ≥ 10) and cognitive impairment (Modified Telephone Interview for Cognitive Status, score < 14) were evaluated at 6 months and yearly up to 2 years. Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models, adjusted for potential confounders (cumulative hazard ratio, HR; 95% confidence interval, CI), for the likelihood of subsequent PSD or PCI progression at 6 months and 2 years, according to stroke laterality (right hemisphere-reference). Among 100 stroke patients, we found 19% had PSD and 38% had PCI 2 years after stroke. Most participants (53%) presented right-sided stroke. However, right-sided stroke was not associated with PSD or PCI. Overall, left-sided stroke was an independent and long-term predictor of PCI, but not of major depression. Left-sided stroke was associated with a high probability of PCI (42.6% and 53.2%, respectively at 6 months and 2 years, p-log-rank: 0.002). The HR of PCI due to left-sided stroke was 3.25 (95%CI, 1.30-8.12) at 6 months and remained almost the same at 2 years (HR,3.22;95%CI, 1.43-7.28). The risk of having worse cognition status increased by >3 times, 2 years after stroke. The results support the hypothesis that involvement of networks in the left, but not in the right hemisphere, contribute to long-term cognitive impairment. Lesion laterality did not influence the risk of PSD.
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Affiliation(s)
- Alessandra Baccaro
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil.
| | - Yuan-Pang Wang
- Institute of Psychiatry, Hospital das Clínicas, Medical School, University of São Paulo, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Medical School, University of São Paulo, Brazil
| | - André Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil; Institute of Psychiatry, Hospital das Clínicas, Medical School, University of São Paulo, Brazil
| | - Miriam Candido
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil
| | - Adriana Bastos Conforto
- Department of Neurology, Hospital das Clínicas, Medical School, University of São Paulo, Brazil
| | - Claudia da Costa Leite
- Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), University of São Paulo, Brazil; Medical School, University of São Paulo, Brazil; Institute of Radiology and Oncology, Hospital das Clínicas, University of São Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil; Medical School, University of São Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil; Medical School, University of São Paulo, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil
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Saa JP, Tse T, Baum C, Cumming T, Josman N, Rose M, Carey L. Longitudinal evaluation of cognition after stroke - A systematic scoping review. PLoS One 2019; 14:e0221735. [PMID: 31465492 PMCID: PMC6715188 DOI: 10.1371/journal.pone.0221735] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cognitive impairment affects up to 80 percent of the stroke population, however, both the available evidence about post-stroke cognition and the measures used to evaluate it longitudinally have not been well described. The aims of this systematic scoping review were: to identify and characterize studies evaluating cognition longitudinally after stroke; to summarize the cognitive instruments used and the domains they target; and to organize cognitive domains assessed using the International Classification of Functioning, Disability and Health (ICF). METHODS We used a systematic scoping approach to search for peer-reviewed articles involving adults with stroke that evaluated cognition longitudinally. Screening of titles, abstracts, and full reports was completed independently by two reviewers, across six electronic databases (PubMed, PsycInfo, Medline, Cinahl Plus, Embase, and Web of Science). Cognitive domains were mapped to an ICF function independently by the same two reviewers, using a previously tested, standardized approach. RESULTS A total of 5,540 records were found; 257 were included, representing a total pooled sample of 120,860 stroke survivors. Of these studies, 200 (78%) provided specific cognitive outcomes from the longitudinal evaluations, 57 (22%) reported model predictions, and 77 (30%) included interventions. Cognition was evaluated with 356 unique instruments, targeting 95 distinct cognitive domains, and 17 mental functions from the ICF. The Mini-Mental State Examination was the most frequently used instrument (117 reports, 46%). Other tools used longitudinally were the Trail Making Test (17% of reports), tests of verbal fluency (14%), the Functional Independence Measure (14%), the Montreal Cognitive Assessment (13%), the Digit Span (11%), and the Stroop test (10%). Global cognition was evaluated in 170 reports (66%), followed by higher-level cognitive functioning (29%), memory (28%), language (21%), attention (21%), and perceptual skills (14%). Studies using functional (or performance-based) cognitive assessments over time were scarce (< 1%). CONCLUSION Our findings indicate that whilst there is a substantial number of studies available that report longitudinal evaluations of cognition after stroke, there is large variability in the measures used and the cognitive domains they target. Nonetheless, the available data for evaluation of cognition over time after stroke can be organized and described systematically.
