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Boot EM, Omes QPM, Maaijwee N, Schaapsmeerders P, Arntz RM, Rutten-Jacobs LCA, Kessels RPC, de Leeuw FE, Tuladhar AM. Functional brain connectivity in young adults with post-stroke epilepsy. Brain Commun 2023; 5:fcad277. [PMID: 37953839 PMCID: PMC10639092 DOI: 10.1093/braincomms/fcad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
Approximately 1 in 10 young stroke patients (18-50 years) will develop post-stroke epilepsy, which is associated with cognitive impairment. While previous studies have shown altered brain connectivity in patients with epilepsy, little is however known about the changes in functional brain connectivity in young stroke patients with post-stroke epilepsy and their relationship with cognitive impairment. Therefore, we aimed to investigate whether young ischaemic stroke patients have altered functional networks and whether this alteration is related to cognitive impairment. We included 164 participants with a first-ever cerebral infarction at young age (18-50 years), along with 77 age- and sex-matched controls, from the Follow-Up of Transient Ischemic Attack and Stroke patients and Unelucidated Risk Factor Evaluation study. All participants underwent neuropsychological testing and resting-state functional MRI to generate functional connectivity networks. At follow-up (10.5 years after the index event), 23 participants developed post-stroke epilepsy. Graph theoretical analysis revealed functional network reorganization in participants with post-stroke epilepsy, in whom a weaker (i.e. network strength), less-integrated (i.e. global efficiency) and less-segregated (i.e. clustering coefficient and local efficiency) functional network was observed compared with the participants without post-stroke epilepsy group and the controls (P < 0.05). Regional analysis showed a trend towards decreased clustering coefficient, local efficiency and nodal efficiency in contralesional brain regions, including the caudal anterior cingulate cortex, posterior cingulate cortex, precuneus, superior frontal gyrus and insula in participants with post-stroke epilepsy compared with those without post-stroke epilepsy. Furthermore, participants with post-stroke epilepsy more often had impairment in the processing speed domain than the group without post-stroke epilepsy, in whom the network properties of the precuneus were positively associated with processing speed performance. Our findings suggest that post-stroke epilepsy is associated with functional reorganization of the brain network after stroke that is characterized by a weaker, less-integrated and less-segregated brain network in young ischaemic stroke patients compared with patients without post-stroke epilepsy. The contralesional brain regions, which are mostly considered as hub regions, might be particularly involved in the altered functional network and may contribute to cognitive impairment in post-stroke epilepsy patients. Overall, our findings provide additional evidence for a potential role of disrupted functional network as underlying pathophysiological mechanism for cognitive impairment in patients with post-stroke epilepsy.
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Affiliation(s)
- Esther M Boot
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen 6525GA, The Netherlands
| | - Quinty P M Omes
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen 6525GA, The Netherlands
| | - Noortje Maaijwee
- Department of Neurology and Neurorehabilitation, Luzerner Kantonsspital Neurocentre, Luzern 16, Switzerland
| | | | - Renate M Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede 7500 KA, The Netherlands
| | | | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Department of Psychology, Radboud University, Nijmegen 6525 GD, The Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen 6525 GA, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray 5803 AC, The Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen 6525GA, The Netherlands
| | - Anil M Tuladhar
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Radboud University Medical Centre, Nijmegen 6525GA, The Netherlands
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Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21:4. [PMID: 36653785 PMCID: PMC9850784 DOI: 10.1186/s12955-023-02090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults. METHODS Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included. RESULTS A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work. CONCLUSION Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).
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Affiliation(s)
- Elena Gurková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Lenka Štureková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Petra Mandysová
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Daniel Šaňák
- grid.10979.360000 0001 1245 3953Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
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Wang HY, Gu HQ, Zhou Q, Jiang YY, Yang X, Wang CJ, Zhao XQ, Wang YL, Liu LP, Meng X, Li H, Liu C, Li ZX, Wang YJ, Jiang Y. Thrombolysis, time-to-treatment and in-hospital outcomes among young adults with ischaemic stroke in China: findings from a nationwide registry study in China. BMJ Open 2022; 12:e055055. [PMID: 35750455 PMCID: PMC9234794 DOI: 10.1136/bmjopen-2021-055055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE We aimed to determine whether young adults (<50 years) with acute ischaemic stroke (AIS) are more likely to receive intravenous tissue plasminogen activator (IV tPA) and have shorter time to treatment than older patients with stroke. METHODS We analysed data from the Chinese Stroke Center Alliance registry for patients with AIS hospitalised between August 2015 and July 2019. Patients were classified into two groups according to age: young adults (<50 years of age) and older adults (≥50 years of age). RESULTS Of 793 175 patients with AIS admitted to 1471 hospitals, 9.1% (71 860) were young adults. Compared with older adults, a higher proportion of young adults received IV tPA among patients without contraindicaitons (7.2% vs 6.1%, adjusted OR (aOR) 1.13, 95% CI 1.10 to 1.17) and among patients without contraindications and with onset-to-door time ≤3.5 hours (23.6% vs 19.3%, aOR 1.20, 95% CI 1.15 to 1.24). We did not observe differences in onset-to-needle time (median hours 2.7 hours) or door-to-needle time (DNT) (median minutes 60 min) between young and older adults. The proportion of DNT ≤30 min, DNT ≤45 min and DNT ≤60 min in young and older IV tPA-treated patients were 16.9% vs 18.8%, 30.2% vs 32.8% and 50.2% vs 54.2%, respectively. Compared with older adults, young adults treated with IV tPA had lower odds of in-hospital mortality (0.5% vs 1.3%, aOR 0.54, 95% CI 0.35 to 0.82) and higher odds of independent ambulation at discharge (61.0% vs 53.6%, aOR 1.15, 95% CI 1.08 to 1.22), and the associations may be partly explained by stroke severity measured by the National Institutes of Health Stroke Scale score. CONCLUSION Young adults with AIS were more likely to receive IV tPA than older adults, although there was no difference between the two groups in time to treatment. Compared with older adults, young adults may had better in-hospital outcomes.
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Affiliation(s)
- Hai-Yan Wang
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hong-Qiu Gu
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Zhou
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Yu Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Yang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chun-Juan Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Quan Zhao
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi-Long Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li-Ping Liu
- Neuro-intensive Care Unit, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chelsea Liu
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Zi-Xiao Li
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Jun Wang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Verhoeven JI, van Lith TJ, Ekker MS, Hilkens NA, Maaijwee NA, Rutten-Jacobs LCA, Klijn CJ, Leeuw FED. Long-term Risk of Bleeding and Ischemic Events After Ischemic Stroke or Transient Ischemic Attack in Young Adults. Neurology 2022; 99:e549-e559. [PMID: 35654598 DOI: 10.1212/wnl.0000000000200808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Guidelines recommend antithrombotic medication as secondary prevention for patients with ischemic stroke or TIA at young age based on results from trials in older patients. We investigated the long-term risk of bleeding and ischemic events in young patients after ischemic stroke or TIA. METHODS We included 30-day survivors of first-ever ischemic stroke or TIA aged 18-50 years from the FUTURE study, a prospective cohort study of stroke at young age. We obtained information on recurrent ischemia based on structured data collection from 1995 until 2014 as part of the FUTURE study follow-up, complemented with information on any bleeding and ischemic events by retrospective chart review from baseline until last medical consultation or June 2020. Primary outcome was any bleeding, secondary outcome any ischemic event during follow-up. Both were stratified for sex, age, etiology, and use of antithrombotic medication at discharge. Bleeding and ischemic events were classified according to location and bleeding events also by severity. RESULTS We included 544 patients (56.1% women, median age of 42.2; interquartile range [IQR] 36.5-46.7 years) with a median follow-up of 9.6 (IQR 2.5-14.3) years. Ten-year cumulative risk of any bleeding event was 21.8% (95% confidence interval [CI] 17.4-26.0) and 33.9% (95% CI 28.3-37.5) of any ischemic event. Risk of bleeding was higher in women with a cumulative risk of 28.2% (95% CI 21.6-34.3) versus 13.7% (95% CI 8.2-18.9) in men (p<0.01), mainly due to gynecological bleeds. Female sex (p<0.001) and age between 40 and 49 years old (p=0.04) were independent predictors of bleeding. DISCUSSION Young patients after ischemic stroke or TIA have a substantial long-term risk of both bleeding (especially women) and ischemic events. Future studies should investigate the effects of long-term antithrombotics in young patients, taking into account the risk of bleeding complications.
