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Chen W, Jiang T, Huang H, Zeng J. Post-stroke fatigue: a review of development, prevalence, predisposing factors, measurements, and treatments. Front Neurol 2023; 14:1298915. [PMID: 38187145 PMCID: PMC10768193 DOI: 10.3389/fneur.2023.1298915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background Post-stroke fatigue (PSF) is a ubiquitous and overwhelming symptom for most stroke survivors. However, there are no effective management strategies for PSF, which is partly due to our limited understanding. Objective In this paper, we review the development, prevalence, predisposing factors, measurements, and treatments of PSF. Results PSF is an independent symptom after stroke, with a prevalence ranging from 42 to 53%, which depends on the selection of measurement tools and stroke characteristics. It is affected by biological, physical, and psychological factors, among which inflammation may play a key role. Conclusion Numerous but non-specific evaluation measurement tools limit the management of PSF. In clinical practice, it may be beneficial to identify PSF by combining scales and objective indexes, such as walking tests and electromyographic examinations. There are no evidence-based interventions to improve PSF. However, increasing evidence suggests that transcranial direct-current stimulation and mindfulness-based interventions may become promising treatments. Further studies are urgently needed to better understand the etiology of PSF, thereby providing the basis for developing new measurement tools and targeted treatments.
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Affiliation(s)
| | - Tao Jiang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Lekoubou A, Nguyen C, Kwon M, Nyalundja AD, Agrawal A. Post-stroke Everything. Curr Neurol Neurosci Rep 2023; 23:785-800. [PMID: 37837566 DOI: 10.1007/s11910-023-01308-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW This review aims at providing updates on selected post-stroke complications. We examined recent advances in diagnosing and treating the following post-stroke complications: cognitive impairment, epilepsy, depression, fatigue, tremors, dysphagia, and pain. RECENT FINDINGS Advances in understanding the mechanisms of post-stroke complications, in general, are needed despite advances made in understanding, treating, and preventing these complications. There are growing progresses in integrating new tools to diagnose post-stroke cognitive impairment. The potential role of acute stroke reperfusion treatment in post-stroke epilepsy and its impact on other stroke complications is getting more transparent. Post-stroke depression remains underestimated and new tools to diagnose depression after stroke are being developed. New promising pharmacological approaches to treating post-stroke pain are emerging. Tremors related to stroke are poorly understood and under-evaluated, while treatment towards post-stroke dysphagia has benefited from new non-pharmacological to pharmacological approaches. CONCLUSIONS An integrative approach to stroke complications and collaborations between providers across specialties are more likely to improve stroke outcomes.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Clever Nguyen
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Michelle Kwon
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA
| | - Arsene Daniel Nyalundja
- Faculty of Medicine, Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of Congo
| | - Ankita Agrawal
- College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Koob JL, Viswanathan S, Mustin M, Mallick I, Krick S, Fink GR, Grefkes C, Rehme AK. To engage or not engage: Early incentive motivation prevents symptoms of chronic post-stroke depression - A longitudinal study. Neuroimage Clin 2023; 37:103360. [PMID: 36889100 PMCID: PMC10009723 DOI: 10.1016/j.nicl.2023.103360] [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: 01/05/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Although post-stroke depression (PSD) is known to disrupt motor rehabilitation after stroke, PSD is often undertreated and its relationship with motor impairment remains poorly understood. METHODS In a longitudinal study design we investigated, which factors at the early post-acute stage may increase the risk for PSD symptoms. We were especially interested in whether interindividual differences in the motivational drive to engage in physically demanding tasks indicate PSD development in patients suffering from motor impairments. Accordingly, we used a monetary incentive grip force task where participants were asked to hold their grip force for high and low rewards at stake to maximize their monetary outcome. Individual grip force was normalized according to the maximal force prior to the experiment. Experimental data, depression, and motor impairment were assessed from 20 stroke patients (12 male; 7.7 ± 6.78 days post-stroke) with mild-to-moderate hand motor impairment and 24 age-matched healthy participants (12 male). RESULTS Both groups showed incentive motivation as indicated by stronger grip force for high versus low reward trials and the overall monetary outcome in the task. In stroke patients, severely impaired patients showed stronger incentive motivation, whereas early PSD symptoms were associated with reduced incentive motivation in the task. Larger lesions in corticostriatal tracts correlated with reduced incentive motivation. Importantly, chronic motivational deficits were preceded by initially reduced incentive motivation and larger corticostriatal lesions in the early stage post-stroke. CONCLUSIONS More severe motor impairment motivates reward-dependent motor engagement, whereas PSD and corticostriatal lesions potentially disturb incentive motivational behavior, thereby increasing the risk of chronic motivational PSD symptoms. Acute interventions should address motivational aspects of behavior to improve motor rehabilitation post-stroke.