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Affiliation(s)
- Juan Pablo Saa
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Tamara Tse
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Carolyn Baum
- Occupational Therapy, Washington University School of Medicine, Saint Louis, Missouri, United States of America
- George Warren Brown School of Social Work, Washington University in Saint Louis, Saint Louis, Missouri, United States of America
| | - Toby Cumming
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Naomi Josman
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Miranda Rose
- Speech Pathology, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science Health and Engineering, La Trobe University, Melbourne, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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Barbay M, Diouf M, Roussel M, Godefroy O. Systematic Review and Meta-Analysis of Prevalence in Post-Stroke Neurocognitive Disorders in Hospital-Based Studies. Dement Geriatr Cogn Disord 2019; 46:322-334. [PMID: 30504699 DOI: 10.1159/000492920] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Post-stroke neurocognitive disorders (post-stroke NCD) have been reported with a very variable prevalence. METHODS Based on a systematic literature search, hospital-based studies published between January 1990 and September 2015 were selected when they reported the prevalence of total, mild, and major post-stroke NCD diagnosed by using specified criteria. Factors affecting prevalence were assessed using meta-regression analysis. RESULTS Among the 7,440 references evaluated, 16 hospital-based studies were selected, corresponding to a total of 3,087 patients. The overall prevalence of total post-stroke NCD was 53.4% (95% CI: 46.9-59.8): 36.4% for mild post-stroke NCD (95% CI: 29-43.8) and 16.5% (95% CI: 12.1-20.8) for major post-stroke NCD. The overall prevalence was mainly influenced by the threshold score used for categorization (p = 0.0001) and, in the subgroup of studies using a conservative threshold (i.e., ≤7th percentile), by the recurrent stroke rate (p = 0.0005). The prevalence of major post-stroke NCD was mainly influenced by age (p = 0.003). CONCLUSION More than half of stroke survivors experience post-stroke NCD, corresponding to mild post-stroke NCD in two-thirds of cases and major post-stroke NCD in one-third of cases. Harmonization of stroke assessment and cognitive score thresholds is urgently needed to allow more accurate estimation of post-stroke NCD prevalence, especially mild post-stroke NCD.
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Affiliation(s)
- Mélanie Barbay
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France,
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
| | - Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
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Tarasova IV, Trubnikova OA, Barbarash OL. EEG and Clinical Factors Associated with Mild Cognitive Impairment in Coronary Artery Disease Patients. Dement Geriatr Cogn Disord 2019; 46:275-284. [PMID: 30404079 DOI: 10.1159/000493787] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although an impaired cognitive status in patients with coronary artery disease (CAD) is not rare, the neurophysiological and clinical indicators of mild cognitive impairment (MCI) have been insufficiently investigated so far. METHODS EEG and neuropsychological testing as well as clinical examination were performed on 122 patients with CAD, who were divided into two groups, those with MCI (n = 60; mean age 57.4 ± 5.81 years) and those without MCI (n = 62; mean age 57.0 ± 5.04 years). Binary logistic regression was used to identify the relationship between EEG and clinical variables and the probability of MCI. RESULTS Higher theta/alpha ratios, theta1 rhythm power with closed eyes in the frontal and occipital areas of the left hemisphere, and alpha2 rhythm power with eyes open in the frontal areas of the right hemisphere were associated with an increased risk for MCI in CAD patients. A low educational level, type 2 diabetes mellitus, and severe coronary lesions according to the SYNTAX Score (≥23 points) increased the risk for MCI as well. CONCLUSIONS The findings of our study show that a theta activity increase in frontal and occipital sites, as well as high theta/alpha ratios, may be considered as the earliest EEG markers of vascular cognitive disorders.
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Affiliation(s)
- Irina V Tarasova
- Department of Cardiovascular Diagnostics, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation,
| | - Olga A Trubnikova
- Department of Multifocal Atherosclerosis, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation
| | - Olga L Barbarash
- Department of Multifocal Atherosclerosis, Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Kemerovo, Russian Federation
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Kovalenko EA, Bogolepova AN, Katunin DA. [The role of pre-stroke cognitive disorders in the formation of post-stroke cognitive impairment]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 117:19-24. [PMID: 29411741 DOI: 10.17116/jnevro201711712219-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To identify pre-stroke cognitive disorders and assess their influence on the post-stroke neuropsychological status of the patient. MATERIAL AND METHODS The study included 103 patients in an acute state of ischemic stroke in the carotid system. Cognitive functions were assessed with MoCA and IQCODE. All patients are evaluated for the presence of vascular risk factors and their relationship to the cognitive impairment. RESULTS AND CONCLUSION According to the MoCA, 89 (86.4%) patients in the acute state of ischemic stroke had cognitive impairment of varying severity. Out of 103 patients, 55 (53.4%) had cognitive impairment prior to onset of stoke, mostly of mild severity. Among the main risk factors that correlated with the presence of pre-stroke cognitive impairment were age, heart rhythm disturbances and heart failure.