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Affiliation(s)
- Jamie Inge Verhoeven
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
| | - Theresa J van Lith
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
| | - Merel S Ekker
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
| | - Nina A Hilkens
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
| | | | - Loes C A Rutten-Jacobs
- Luzerner Kantonsspital; Neurocentre, Department of Neurology and Neurorehabilitation; Luzern; Switzerland
| | - Catharina Jm Klijn
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre; Donders Institute for Brain, Cognition and Behaviour; Department of Neurology, Nijmegen; The Netherlands
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Boot EM, van de Camp SAJH, Maaijwee NA, Arntz RM, Kessels RPC, de Leeuw FE, Tuladhar AM. Neuroimaging Parameters Are Not Associated With Chronic Post-stroke Fatigue in Young Stroke Patients. Front Neurol 2022; 13:831357. [PMID: 35572922 PMCID: PMC9096084 DOI: 10.3389/fneur.2022.831357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/04/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Post-stroke fatigue is frequently present in young adults, but its underlying mechanism is still unclear. The aim of the study was to investigate the association between lesion location, network efficiency and chronic post-stroke fatigue based on voxel-based lesion-symptom mapping and structural network connectivity analysis. Patients and Methods One hundred and thirty five young patients, aged 18–50 years, with a first-ever transient ischemic attack or cerebral infarction from the Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation (FUTURE) study, underwent 1.5T MRI and were assessed for fatigue using the self-report Checklist Individual Strength. Stroke lesions were manually segmented, and structural network efficiency was calculated using the diffusion MRI-based brain networks and graph theory for each patient. Univariate and multivariate analyses was performed to study the associations between MRI parameters and chronic post-stroke fatigue. In addition, we used voxel-based lesion-symptom mapping to analyze the relationship between the lesion location and chronic post-stroke fatigue. Results Mean age at index event was 39.0 years (SD ± 8.2), and mean follow-up duration was 11.0 years (SD ± 8.0). 50 patients (37%) had post-stroke fatigue. Voxel-based lesion-symptom mapping showed no significant relation between stroke lesions and the presence of chronic post-stroke fatigue. Furthermore, there were no significant associations between the lesion size or network efficiency, and the presence of chronic post-stroke fatigue. Discussion We did not find any association between stroke characteristics (lesion location and size) and chronic post-stroke fatigue (CIS20-R), nor associations between structural brain network connectivity and post-stroke fatigue on the long term in young stroke patients.
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Affiliation(s)
- Esther M. Boot
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sanne A. J. H. van de Camp
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje A. Maaijwee
- Department of Neurology and Neurorehabilitation, Luzerner Kantonsspital Neurocentre, Luzern, Switzerland
| | - Renate M. Arntz
- Department of Neurology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Roy P. C. Kessels
- Department of Psychology, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Department of Medical Psychology and Radboudumc Alzheimer's Centre, Radboud University Medical Centre, Nijmegen, Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Anil M. Tuladhar
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Anil M. Tuladhar
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Wassenius C, Claesson L, Blomstrand C, Jood K, Carlsson G. Integrating consequences of stroke into everyday life - Experiences from a long-term perspective. Scand J Occup Ther 2020; 29:126-138. [PMID: 33307938 DOI: 10.1080/11038128.2020.1857433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Occupational engagement encompasses both objective and subjective aspects of occupation. Long-term follow-up studies indicate that stroke can have a negative impact on the ability to perform IADL. Less is known about the subjective experiences of occupational engagement and how engagement may evolve after stroke. OBJECTIVE To explore stroke survivors' experiences of occupational engagement and how engagement changed over time and across contexts. MATERIAL AND METHODS Repeat, semi-structured interviews 15-18 years post-stroke, analysed using thematic analysis. Eight out of nine participants were classified as having had a mild stroke at onset. RESULTS The analysis resulted in five themes that together formed the main theme 'It takes time - integrating consequences of stroke into everyday life by engaging in occupation, using internal resources and adapting to context'. This illustrated how occupational outcome was the result of a continuous process in which occupational engagement was a way of gradually integrating consequences of stroke into everyday life. CONCLUSION AND SIGNIFICANCE Occupational engagement plays an important part in the process of moving on with life and can serve as both goal and means of achieving desired outcomes after stroke. Interventions that focus on enabling opportunities for occupational engagement in valued occupations and support the use of abilities and internal resources can reduce the impact of stroke in everyday life.
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Affiliation(s)
- Charlotte Wassenius
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Occupational therapy and Department of Research, Education and Innovation, Södra Älvsborg Hospital, Region Västra Götaland, Borås, Sweden
| | - Lisbeth Claesson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Stroke Centre West, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Neurology, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnel Carlsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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7
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Investigation of Sleep Breathing Disorders in Young Patients (Under 55 years) with Mild Stroke. J Stroke Cerebrovasc Dis 2020; 29:105263. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022] Open
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Blomgren C, Samuelsson H, Blomstrand C, Jern C, Jood K, Claesson L. Long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors-Impact of cognitive dysfunction, emotional problems and fatigue. PLoS One 2019; 14:e0216822. [PMID: 31095631 PMCID: PMC6522019 DOI: 10.1371/journal.pone.0216822] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/29/2019] [Indexed: 12/26/2022] Open
Abstract
Background With an upward trend in the number of people who return home to independent living after stroke, the ability to perform more complex activities is becoming an increasingly important long-term outcome after stroke. Although associations between Instrumental Activities of Daily Living (IADL) and cognitive dysfunction, emotional problems, and fatigue have been reported, less is known about the long-term impact of these stroke consequences on the performance of everyday activities in young and middle-aged stroke survivors. Objective To explore the impact of cognitive dysfunction, emotional problems, and fatigue on long-term performance of instrumental activities of daily living in young and middle-aged stroke survivors Method Data on stroke survivors, aged 18–69 at index stroke, were collected from the Sahlgrenska Academy Study on Ischaemic Stroke. IADL outcome was assessed using the Frenchay Activities Index (FAI), and the impact of chosen variables was assessed using Spearman´s rank-order correlation and logistic regression. Results Seven years after index stroke, 296 stroke survivors (median age of 64) were included in this study. Cognitive dysfunction showed the strongest correlations with FAI outcome and independently explained worse outcome on FAI summary score and the domain of work/leisure activities. Fatigue was independently explanatory of worse outcome on FAI summary score and domestic chores, while depressive symptoms independently explained worse outcome on work/leisure activities. In a subgroup with only those participants who had no or minimal residual neurological deficits at follow-up (NIHSS score 0), cognitive dysfunction independently explained worse outcome on FAI summary score and work/leisure activities. Depressive symptoms independently explained worse outcome on FAI summary score and domestic chores. Conclusion Our results show that in young and middle-aged stroke survivors, cognitive dysfunction, depressive symptoms, and fatigue negatively impact performance of IADL even at seven years post stroke onset. Further, we have shown that an impact of both cognitive dysfunction and depressive symptoms can be found also among stroke survivors with mild or no remaining neurological deficits.