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Affiliation(s)
- Janusz L Koob
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.
| | - Shivakumar Viswanathan
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany
| | - Maike Mustin
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Imon Mallick
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Sebastian Krick
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany; Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
| | - Anne K Rehme
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
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Stockbridge MD, Vitti E, Faria AV, Hillis AE. Emotional and qualitative outcomes among patients with left and right hemisphere stroke. Front Neurol 2022; 13:969331. [DOI: 10.3389/fneur.2022.969331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
The differences in mental health outcomes of right and left hemisphere strokes are well studied; however, there is a long-standing controversy surrounding whether depression is associated with lateralization of stroke or not. In this investigation, we examined the effect of lesion location on post-stroke depression controlling for lesion size and hemiparesis in a longitudinal sample assessed at acute, subacute, and chronic timepoints. As a secondary aim, we further examined the effect of lesion location on self-reported difficulties across a wide array of domains. A series of 134 patients with left hemisphere strokes and 79 with right hemisphere strokes completed the Patient Health Questionnaire-9 and an inventory of post-stroke abilities at within acute, subacute, and chronic windows following stroke. When controlling for hemiparesis and overall lesion volume, we found no difference in depression between groups at any timepoint. Additional exploratory analyses provided a further look at differing challenges associated with depression in each group.
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Wang Y, Zhu L, Tan X, Cheng Y, Wang X, Fang S. Higher levels of peripheral blood glucose in the acute stage of stroke increase the risk of Post-stroke Depression: A Systematic Review and Meta-Analysis. Neurosci Biobehav Rev 2022; 142:104829. [PMID: 35970415 DOI: 10.1016/j.neubiorev.2022.104829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/12/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple investigations have shown that diabetes mellitus is a predictor of post-stroke depression (PSD). However, whether elevated levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are associated with an increased risk of PSD remains controversial. METHODS We comprehensively searched databases for eligible studies. Standard mean differences and 95% confidence intervals were used to examine the relationship between peripheral blood glucose levels during the acute phase of stroke and the risk of PSD. Narrative syntheses and meta-analyses were conducted when appropriate unadjusted or adjusted ORs were available. RESULTS A total of 21 prospective cohort studies were included in the analysis. PSD patients had significantly higher peripheral blood glucose levels than non-PSD patients (FPG: SMD, 0.28, 95% CI, 0.11-0.45, p<0.01, HbA1c: SMD, 0.49, 95%CI, 0.20-0.78, p<0.01, respectively). In the subgroup analyses by classifying the time point of depression assessment, HbA1c was more statistically significant associated with the risk of PSD than FPG. Differences in the prevalence of diabetes were not heterogeneity sources. CONCLUSION Higher levels of peripheral blood glucose in the acute phase of stroke increase the risk of PSD. HbA1c might be a better biomarker for the risk of PSD than FPG.
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Affiliation(s)
- Yiwen Wang
- Department of Neurology, Neuroscience Centre, the First Hospital of Jilin University, Changchun, China
| | - Lijun Zhu
- China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiangyu Tan
- Department of Neurology, Neuroscience Centre, the First Hospital of Jilin University, Changchun, China
| | - Yanwei Cheng
- Department of Neurology, Neuroscience Centre, the First Hospital of Jilin University, Changchun, China
| | - Xiangyi Wang
- Department of Neurology, Neuroscience Centre, the First Hospital of Jilin University, Changchun, China
| | - Shaokuan Fang
- Department of Neurology, Neuroscience Centre, the First Hospital of Jilin University, Changchun, China.
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Bui Q, Kaufman KJ, Munsell EGS, Lenze EJ, Lee JM, Mohr DC, Fong MWM, Metts CL, Tomazin SE, Pham V, Wong AWK. Smartphone assessment uncovers real-time relationships between depressed mood and daily functional behaviors after stroke. J Telemed Telecare 2022:1357633X221100061. [PMID: 35549589 PMCID: PMC9653506 DOI: 10.1177/1357633x221100061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The impact of depressed mood in daily life is difficult to investigate using traditional retrospective assessments, given daily or even within-day mood fluctuations in various contexts. This study aimed to use a smartphone-based ambulatory assessment to examine real-time relationships between depressed mood and functional behaviors among individuals with stroke. METHODS A total of 202 participants with mild-to-moderate stroke (90% ischemic, 45% female, 44% Black) completed an ecological momentary assessment five times per day for 2 weeks by reporting their depressed mood and functional behaviors regarding where, with whom, and what activity was spent. RESULTS Participants spent 28% of their wake-up time participating in passive leisure activities but spent the least time in physical (4%) and vocational (9%) activities. Depressed mood was concurrently lower when participants engaged in social activities (β = -0.023 ± 0.011) and instrumental activities of daily living (β = -0.061 ± 0.013); spent time with family members (β = -0.061 ± 0.014), spouses (β = -0.043, ± 0.016), friends (β = -0.094, ± 0.021), and coworkers (β = -0.050 ± 0.021); and were located in restaurants (β = -0.068 ± 0.029), and homes of family members (β = -0.039 ± 0.020) or friends (β = -0.069 ± 0.031). Greater depressed mood was associated with worse ratings in satisfaction, performance, and engagement of activities in concurrent (βs = -0.036 ± 0.003, -0.053 ± 0.003, -0.044 ± 0.003) and time-lagged models (βs = -0.011 ± 0.004, -0.012 ± 0.004, -0.013 ± 0.004). DISCUSSION Smartphone-based ambulatory assessment can elucidate functional behaviors and associated mood after stroke. Findings support behavioral activation treatments to schedule social and instrumental activities for stroke survivors to reduce their depressed mood.
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Affiliation(s)
- Quoc Bui
- Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA
| | - Katherine J Kaufman
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elizabeth GS Munsell
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Jin-Moo Lee
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mandy WM Fong
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
- Psychology and Patient Family Counseling, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Stephanie E Tomazin
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Vy Pham
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Alex WK Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation and Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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