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Affiliation(s)
- E A Kovalenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D A Katunin
- Sechenov First Moscow State Medical University, Moscow, Russia
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Baccaro A, Wang YP, Candido M, Conforto AB, Brunoni AR, Leite CDC, Busatto Filho G, Lotufo PA, Benseñor IM, Goulart AC. Post-stroke depression and cognitive impairment: Study design and preliminary findings in a Brazilian prospective stroke cohort (EMMA study). J Affect Disord 2019; 245:72-81. [PMID: 30368073 DOI: 10.1016/j.jad.2018.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 09/13/2018] [Accepted: 10/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). METHODS Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time. RESULTS Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI. LIMITATIONS Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness. CONCLUSIONS Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.
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Affiliation(s)
- Alessandra Baccaro
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil.
| | - Yuan-Pang Wang
- Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Universidade de Sao Paulo, Medical School, Brazil
| | - Miriam Candido
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil
| | - Adriana Bastos Conforto
- Department of Neurology, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil
| | - André Russowsky Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil
| | - Claudia da Costa Leite
- Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil; Institute of Radiology and Oncology, Hospital das Clinicas, Universidade de Sao Paulo, Brazil
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil; Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Medical School, Universidade de Sao Paulo, Brazil; Nucleo de Apoio a Pesquisa em Neurociencia Aplicada (NAPNA), Universidade de Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Medical School, Universidade de Sao Paulo, Brazil
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Medical School, Universidade de Sao Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil.
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Sexton E, McLoughlin A, Williams DJ, Merriman NA, Donnelly N, Rohde D, Hickey A, Wren MA, Bennett K. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur Stroke J 2019; 4:160-171. [PMID: 31259264 DOI: 10.1177/2396987318825484] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/20/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995-2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1-12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic. Results A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32-43%] (I2=92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35-42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time.Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.
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Affiliation(s)
- Eithne Sexton
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Thingstad P, Askim T, Beyer MK, Bråthen G, Ellekjær H, Ihle-Hansen H, Knapskog AB, Lydersen S, Munthe-Kaas R, Næss H, Pendlebury ST, Seljeseth YM, Saltvedt I. The Norwegian Cognitive impairment after stroke study (Nor-COAST): study protocol of a multicentre, prospective cohort study. BMC Neurol 2018; 18:193. [PMID: 30477436 PMCID: PMC6260901 DOI: 10.1186/s12883-018-1198-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early and late onset post-stroke cognitive impairment (PCI) contributes substantially to disability following stroke, and is a high priority within stroke research. The aetiology for PCI is complex and related to the stroke itself, brain resilience, comorbid brain diseases, prestroke vulnerability and complications during the hospital stay. The aim of the Norwegian Cognitive Impairment After Stroke study (Nor-COAST) is to quantify and measure levels of cognitive impairments in a general Norwegian stroke population and to identify biological and clinical markers associated with prognosis for cognitive disorders following incident stroke. The study will be organised within five work packages: 1) Incidence and trajectories 2) Pathological mechanisms 3) Development of a risk score 4) Impact of physical activity and 5) Adherence to secondary prevention. METHODS Nor-COAST is an ongoing multicentre (five participating hospitals), prospective, cohort study with consecutive inclusion during the acute phase and with follow-up at three and 18 months, and at three years. Inclusion criteria are stroke defined according to the WHO criteria. During the recruitment period from 18.05.2015 to 31.03.2017, 816 participants have been included. Cognitive impairment will be classified according to the DSM-5 criteria using a consensus group. Cognitive function is assessed by a standardised neuropsychological test battery, the Montreal Cognitive Assessment, Trail making A and B, ten-word immediate and delayed recall test, the Controlled Oral Word Association, Global Deterioration Scale and proxy based information by and the Ascertain Dementia 8 item informant questionnaire. Biomarkers include magnetic resonance imaging, routine blood samples and bio-banking. Clinical assessments include characteristics of the stroke, comorbidity, delirium, frailty and tests for cognitive and physical function, sensor based activity monitoring and adherence to secondary prophylaxis. DISCUSSION Nor-COAST is the first Norwegian multicentre study to quantify burden of PCI that will provide reliable estimates in a general stroke population. A multidisciplinary approach aiming to identify biomarkers and clinical markers of overall prognosis will add new knowledge about risk profiles, including pre-stroke vulnerability and modifiable factors such as physical activity and secondary prophylaxis of relevance for clinical practice and later intervention studies. TRIAL REGISTRATION ClinicalTrials.gov: NCT02650531 . Retrospectively registered January 8, 2016. First participant included May 18, 2015.