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Affiliation(s)
- Charlotte Blomgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Södra Älvsborg Hospital, Dept of Occupational therapy, Borås, Sweden
- * E-mail:
| | - Hans Samuelsson
- Department of Psychology, Faculty of Social Sciences at University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Stroke Centre West, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Christina Jern
- Department of Laboratory Medicine, Institute of Biomedicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, the Sahlgrenska University Hospital, Gothenburg, Gothenburg, Sweden
| | - Lisbeth Claesson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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9
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Interdisciplinary Approaches to Facilitate Return to Driving and Return to Work in Mild Stroke: A Position Paper. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.01.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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van Alebeek ME, Arntz RM, Ekker MS, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38:1631-1641. [PMID: 28534705 PMCID: PMC6120122 DOI: 10.1177/0271678x17707138] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/17/2017] [Indexed: 11/16/2022]
Abstract
Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30-40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as "unknown etiology". Risk factors of 656 young stroke patients (aged 18-50) of the FUTURE study were categorized according to the "International Pediatric Stroke Study" (IPSS), with stratification on gender, age and stroke of "unknown etiology". Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as "stroke of unknown etiology" using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly . This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.
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Affiliation(s)
- Mayte E van Alebeek
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth
Tweesteden Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
| | - Noortje AMM Maaijwee
- Center for Neurology and
Neurorehabilitation, Luzern State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
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11
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Schellekens MMI, van Alebeek ME, Arntz RM, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt HC, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study. J Thromb Thrombolysis 2018; 45:504-511. [PMID: 29480382 PMCID: PMC5889776 DOI: 10.1007/s11239-018-1631-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of hypercoagulable states and preceding infections in the etiology of young stroke and their role in developing recurrent ischemic events remains unclear. Our aim is to determine the prevalence of these conditions in patients with cryptogenic stroke at young age and to assess the long-term risk of recurrent ischemic events in patients with and without a hypercoagulable state or a recent pre-stroke infection with Borrelia or Syphilis. PATIENTS AND METHODS We prospectively included patients with a first-ever transient ischemic attack or ischemic stroke, aged 18-50, admitted to our hospital between 1995 and 2010. A retrospective analysis was conducted of prothrombotic factors and preceding infections. Outcome was recurrent ischemic events. RESULTS Prevalence of prothrombotic factors did not significantly differ between patients with a cryptogenic stroke and with an identified cause (24/120 (20.0%) and 32/174 (18.4%) respectively). In patients with a cryptogenic stroke the long-term risk [mean follow-up of 8.9 years (SD 4.6)] of any recurrent ischemic event or recurrent cerebral ischemia did not significantly differ between patients with and without a hypercoagulable state or a recent infection. In patients with a cryptogenic stroke 15-years cumulative risk of any recurrent ischemic event was 24 and 23% in patients with and without any prothrombotic factor respectively. CONCLUSIONS The prevalence of prothrombotic factors and preceding infections did not significantly differ between stroke patients with a cryptogenic versus an identified cause of stroke and neither is significantly associated with an increased risk of recurrent ischemic events after cryptogenic stroke.
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Affiliation(s)
- Mijntje M I Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth Tweesteden Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Noortje A M M Maaijwee
- Center for Neurology and Neurorehabilitation, Luzern State Hospital, Spitalstrasse 31, 6000, Luzern 16, Switzerland
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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12
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van Alebeek ME, de Vrijer M, Arntz RM, Maaijwee NA, Synhaeve NE, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, de Heus R, Rutten-Jacobs LC, de Leeuw FE. Increased Risk of Pregnancy Complications After Stroke. Stroke 2018; 49:877-883. [DOI: 10.1161/strokeaha.117.019904] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/02/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mayte E. van Alebeek
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Myrthe de Vrijer
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Renate M. Arntz
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Noortje A.M.M. Maaijwee
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Nathalie E. Synhaeve
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Hennie Schoonderwaldt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Maureen J. van der Vlugt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Ewoud J. van Dijk
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Roel de Heus
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Loes C.A. Rutten-Jacobs
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
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13
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Zhou X, Yu F, Feng X, Wang J, Li Z, Zhan Q, Xia J. Immunity and inflammation predictors for short-term outcome of stroke in young adults. Int J Neurosci 2017; 128:634-639. [PMID: 29172921 DOI: 10.1080/00207454.2017.1408614] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The current study was conducted to identify independent predictors of severity and short-term outcome of first-ever ischemic stroke in young adults. METHODS We retrospectively enrolled 325 consecutive patients aged 18-49 years with first-ever ischemic stroke admitted to our center between April 2013 and June 2015. Variables were systematically registered and compared between patients with different neurological severity (mild stroke: National Institutes of Health Stroke Scale [NIHSS] ≤ 8 and severe stroke: >8) and different stroke outcome (favorable: modified Rankin scale score 0-2 and unfavorable: 3-5 or death) at 14 days after stroke onset. RESULTS A total of 325 patients fulfilled the inclusion criteria. There were 242 patients with mild stroke. They exhibited lower white blood cell (WBC), globulin, plasma glucose, fibrinogen (Fib) levels and higher albumin, albumin/globulin (A/G), free triiodothyronine (FT3) levels. Logistic regression analysis showed that FT3 (≧3.18) and WBC (≧7.1) were independent predictors. There were 122 patients demonstrating an unfavorable outcome. Higher WBC, globulin, plasma glucose and Fib levels, lower albumin, FT3, A/G levels, higher NIHSS score and longer hospital stay were significantly associated with unfavorable outcome. In the logistic regression model, we found that A/G (≧1.56), FT3 (≧4.09) and WBC (≧7.1) were independent predictors for short-term outcome. CONCLUSIONS Our data suggested that higher A/G, FT3 levels served as independent predictors of favorable outcome, and a higher FT3 value may also predict mild stroke, while higher WBC may predict a poor functional outcome and severe stroke in patients with acute ischemia.
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Affiliation(s)
- Xiaoqing Zhou
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Fang Yu
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Xianjing Feng
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Junyan Wang
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Zhibin Li
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Qiong Zhan
- b Department of Neurology, The Second Xiangya Hospital , Central South University , Changsha , P.R. China
| | - Jian Xia
- a Department of Neurology, Xiangya Hospital , Central South University , Changsha , P.R. China
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14
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Chalmers C, Leathem J, Bennett S, McNaughton H, Mahawish K. The efficacy of problem solving therapy to reduce post stroke emotional distress in younger (18-65) stroke survivors. Disabil Rehabil 2017; 41:753-762. [PMID: 29172817 DOI: 10.1080/09638288.2017.1408707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the efficacy of problem solving therapy for reducing the emotional distress experienced by younger stroke survivors. METHOD A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up. RESULTS Changes on outcome measures between baseline and post-treatment (n = 13) were not significantly different between the two groups, treatment (n = 13), and the waitlist control group (n = 16) (between-subject design). The pooled data (n = 28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding. CONCLUSION The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be. Implications for Rehabilitation Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group. Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors. Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives. Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.
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Affiliation(s)
| | - Janet Leathem
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Simon Bennett
- a School of Psychology , Massey University , Wellington , New Zealand
| | - Harry McNaughton
- b Stroke/Rehabilitation Research , Medical Research Institute of New Zealand , Wellington , New Zealand
| | - Karim Mahawish
- c Older Persons Rehabilitation Services , Rotorua Hospital , Rotorua , New Zealand
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15
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Misconceptions about Stroke: Causal Attributions for Stroke-Related Symptoms Reflect the Age of the Survivor. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
With visible disabilities, observers tend to overgeneralise from the disability. In contrast, with invisible disabilities such as traumatic brain injury and stroke, observers often fail to allow for challenges resulting from the disability. Persons who have suffered a stroke claim that people misunderstand their symptoms and stigmatise them as a result of these symptoms. This misunderstanding, which happens particularly with young survivors of stroke, may reflect people's causal attributions for symptoms that follow a stroke. Using a scenario design, this cross-sectional study examined whether people attribute ambiguous symptoms that may result from stroke to other causes (the stroke survivor's personality and age) and whether these attributions reflect the age of the stroke survivor. Participants (N = 120) read scenarios describing a male who was aged either 22, 72, or whose age was unstated and who showed four symptom changes: fatigue, depression, irritability and reduced friendships. For each symptom change, participants rated three causal attributions: the person's age, his personality and stroke. The age of the person in the scenario affected attributions; when the person in the scenario was 22, participants attributed his symptoms significantly more to his personality than to his age or stroke, whereas when he was 72, participants attributed his symptoms more to his age than to his personality or stroke and when his age was unstated, they attributed his symptoms equally to age, stroke and personality. Because misattributions for stroke symptoms hinder rehabilitation, therapy can target people's misattributions to enhance rehabilitation for survivors of stroke.
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16
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Effect of Formal Education on Vascular Cognitive Impairment after Stroke: A Meta-analysis and Study in Young-Stroke Patients. J Int Neuropsychol Soc 2017; 23:223-238. [PMID: 28067185 DOI: 10.1017/s1355617716001016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The extent of vascular cognitive impairment (VCI) after stroke varies greatly across individuals, even when the same amount of brain damage is present. Education level is a potentially protective factor explaining these differences, but results on its effects on VCI are inconclusive. METHODS First, we performed a meta-analysis on formal education and VCI, identifying 21 studies (N=7770). Second, we examined the effect of formal education on VCI in young-stroke patients who were cognitively assessed on average 11.0 (SD=8.2) years post-stroke (the FUTURE study cohort). The total sample consisted of 277 young-stroke patients with a mean age at follow-up 50.9 (SD=10.3). Age and education-adjusted expected scores were computed using 146 matched stroke-free controls. RESULTS The meta-analysis showed an overall effect size (z') of 0.25 (95% confidence interval [0.18-0.31]), indicating that formal education level had a small to medium effect on VCI. Analyses of the FUTURE data showed that the effect of education on post-stroke executive dysfunction was mediated by age (β age -0.015; p<.05). Below-average performance in the attention domain was more frequent for low-education patients (χ2(2)=9.8; p<.05). CONCLUSIONS While education level was found to be related to post-stroke VCI in previous research, the effects were small. Further analysis in a large stroke cohort showed that these education effects were fully mediated by age, even in relatively young stroke patients. Education level in and of itself does not appear to be a valid indicator of cognitive reserve. Multi-indicator methods may be more valid, but have not been studied in relation to VCI. (JINS, 2017, 23, 223-238).
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17
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Ghafoorian M, Karssemeijer N, Heskes T, Bergkamp M, Wissink J, Obels J, Keizer K, de Leeuw FE, Ginneken B, Marchiori E, Platel B. Deep multi-scale location-aware 3D convolutional neural networks for automated detection of lacunes of presumed vascular origin. Neuroimage Clin 2017; 14:391-399. [PMID: 28271039 PMCID: PMC5322213 DOI: 10.1016/j.nicl.2017.01.033] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/20/2017] [Accepted: 01/29/2017] [Indexed: 12/15/2022]
Abstract
Lacunes of presumed vascular origin (lacunes) are associated with an increased risk of stroke, gait impairment, and dementia and are a primary imaging feature of the small vessel disease. Quantification of lacunes may be of great importance to elucidate the mechanisms behind neuro-degenerative disorders and is recommended as part of study standards for small vessel disease research. However, due to the different appearance of lacunes in various brain regions and the existence of other similar-looking structures, such as perivascular spaces, manual annotation is a difficult, elaborative and subjective task, which can potentially be greatly improved by reliable and consistent computer-aided detection (CAD) routines. In this paper, we propose an automated two-stage method using deep convolutional neural networks (CNN). We show that this method has good performance and can considerably benefit readers. We first use a fully convolutional neural network to detect initial candidates. In the second step, we employ a 3D CNN as a false positive reduction tool. As the location information is important to the analysis of candidate structures, we further equip the network with contextual information using multi-scale analysis and integration of explicit location features. We trained, validated and tested our networks on a large dataset of 1075 cases obtained from two different studies. Subsequently, we conducted an observer study with four trained observers and compared our method with them using a free-response operating characteristic analysis. Shown on a test set of 111 cases, the resulting CAD system exhibits performance similar to the trained human observers and achieves a sensitivity of 0.974 with 0.13 false positives per slice. A feasibility study also showed that a trained human observer would considerably benefit once aided by the CAD system.
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Affiliation(s)
- Mohsen Ghafoorian
- Institute for Computing and Information Sciences, Radboud
University, Nijmegen, The Netherlands
- Diagnostic Image Analysis Group, Department of Radiology and
Nuclear Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and
Nuclear Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud
University, Nijmegen, The Netherlands
| | - Mayra Bergkamp
- Donders Institute for Brain, Cognition and Behaviour, Department
of Neurology, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Joost Wissink
- Donders Institute for Brain, Cognition and Behaviour, Department
of Neurology, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Jiri Obels
- Diagnostic Image Analysis Group, Department of Radiology and
Nuclear Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Karlijn Keizer
- Donders Institute for Brain, Cognition and Behaviour, Department
of Neurology, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Frank-Erik de Leeuw
- Donders Institute for Brain, Cognition and Behaviour, Department
of Neurology, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and
Nuclear Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Elena Marchiori
- Institute for Computing and Information Sciences, Radboud
University, Nijmegen, The Netherlands
| | - Bram Platel
- Diagnostic Image Analysis Group, Department of Radiology and
Nuclear Medicine, Radboud University Medical Center, Nijmegen, The
Netherlands
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18
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Arntz RM, van Alebeek ME, Synhaeve NE, van Pamelen J, Maaijwee NA, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LC, de Leeuw FE. The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study. Eur Stroke J 2016; 1:337-345. [PMID: 31008296 DOI: 10.1177/2396987316673440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18-50, who visited our hospital (1980-2010). Outcomes assessed at follow-up (2014-2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan-Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4-51.5) for any ischaemic event, 30.1% (95%CI: 24.8-35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1-33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04-1.74), poor kidney function (HR 2.10, 95%CI: 1.32-3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08-3.76) and cardiac disease (HR 1.84, 95%CI: 1.06-3.18) (C-statistic 0.59 (95%CI: 0.55-0.64)). Discussion and conclusion Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.