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Affiliation(s)
- Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona K. Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clin. Neurophysiology, St Olavs University hospital, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Internal Medicine, Stroke Unit, St. Olavs University Hospital, Trondheim, Norway
| | - Hege Ihle-Hansen
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | | | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Care, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | - Halvor Næss
- Department of neurology, Haukeland University Hospital, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
- Institute of clinical medicine, University of Bergen, Bergen, Norway
| | - Sarah T. Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | | | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, St. Olavs University Hospital, Trondheim, Norway
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Gait and balance one year after stroke; relationships with lesion side, subtypes of cognitive impairment and neuroimaging findings-a longitudinal, cohort study. Physiotherapy 2018; 105:254-261. [PMID: 30340837 DOI: 10.1016/j.physio.2018.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/29/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The aims of this study are to investigate impairments of balance and gait in various types of dementia and cognitive impairment, and neuroimaging correlates in patients one year after first-ever stroke or transient ischemic attack. DESIGN This is a longitudinal cohort study. PARTICIPANTS 180 participants were included and a total of 156 participated in the assessments at the one-year follow-up. MAIN OUTCOME MEASURES Measurements of balance and gait comprised the Berg Balance Scale (BBS) and the 10meter walk test (10MWT). Dementia was diagnosed with the International Classification of Diseases 10th revision. Magnet Resonance Imaging assessed vascular and degenerative changes in the brain. Multivariate linear regressions were conducted regarding associations between the motoric test performances, white matter lesions, lesion of the stroke and cognition. RESULTS Cognitive impairment was significant associated with BBS (β=-7.28, P=0.005) and MWS (β=1.89, P=0.046) in the linear regression analyses. An association between 10MWT to living arrangements (β=1.58, P=0.049) and lesion side of the stroke (β=-1.50, P=0.037) was also observed. Pairwise associations with Mann-Whitney U test showed that participants with mixed pathology differed significantly from degenerative pathology (P=0.04, z=-2.1) with more impaired balance measured by BBS. CONCLUSIONS Impaired balance and gait are associated with cognitive impairment, and a lesion in the right hemisphere is related to impaired gait in this cohort of stroke survivors.
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Zhang C, She Y, Lan T, Hu B, Zhang G, He J, Wang Z, Jiang M, Hu R. Study on epidemiology of cognitive dysfunction after stroke in the population over the age of 45 in Inner Mongolia. Int J Neurosci 2018; 128:654-662. [PMID: 29172850 DOI: 10.1080/00207454.2017.1408615] [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: 10/18/2022]
Abstract
OBJECTIVE To analyze the prevalence of different degrees vascular cognitive impairment (VCI) in stroke and the characteristics of demography distribution in Inner Mongolia. In order to provide reference data and theoretical guidance for the prevention and treatment of VCI after stroke in the area. METHODS Stratified multi-stage random sampling was used to extract six regions of Inner Mongolia as the first sampling cluster; and then the corresponding banners (counties) were selected randomly as the secondary sampling cluster; according to the number of patient required to investigation, the corresponding number of communities was randomly selected from the secondary sampling cluster. According to the diagnostic criteria of 'Guidelines for the diagnosis and treatment of vascular cognitive impairment' and National Institute of Neurological Disorders and Stroke convened an International Workshop with support from the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN), we screened all stroke patients aged 45 or older from each community, a total of 444 patients participated in the questionnaire and various scale assessments. RESULTS The prevalence of VCI, vascular cognitive impairment no dementia and vascular dementia was 80.41%, 34.46% and 45.95% respectively. The prevalence of VCI in stroke was significantly different in different nationality, age and education level (P < 0.05), and there was no significant difference in gender, occupation, marital status and family structure (P > 0.05). CONCLUSION The prevalence of VCI after stroke was higher in Inner Mongolia, and VCI had a relatively high morbidity in old age people and person with less education in Chinese Han population.