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Affiliation(s)
- Renate M Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jeske van Pamelen
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Noortje Amm Maaijwee
- Centre for Neurology and Neurorehabilitation, State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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Schaapsmeerders P, Tuladhar AM, Arntz RM, Franssen S, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, Kessels RP, de Leeuw FE. Remote Lower White Matter Integrity Increases the Risk of Long-Term Cognitive Impairment After Ischemic Stroke in Young Adults. Stroke 2016; 47:2517-25. [DOI: 10.1161/strokeaha.116.014356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/05/2016] [Indexed: 12/16/2022]
Abstract
Background and Purpose—
Poststroke cognitive impairment occurs frequently in young patients with ischemic stroke (18 through 50 years of age). Accumulating data suggest that stroke is associated with lower white matter integrity remote from the stroke impact area, which might explain why some patients have good long-term cognitive outcome and others do not. Given the life expectancy of decades in young patients, we therefore investigated remote white matter in relation to long-term cognitive function.
Methods—
We included all consecutive first-ever ischemic stroke patients, left/right hemisphere, without recurrent stroke or transient ischemic attack during follow-up, aged 18 through 50 years, admitted to our university medical center between 1980 and 2010. One hundred seventeen patients underwent magnetic resonance imaging scanning including a T1-weighted scan, a diffusion tensor imaging scan, and completed a neuropsychological assessment. Patients were compared with a matched stroke-free control group (age, sex, and education matched). Cognitive impairment was defined as >1.5 SD below the mean cognitive index score of controls and no cognitive impairment as ≤1 SD. Tract-Based Spatial Statistics was used to assess the white matter integrity (fractional anisotropy and mean diffusivity).
Results—
About 11 years after ischemic stroke, lower remote white matter integrity was associated with a worse long-term cognitive performance. A lower remote white matter integrity, even in the contralesional hemisphere, was observed in cognitively impaired patients (n=25) compared with cognitively unimpaired patients (n=71).
Conclusions—
These findings indicate that although stroke has an acute onset, it might have long lasting effects on remote white matter integrity and thereby increases the risk of long-term cognitive impairment.
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Affiliation(s)
- Pauline Schaapsmeerders
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Anil M. Tuladhar
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Renate M. Arntz
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Sieske Franssen
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Noortje A.M. Maaijwee
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Loes C.A. Rutten-Jacobs
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Hennie C. Schoonderwaldt
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Lucille D.A. Dorresteijn
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Ewoud J. van Dijk
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Roy P.C. Kessels
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Frank-Erik de Leeuw
- From the Departments of Neurology (P.S., A.M.T., R.M.A., S.F., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.) and Medical Psychology (R.P.C.K.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Clinical Neurosciences, University of Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
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20
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Arntz RM, van den Broek SMA, van Uden IWM, Ghafoorian M, Platel B, Rutten-Jacobs LCA, Maaijwee NAM, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Accelerated development of cerebral small vessel disease in young stroke patients. Neurology 2016; 87:1212-9. [PMID: 27521431 PMCID: PMC5035980 DOI: 10.1212/wnl.0000000000003123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/08/2016] [Indexed: 01/30/2023] Open
Abstract
Objective: To study the long-term prevalence of small vessel disease after young stroke and to compare this to healthy controls. Methods: This prospective cohort study comprises 337 patients with an ischemic stroke or TIA, aged 18–50 years, without a history of TIA or stroke. In addition, 90 age- and sex-matched controls were included. At follow-up, lacunes, microbleeds, and white matter hyperintensity (WMH) volume were assessed using MRI. To investigate the relation between risk factors and small vessel disease, logistic and linear regression were used. Results: After mean follow-up of 9.9 (SD 8.1) years, 337 patients were included (227 with an ischemic stroke and 110 with a TIA). Mean age of patients was 49.8 years (SD 10.3) and 45.4% were men; for controls, mean age was 49.4 years (SD 11.9) and 45.6% were men. Compared with controls, patients more often had at least 1 lacune (24.0% vs 4.5%, p < 0.0001). In addition, they had a higher WMH volume (median 1.5 mL [interquartile range (IQR) 0.5–3.7] vs 0.4 mL [IQR 0.0–1.0], p < 0.001). Compared with controls, patients had the same volume WMHs on average 10–20 years earlier. In the patient group, age at stroke (β = 0.03, 95% confidence interval [CI] 0.02–0.04) hypertension (β = 0.22, 95% CI 0.04–0.39), and smoking (β = 0.18, 95% CI 0.01–0.34) at baseline were associated with WMH volume. Conclusions: Patients with a young stroke have a higher burden of small vessel disease than controls adjusted for confounders. Cerebral aging seems accelerated by 10–20 years in these patients, which may suggest an increased vulnerability to vascular risk factors.
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Affiliation(s)
- Renate M Arntz
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Steffen M A van den Broek
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Inge W M van Uden
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Mohsen Ghafoorian
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Bram Platel
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Loes C A Rutten-Jacobs
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Noortje A M Maaijwee
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Pauline Schaapsmeerders
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Hennie C Schoonderwaldt
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Ewoud J van Dijk
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK
| | - Frank-Erik de Leeuw
- From Donders Institute for Brain, Cognition and Behaviour, Department of Neurology (R.M.A., S.M.A.v.d.B., I.W.M.v.U., L.C.A.R.-J., N.A.M.M., P.S., H.C.S., E.J.v.D., F.-E.d.L.), and Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine (M.G., B.P.), Radboudumc; Institute for Computing and Information Sciences (M.G.), Radboud University, Nijmegen, the Netherlands; and Department of Clinical Neurosciences, Neurology Unit (L.C.A.R.-J.), University of Cambridge, UK.
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21
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Synhaeve NE, van Alebeek ME, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, de Kort PL, van der Vlugt MJ, Van Dijk EJ, Wetzels JF, de Leeuw FE. Kidney Dysfunction Increases Mortality and Incident Events after Young Stroke: The FUTURE Study. Cerebrovasc Dis 2016; 42:224-31. [DOI: 10.1159/000444683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background: In about 30% of young stroke patients, no cause can be identified. In elderly patients, kidney dysfunction has been suggested as a contributing risk factor for mortality as well as stroke. There are hypotheses that novel non-traditional risk factors, like chronic inflammation and oxidative stress, are involved in chronic kidney disease, affecting the cerebral microvasculature that would in turn lead to stroke. Our objective is to investigate the influence of kidney dysfunction on long-term mortality and incident vascular events after stroke in young adults aged 18 through 50 and if this relationship would be independent of other cardiovascular risk factors. Methods: We prospectively included 460 young stroke patients with an ischemic stroke or transient ischemic attack admitted to our department between January 1, 1980 and November 1, 2010. Follow-up was done between 2014 and 2015. Estimated glomerular filtration rate (eGFR) was calculated from baseline creatinine levels and was divided in 3 subgroups: eGFR <60, 60-120 and >120 ml/min/1.73 m2. Cox proportional hazard models were used to determine the effect of kidney dysfunction on mortality and incident vascular events, adjusting for cardiovascular risk factors. Results: An eGFR <60 (HR 4.6; 95% CI 2.6-8.2) was associated with an increased risk of death and an increased risk of incident stroke (HR 4.1; 95% CI 1.9-9.0) independent of cardiovascular risk factors, but it was not associated with other vascular events. The point estimate for the 15-year cumulative mortality was 70% (95% CI 46-94) for patients with a low eGFR, 24% (95% CI 18-30) for patients with a normal eGFR and 30% (95% CI 12-48) for patients with a high eGFR. The point estimate for the 15-year cumulative risk of incident stroke was 45% (95% CI 16-74) for patients with a low eGFR, 13% (95% CI 9-17) for patients with a normal eGFR and 8% (95% CI 0-18) for patients with a high eGFR. Conclusions: Kidney dysfunction is related to long-term mortality and stroke recurrence, but not to incident cardiovascular disease, on average 11 years after young stroke. This warrants a more intensive follow-up of young stroke patients with signs of kidney dysfunction in the early phase. In addition, the clear association between kidney dysfunction and incident stroke seen in our young stroke population might be a first step in the recognition of kidney dysfunction as a new risk factor for the development of stroke at young age. Also, it can lead to new insights in the etiological differences between cardiovascular and cerebrovascular disease.