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Affiliation(s)
- Chunyu Zhang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Yan She
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Tian Lan
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Baolige Hu
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Guohua Zhang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Juan He
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Zhiguang Wang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Mingfang Jiang
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
| | - Riletemuer Hu
- a Department of Neurology , The Affiliated Hospital of Inner Mongolia Medical University , Hohhot , China
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Salihović D, Smajlović D, Mijajlović M, Zoletić E, Ibrahimagić OĆ. Cognitive syndromes after the first stroke. Neurol Sci 2018; 39:1445-1451. [PMID: 29779138 DOI: 10.1007/s10072-018-3447-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/10/2018] [Indexed: 11/24/2022]
Abstract
AIM The aim of this study is to determine impairments of certain cognitive functions in certain vascular cognitive syndromes and to identify predictors of dementia. PATIENTS AND METHODS One-year prospective study included 275 patients, who were hospitalized at the Department of Neurology Tuzla and therefore fulfilled certain criteria. Patients were divided into following subgroups of vascular cognitive impairment (VCI): dementia of strategic infarct (DSI), cortical dementia (CD), sub cortical dementia (SCD), hemorrhagic dementia (HD), and patients without dementia. Each of the patients underwent the clinical examination and scoring with appropriate measurement scales. RESULTS Some of the types of VCI were verified in 190 (69%) patients, and the most common was SCD (58%). There was statistically significant connection between the level of intelligence and occurrence of VCI in patients after stroke (p < 0.001). We found significant connection between occurrence of dementia and impairment in narrative memory, numerical memory, visual perceptive, and visual constructive functions in patients with dementia compared with non-demented (p = 0.0001). The executive functions were statistically impaired in patients with CD (p = 0.004) and SCD (p < 0.001). Patients without dementia have significantly better quality of life than the demented ones (p < 0.0001). The algorithm "tree of decision" can help us in the prediction of dementia based on the impairment of certain cognitive functions. CONCLUSION Vascular cognitive syndromes are common after stroke. Some of the cognitive functions are significantly impaired in patients with dementia. Impairment of the certain cognitive functions can help in predicting the onset of dementia. Patients without dementia have better quality of life.
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Affiliation(s)
- Denisa Salihović
- Department of Neurology, University Cinical Center Tuzla, Prof. dr. Ibre Pašića bb, 75000, Tuzla, Bosnia and Herzegovina.
| | - Dževdet Smajlović
- Department of Neurology, University Cinical Center Tuzla, Prof. dr. Ibre Pašića bb, 75000, Tuzla, Bosnia and Herzegovina
| | - Milija Mijajlović
- Neurology Clinic, Clinical Center of Serbia and School of Medicine, University of Belgrade, Dr Subotića 6, 11000, Belgrade, Serbia
| | - Emina Zoletić
- Department of Psychology, University Clinical Center Tuzla, Prof. dr. Ibre Pašića bb, 75000, Tuzla, Bosnia and Herzegovina
| | - Omer Ć Ibrahimagić
- Department of Neurology, University Cinical Center Tuzla, Prof. dr. Ibre Pašića bb, 75000, Tuzla, Bosnia and Herzegovina
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Barbay M, Taillia H, Nédélec-Ciceri C, Bompaire F, Bonnin C, Varvat J, Grangette F, Diouf M, Wiener E, Mas JL, Roussel M, Godefroy O. Prevalence of Poststroke Neurocognitive Disorders Using National Institute of Neurological Disorders and Stroke-Canadian Stroke Network, VASCOG Criteria (Vascular Behavioral and Cognitive Disorders), and Optimized Criteria of Cognitive Deficit. Stroke 2018; 49:1141-1147. [PMID: 29643258 DOI: 10.1161/strokeaha.117.018889] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/25/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The prevalence of poststroke neurocognitive disorder (NCD) has yet to be accurately determined. The primary objective of the present study was to optimize operationalization of the criterion for NCD by using an external validity criterion. METHODS The GRECOG-VASC cohort (Groupe de Réflexion pour l'Évaluation Cognitive Vasculaire) of 404 stroke patients with cerebral infarct (91.3%) or hemorrhage (18.7%) was assessed 6 months poststroke and 1003 healthy controls, with the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network standardized battery. Three dimensions of the criterion for cognitive impairment were systematically examined by using the false-positive rate as an external validity criterion. Diagnosis of mild and major NCD was based on the VASCOG criteria (Vascular Behavioral and Cognitive Disorders). The mechanisms of functional decline were systematically assessed. RESULTS The optimal criterion for cognitive impairment was the shortened summary score (ie, averaged performance for action speed, executive functions, and language) because it was associated with the highest (P=0.0001) corrected true-positive rate (43.5%) and a false-positive rate ≤5%. Using this criterion, the mean (95% confidence interval) prevalence of poststroke NCD was 49.5% (44.6-54.4), most of which corresponded to mild NCD (39.1%; 95% confidence interval, 34.4-43.9) rather than dementia (10.4%; 95% confidence interval, 7.4-13.4). CONCLUSIONS This study is the first to have optimized the operationalization of the criterion for poststroke cognitive impairment. It documented the prevalence of poststroke NCD in the GRECOG-VASC cohort and showed that mild cognitive impairment accounts for 80% of the affected patients. Finally, the method developed in the present study offers a means of harmonizing the diagnosis of NCD. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01339195.