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Maaijwee NAMM, Tendolkar I, Rutten-Jacobs LCA, Arntz RM, Schaapsmeerders P, Dorresteijn LD, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Long-term depressive symptoms and anxiety after transient ischaemic attack or ischaemic stroke in young adults. Eur J Neurol 2016; 23:1262-8. [PMID: 27094933 DOI: 10.1111/ene.13009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Few studies exist on long-term post-stroke depressive symptoms and anxiety in young adults, although these young patients have a particular interest in their long-term prognosis, given their usually long life expectancy and being in the midst of an active social, working and family life. The aims of this study were to investigate the prevalence of depressive symptoms and anxiety and their association with clinical and demographic variables and with functional outcome after stroke in young adults. METHODS AND RESULTS Long-term prevalence of depressive symptoms and anxiety was calculated in 511 patients with a transient ischaemic attack or ischaemic stroke, aged 18-50 years, using the Hospital Anxiety and Depression scale, compared with 147 controls. Functional outcome was assessed with the modified Rankin Score (mRS) and the Instrumental Activities of Daily Living scale (IADL). 16.8% of patients had depressive symptoms and 23.0% had anxiety, versus 6.1% (P = 0.001) and 12.2% (P < 0.001) in controls. In ischaemic stroke patients, depressive symptoms and anxiety were associated with poor functional outcome (mRS > 2 or IADL < 8). CONCLUSION Even a decade after stroke at young age, depressive symptoms and anxiety were prevalent and associated with poor functional outcome. Therefore, even in the long term, treating physicians should be aware of the long-term presence of these symptoms as their recognition may be the first step in improving long-term functional independence.
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Affiliation(s)
- N A M M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - R M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L D Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - H C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - F-E de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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23
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Women have a poorer very long-term functional outcome after stroke among adults aged 18-50 years: the FUTURE study. J Neurol 2016; 263:1099-105. [PMID: 27039389 PMCID: PMC4893376 DOI: 10.1007/s00415-016-8042-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 11/30/2022]
Abstract
Due to their young age young stroke survivors have to cope with a dramatic impact on their life for the decades to come. We investigated the sex-specific very long-term functional outcome after transient ischemic attack (TIA) and ischemic stroke (IS) in adults aged 18–50 years. This study is part of a cohort study among 619 first-ever young ischemic stroke patients, admitted to our department between January 1, 1980 and November 1, 2010. Functional outcome was assessed during follow-up in 2009–2011 and in 2014–2015 with the modified Rankin Scale (mRS) and instrumental Activities of Daily Living scale (iADL). Risk factors for a poor functional outcome (mRS > 2 and iADL < 8) were calculated by logistic regression analysis. After a mean follow-up of 13.9 (SD 8.2) years, 24.5 % of TIA patients and 44.7 % of IS patients had a poor functional outcome (mRS > 2). When assessing the survivors, 15.2 % of TIA patients and 22.9 % of IS patients had a poor outcome as assessed by iADL. The strongest baseline predictors of poor outcome were female sex (OR 2.7, 95 % CI 1.5–5.0) and baseline NIHSS (OR 1.1, 95 % CI 1.1–1.2 per point increase). In conclusion, 14 years after an ischemic cerebrovascular event in young adults, one out of five IS survivors and one out of ten TIA survivors is still dependent in daily life, with a two to threefold higher risk of a poor outcome in women. This includes a period of life, during which important decisions regarding work and family life have to be made.
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Maas AH, Leiner T. Gender and age-specific focus needed for cardiovascular outcome measures to improve life-time prevention in high risk women. Maturitas 2016; 86:74-6. [DOI: 10.1016/j.maturitas.2016.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/25/2016] [Indexed: 01/05/2023]
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Kwon HS, Kim C, Lee SH, Jung KH, Kim YD, Kwon HM, Heo SH, Chang DI, Kim BJ, Kim JM, Kim HY, Kim YS. Protocol of the Stroke in Korean Young Adults Study: A Multicenter Case-Control Study and Prospective Cohort Study. J Stroke Cerebrovasc Dis 2016; 25:1503-8. [PMID: 27038977 DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/18/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The incidence of ischemic stroke in young adults has been rising over recent decades, but there is still limited information on its risk factors, etiologies, and outcomes. Because these patients generally participate in social life, risk factors associated with lifestyle may have a great impact and need to be identified. METHODS The SKY (Stroke in Korean Young Adults) study is a multicenter case-control study and a prospective cohort study in 8 tertiary medical centers in the Republic of Korea. The case subjects are patients aged 18-44 years with first-ever ischemic stroke occurring within 1 month of stroke onset, and the control subjects are age- and gender-matched community controls. Our aim is to include 470 cases and 470 controls. The main objective of our study is to determine the risk factors and the causes of ischemic stroke in Korean young adults. Both well-documented risk factors and little-known lifestyle-related risk factors such as lifestyle habits and psychological distress including job strain will be evaluated by comparing cases and controls using a structured questionnaire. Secondary objectives are to determine the risks of mortality, recurrent vascular events, and poststroke epilepsy in these patients. Conditional logistic regression analysis will be used to estimate odds ratios and 95% confidence intervals. CONCLUSIONS The SKY study is designed to obtain more insights into relatively little-known risk factors in young Korean adults with ischemic stroke. The results may also help identify the frequencies of uncommon etiologies and outcomes in these patients.
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Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea.
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Schaapsmeerders P, Tuladhar AM, Maaijwee NAM, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, Kessels RPC, de Leeuw FE. Lower Ipsilateral Hippocampal Integrity after Ischemic Stroke in Young Adults: A Long-Term Follow-Up Study. PLoS One 2015; 10:e0139772. [PMID: 26462115 PMCID: PMC4603678 DOI: 10.1371/journal.pone.0139772] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background and purpose Memory impairment after stroke is poorly understood as stroke rarely occurs in the hippocampus. Previous studies have observed smaller ipsilateral hippocampal volumes after stroke compared with controls. Possibly, these findings on macroscopic level are not the first occurrence of structural damage and are preceded by microscopic changes that may already be associated with a worse memory function. We therefore examined the relationship between hippocampal integrity, volume, and memory performance long after first-ever ischemic stroke in young adults. Methods We included all consecutive first-ever ischemic stroke patients, without hippocampal strokes or recurrent stroke/TIA, aged 18–50 years, admitted to our academic hospital between 1980 and 2010. One hundred and forty-six patients underwent T1 MPRAGE, DTI scanning and completed the Rey Auditory Verbal Learning Test and were compared with 84 stroke-free controls. After manual correction of hippocampal automatic segmentation, we calculated mean hippocampal fractional anisotropy (FA) and diffusivity (MD). Results On average 10 years after ischemic stroke, lesion volume was associated with lower ipsilateral hippocampal integrity (p<0.05), independent of hippocampal volume. In patients with a normal ipsilateral hippocampal volume (volume is less than or equal to 1.5 SD below the mean volume of controls) significant differences in ipsilateral hippocampal MD were observed (p<0.0001). However, patients with a normal hippocampal volume and high hippocampal MD did not show a worse memory performance compared with patients with a normal volume and low hippocampal MD (p>0.05). Conclusions Patients with average ipsilateral hippocampal volume could already have lower ipsilateral hippocampal integrity, although at present with no attendant worse memory performance compared with patients with high hippocampal integrity. Longitudinal studies are needed to investigate whether a low hippocampal integrity after stroke might lead to exacerbated memory decline with increasing age.
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Affiliation(s)
- Pauline Schaapsmeerders
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Anil M. Tuladhar
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Noortje A. M. Maaijwee
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Renate M. Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Hennie C. Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | | | - Ewoud J. van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Roy P. C. Kessels
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience and Centre for Cognition, Radboud University Nijmegen, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud university medical centre, Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, the Netherlands
- * E-mail:
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Demir R, Saritemur M, Atis O, Ozel L, Kocaturk İ, Emet M, Ulvi H. Can we distinguish stroke and stroke mimics via red cell distribution width in young patients? Arch Med Sci 2015; 11:958-63. [PMID: 26528336 PMCID: PMC4624731 DOI: 10.5114/aoms.2014.40995] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 09/05/2013] [Accepted: 10/21/2013] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Discrimination of stroke and stroke mimics is problematic in young patients. The aim of the study was to determine whether arterial ischemic stroke and stroke mimics can be differentiated via the red cell distribution width (RDW) value in young patients. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 236 patients hospitalized at the neurology ward were investigated. The patients were divided into 3 groups: the 1(st) group included young stroke patients, the 2(nd) group included patients with epilepsy, and the 3rd group included patients with multiple sclerosis (MS). Complete blood count and computed tomographic brain imaging tests were performed in all patients, and magnetic resonance imaging was done when necessary. RESULTS A total of 236 patients were included in this study. Ninety-five (40%) patients were young stroke patients, 71 (30%) had epilepsy and 70 (30%) had MS. The mean RDW values of young patients with stroke were significantly higher than patients with epilepsy or MS (14.9 ±1.2, 13.3 ±1.2, 13.4 ±0.6, p < 0.0001, respectively). The diagnostic power of RDW in the differentiation of patients with stroke is good (area under the curve (AUC) = 0.89). When an RDW cut-off value of 14.05% is accepted for differentiating young patients with stroke from other disorders, the sensitivity, specificity, positive predictive and negative predictive values were 73.7%, 87.9%, 6.1 and 0.043, respectively. CONCLUSIONS Red cell distribution width is a promising, rapid, easy and inexpensive parameter to distinguish young stroke from stroke mimics (such as epilepsy and MS) in young patients.
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Affiliation(s)
- Recep Demir
- Department of Neurology, Medical School, Atatürk University, Erzurum, Turkey
| | - Murat Saritemur
- Department of Emergency Medicine, Medical School, Atatürk University, Erzurum, Turkey
| | - Omer Atis
- Department of Medical Biology, Medical School, Atatürk University, Erzurum, Turkey
| | - Lutfi Ozel
- Department of Neurology, Medical School, Atatürk University, Erzurum, Turkey
| | - İdris Kocaturk
- Department of Neurology, Medical School, Atatürk University, Erzurum, Turkey
| | - Mucahit Emet
- Department of Emergency Medicine, Medical School, Atatürk University, Erzurum, Turkey
| | - Hizir Ulvi
- Department of Neurology, Medical School, Atatürk University, Erzurum, Turkey
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Maaijwee NAMM, Arntz RM, Rutten-Jacobs LCA, Schaapsmeerders P, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Post-stroke fatigue and its association with poor functional outcome after stroke in young adults. J Neurol Neurosurg Psychiatry 2015; 86:1120-6. [PMID: 25362090 DOI: 10.1136/jnnp-2014-308784] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/10/2014] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Post-stroke fatigue negatively influences short-term functional outcome in older stroke survivors. In young adults, in the midst of their active working and family life, this influence may even be more pronounced. However, there are only few studies on this topic in young patients with stroke. Therefore, we investigated the long-term prevalence of post-stroke fatigue in patients with a young transient ischaemic attack (TIA) or ischaemic stroke and its association with functional outcome. METHODS This study is part of a large cohort study among 511 stroke survivors with a first-ever TIA or ischaemic stroke, aged 18-50 years. After a mean follow-up of 9.8 (SD 8.4) years, we assessed the presence of fatigue with the fatigue subscale of the Checklist Individual Strength questionnaire and functional outcome. Prevalence of fatigue between young patients with stroke and 147 stroke-free sex-matched and age-matched controls was compared. OR's for poor functional outcome on modified Rankin Score (mRS>2) and Instrumental Activities of Daily Living (IADL<8) and cognitive performance were calculated using logistic regression analysis. RESULTS Of the young patients with stroke, 41% experienced symptoms of fatigue, versus 18.4% in controls (p 0.0005). Fatigue was associated with a poor functional outcome, as assessed by the mRS (OR 4.0 (95% CI 1.6 to 9.6), IADL (OR 2.2 (95% CI 1.1 to 4.6), and impairment in speed of information processing (OR 2.2 (95% CI 1.3 to 3.9). CONCLUSIONS Fatigue was very common in young stroke survivors and was associated with a poor functional outcome, even after almost a decade of follow-up.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | | | - Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Henny C Schoonderwaldt
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Nijmegen, The Netherlands
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Synhaeve NE, Schaapsmeerders P, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, Dorresteijn LD, de Kort PL, van Dijk EJ, Kessels RP, de Leeuw FE. Cognitive performance and poor long-term functional outcome after young stroke. Neurology 2015; 85:776-82. [DOI: 10.1212/wnl.0000000000001882] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/04/2015] [Indexed: 01/24/2023] Open
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Arntz RM, Rutten-Jacobs LCA, Maaijwee NAM, Schoonderwaldt HC, Dorresteijn LDA, van Dijk EJ, de Leeuw FE. Poststroke Epilepsy Is Associated With a High Mortality After a Stroke at Young Age: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation Study. Stroke 2015; 46:2309-11. [PMID: 26138118 DOI: 10.1161/strokeaha.115.010115] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke epilepsy is a common complication after a young stroke. We investigated the association between poststroke epilepsy and mortality. METHODS We performed a prospective cohort study among 631 patients with a first-ever transient ischemic attack or ischemic stroke, aged 18 to 50 years. Survival analysis and Cox proportional hazard analysis were used to estimate cumulative mortality and hazard ratios for patients with and without epilepsy. RESULTS After mean follow-up of 12.5 years (SD 8.6), 76 (12.0%) developed poststroke epilepsy. Case fatality was 27.4% for patients with poststroke epilepsy and 2.1% for those without. Poststroke epilepsy was associated with 30-day mortality (hazard ratio, 4.8; 95% confidence interval, 1.7-14.0) and long-term mortality (hazard ratio, 1.8; 95% confidence interval, 1.2-2.9). CONCLUSIONS Epilepsy is a common problem after a young stroke and is associated with an increased short-term and long-term mortality.