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Affiliation(s)
- Mélanie Barbay
- From the Laboratory of Functional Neurosciences, Department of Neurology, Amiens University Hospital, France (M.B., E.W., M.R., O.G.)
| | - Hervé Taillia
- Department of Neurology, Val-de-Grâce Hospital, Paris, France (H.T., F.B.)
| | | | - Flavie Bompaire
- Department of Neurology, Val-de-Grâce Hospital, Paris, France (H.T., F.B.)
| | - Camille Bonnin
- Department of Neurology, La Rochelle Hospital, France (C.N.-C., C.B.)
| | - Jérôme Varvat
- Department of Neurology, University Hospital, Saint-Étienne, France (J.V., F.G.)
| | - Françoise Grangette
- Department of Neurology, University Hospital, Saint-Étienne, France (J.V., F.G.)
| | - Momar Diouf
- Department of Biostatistics (M.D.), Amiens University Hospital, France
| | - Emmanuel Wiener
- From the Laboratory of Functional Neurosciences, Department of Neurology, Amiens University Hospital, France (M.B., E.W., M.R., O.G.)
| | - Jean-Louis Mas
- Department of Neurology, Sainte Anne Hospital, Paris, France (J.-L.M.)
| | - Martine Roussel
- From the Laboratory of Functional Neurosciences, Department of Neurology, Amiens University Hospital, France (M.B., E.W., M.R., O.G.)
| | - Olivier Godefroy
- From the Laboratory of Functional Neurosciences, Department of Neurology, Amiens University Hospital, France (M.B., E.W., M.R., O.G.)
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Sun MK. Potential Therapeutics for Vascular Cognitive Impairment and Dementia. Curr Neuropharmacol 2018; 16:1036-1044. [PMID: 29046153 PMCID: PMC6120112 DOI: 10.2174/1570159x15666171016164734] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As the human lifespan increases, the number of people affected by agerelated dementia is growing at an epidemic pace. Vascular pathology dramatically affects cognitive profiles, resulting in dementia and cognitive impairment. While vascular dementia itself constitutes a medical challenge, hypo-perfusion/vascular risk factors enhance amyloid toxicity and other memory- damaging factors and hasten Alzheimer's disease (AD) and other memory disorders' progression, as well as negatively affect treatment outcome. METHODS Research and online content related to vascular cognitive impairment and dementia is reviewed, specifically focusing on the potential treatment of the disorder. RESULTS Few therapeutic options are currently available to improve the prognosis of patients with vascular dementia and cognitive impairment, mixed AD dementia with vascular pathology, or other memory disorders. Emerging evidence, however, indicates that, like AD and other memory disorders, synaptic impairment underlies much of the memory impairment in the cognitive decline of vascular cognitive impairment and vascular dementia. CONCLUSION Effective rescues of the memory functions might be achieved through synaptic and memory therapeutics, targeting distinct molecular signaling pathways that support the formation of new synapses and maintaining their connections. Potential therapeutic agents include: 1) memory therapeutic agents that rescue synaptic and memory functions after the brain insults; 2) antipathologic therapeutics and an effective management of vascular risk factors; and 3) preventative therapeutic agents that achieve memory therapy through functional enhancement. These therapeutic agents are also likely to benefit patients with AD and/or other types of memory disorders.
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Affiliation(s)
- Miao-Kun Sun
- Blanchette Rockefeller Neurosciences Institute, 8 Medical Center Drive, Morgantown, West Virginia26505, USA
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Geng S, Liu N, Meng P, Ji N, Sun Y, Xu Y, Zhang G, He X, Cai Z, Wang B, Xu B, Li Z, Niu X, Zhang Y, Xu B, Zhou X, He M. Midterm Blood Pressure Variability Is Associated with Poststroke Cognitive Impairment: A Prospective Cohort Study. Front Neurol 2017; 8:365. [PMID: 28804475 PMCID: PMC5532726 DOI: 10.3389/fneur.2017.00365] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/11/2017] [Indexed: 01/27/2023] Open
Abstract
Objective The aim of this study was to investigate the relationship between blood pressure variability (BPV) and poststroke cognitive impairment (PSCI). Methods Seven-hundred ninety-six patients with acute ischemic stroke were included in this study. Midterm BPV was evaluated by calculating the SD and coefficient of variation (CV, 100 × SD/mean) of systolic blood pressure (SBP) and diastolic blood pressure during the 7 days after stroke onset. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at admission and at all follow-up visits. Patients with MoCA scores <26 were considered to have PSCI. Results The incidence of PSCI reached its peak (72%) 3 months after stroke onset and decreased to 30.3% at 12 months poststroke. After adjusting for covariables, the increase in the prevalence of PSCI at 3 months was independently associated with increases in the CV of blood pressure during the 7 days after stroke [odds ratios and 95% CI for patients in the second to fifth quintiles of SBP CV were 2.28 (1.18, 4.39), 2.33 (1.18, 4.62), 2.69 (1.31, 5.53), and 4.76 (1.95, 11.67), respectively]. Sub-analysis of the MoCA scores revealed that the patients had impairments in visuoperceptual abilities and executive functions, as well as in naming and delayed recall (p < 0.05). Conclusion Midterm BPV during the early phase of acute ischemic stroke is independently associated with PSCI, especially in the visuoperceptual, executive, and delayed recall domains. Clinical Trial Registration http://www.chictr.org.cn, identifier ChiCTR-TRC-14004804.
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Affiliation(s)
- Shan Geng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Na Liu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Pin Meng
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Niu Ji
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yong'an Sun
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yingda Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Guanghui Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaobing He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zenglin Cai
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Wang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bei Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Zaipo Li
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaoqin Niu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yongjin Zhang
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Bingchao Xu
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xinyu Zhou
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Mingli He
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
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Yang T, Sun Y, Lu Z, Leak RK, Zhang F. The impact of cerebrovascular aging on vascular cognitive impairment and dementia. Ageing Res Rev 2017; 34:15-29. [PMID: 27693240 DOI: 10.1016/j.arr.2016.09.007] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/09/2016] [Accepted: 09/26/2016] [Indexed: 02/07/2023]
Abstract
As human life expectancy rises, the aged population will increase. Aging is accompanied by changes in tissue structure, often resulting in functional decline. For example, aging within blood vessels contributes to a decrease in blood flow to important organs, potentially leading to organ atrophy and loss of function. In the central nervous system, cerebral vascular aging can lead to loss of the integrity of the blood-brain barrier, eventually resulting in cognitive and sensorimotor decline. One of the major of types of cognitive dysfunction due to chronic cerebral hypoperfusion is vascular cognitive impairment and dementia (VCID). In spite of recent progress in clinical and experimental VCID research, our understanding of vascular contributions to the pathogenesis of VCID is still very limited. In this review, we summarize recent findings on VCID, with a focus on vascular age-related pathologies and their contribution to the development of this condition.
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Affiliation(s)
- Tuo Yang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Yang Sun
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Zhengyu Lu
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese, Shanghai 200437, China
| | - Rehana K Leak
- Division of Pharmaceutical Sciences, Mylan School of Pharmacy, Duquesne University, Pittsburgh, PA 15282, USA
| | - Feng Zhang
- Department of Neurology, Pittsburgh Institute of Brain Disorders and Recovery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA; Key Lab of Cerebral Microcirculation in Universities of Shandong, Taishan Medical University, Taian, Shandong, 271000, China.
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