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Affiliation(s)
- Renate M Arntz
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Loes C A Rutten-Jacobs
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Noortje A M Maaijwee
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Hennie C Schoonderwaldt
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Lucille D A Dorresteijn
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Ewoud J van Dijk
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology and Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands (R.M.A., L.C.A.R.-J., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Neurology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurolog, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.).
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Comparative evaluation of risk factors, outcome and biomarker levels in young and old acute ischemic stroke patients. Ann Neurosci 2015; 22:70-7. [PMID: 26130910 PMCID: PMC4480259 DOI: 10.5214/ans.0972.7531.220204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/23/2015] [Accepted: 02/12/2015] [Indexed: 11/17/2022] Open
Abstract
Background Stroke is the third leading cause of death and disability worldwide accounting for 400-800 strokes per 100,000 individuals each year. Purpose In the present study, we compared risk factors, clinical outcome, and prognostic biomarkers NSE, S-100 ßß and ITIH4 levels in young and old acute ischemic stroke (AIS) patients. Methods We compared the risk factors and clinical outcomes in young (n = 38) and old (n = 66) AIS patients admitted to tertiary health care centre in Central India. In addition, we also evaluated NSE, S100ββ & ITIH4 levels in admission and discharge samples of young and old AIS patients with different clinical outcome. Results Hypertension was a major risk factor in 45% of young and 80% of old AIS patients. Hospital outcome was less favorable in young AIS patients with higher dependent rates of 24% as compared to 12% in old AIS patients. Whereas long term outcome at 12 and 18 months after discharge was more favorable in young AIS patients with low dependency rates of 16% and 11% as compared to 41% and 24% in older AIS patients respectively. Similarly, serum NSE, S100ββ and ITIH4 levels showed a distinct pattern of expression at discharge time in AIS patients with improved and dependent outcome in both the age groups. Conclusion Young males with hypertension and smoking habits are at a high risk of AIS while old AIS patients are at a greater risk of worse long term outcome. Serum levels of NSE and S100ββ are independent predictors of outcome in AIS patients. Similarly, it also suggests that serum ITIH4 levels could be used as a potential biomarker for predicting the outcome in AIS patients.
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Schaapsmeerders P, van Uden IW, Tuladhar AM, Maaijwee NA, van Dijk EJ, Rutten‐Jacobs LC, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, de Leeuw F, Kessels RP. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults. Hum Brain Mapp 2015; 36:2432-42. [PMID: 25757914 PMCID: PMC6869088 DOI: 10.1002/hbm.22782] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/16/2015] [Accepted: 02/24/2015] [Indexed: 11/06/2022] Open
Abstract
Memory impairment after stroke in young adults is poorly understood. In elderly stroke survivors memory impairments and the concomitant loss of hippocampal volume are usually explained by coexisting neurodegenerative disease (e.g., amyloid pathology) in interaction with stroke. However, neurodegenerative disease, such as amyloid pathology, is generally absent at young age. Accumulating evidence suggests that infarction itself may cause secondary neurodegeneration in remote areas. Therefore, we investigated the relation between long-term memory performance and hippocampal volume in young patients with first-ever ischemic stroke. We studied all consecutive first-ever ischemic stroke patients, aged 18-50 years, admitted to our academic hospital center between 1980 and 2010. Episodic memory of 173 patients was assessed using the Rey Auditory Verbal Learning Test and the Rey Complex Figure and compared with 87 stroke-free controls. Hippocampal volume was determined using FSL-FIRST, with manual correction. On average 10 years after stroke, patients had smaller ipsilateral hippocampal volumes compared with controls after left-hemispheric stroke (5.4%) and right-hemispheric stroke (7.7%), with most apparent memory dysfunctioning after left-hemispheric stroke. A larger hemispheric stroke was associated with a smaller ipsilateral hippocampal volume (b=-0.003, P<0.0001). Longer follow-up duration was associated with smaller ipsilateral hippocampal volume after left-hemispheric stroke (b=-0.028 ml, P=0.002) and right-hemispheric stroke (b=-0.015 ml, P=0.03). Our results suggest that infarction is associated with remote injury to the hippocampus, which may lower or expedite the threshold for cognitive impairment or even dementia later in life.
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Affiliation(s)
- Pauline Schaapsmeerders
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Inge W.M. van Uden
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Anil M. Tuladhar
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Noortje A.M. Maaijwee
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Ewoud J. van Dijk
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | | | - Renate M. Arntz
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Hennie C. Schoonderwaldt
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | | | - Frank‐Erik de Leeuw
- Department of NeurologyDonders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Medical CentreNijmegenThe Netherlands
| | - Roy P.C. Kessels
- Centre for Neuroscience and Centre for CognitionDonders Institute for Brain, Cognition and Behaviour, Radboud UniversityNijmegenThe Netherlands
- Department of Medical PsychologyRadboud University Medical CentreNijmegenThe Netherlands
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Rutten-Jacobs LC, Arntz RM, Maaijwee NA, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, de Leeuw FE. Cardiovascular Disease Is the Main Cause of Long-Term Excess Mortality After Ischemic Stroke in Young Adults. Hypertension 2015; 65:670-5. [DOI: 10.1161/hypertensionaha.114.04895] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adults with stroke at a young age (18–50 years) remain at an increased risk of death for decades. It is unclear what cause underlies this long-term excess mortality and whether this is sex and time specific. Therefore, we investigated sex-specific temporal changes in cause of death after transient ischemic attack or ischemic stroke in young adults aged 18 to 50 years. We included all 845 consecutive 30-day survivors, of a first-ever transient ischemic attack (n=261) or ischemic stroke (n=584), admitted to our hospital between 1980 and 2010. Survival status was assessed at April 1, 2013. Observed cause-specific mortality was compared with expected mortality, derived from mortality rates in the general population with similar age, sex, and calendar-year characteristics. During a median follow-up of 9.2 years, 146 patients (17.3%) died, such that 29 years of life was lost by each individual. For all causes of death, observed mortality exceeded expected mortality. The absolute excess risk of death was for 74% attributable to a vascular cause (absolute excess risk, 2.8 per 1000 person-years [95% confidence interval, 1.8–4.1] for stroke and absolute excess risk, 4.3 per 1000 person-years [95% confidence interval, 2.9–5.9] for other vascular causes). The absolute excess risk was highest between 10 and 15 years after stroke and this peak was most pronounced in men and mainly attributable to vascular death. Long-term excess death after stroke in young adults is mainly attributable to a vascular cause and most pronounced in men. Attempts to reduce the risk of vascular disease after stroke in young adults should extend beyond the acute phase into the long term.
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Affiliation(s)
- Loes C.A. Rutten-Jacobs
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Renate M. Arntz
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Noortje A.M. Maaijwee
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Hennie C. Schoonderwaldt
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Lucille D. Dorresteijn
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Ewoud J. van Dijk
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands (L.C.A.R.-J., R.M.A., N.A.M.M., H.C.S., E.J.v.D., F.-E.d.L.); Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom (L.C.A.R.-J.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.D.)
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Man D, Yip C, Lee G, Fleming J, Shum D. Self-report prospective memory problems in people with stroke. Brain Inj 2014; 29:329-35. [DOI: 10.3109/02699052.2014.974672] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, van Dijk EJ, de Leeuw FE. Clinical characteristics and outcome of intracerebral hemorrhage in young adults. J Neurol 2014; 261:2143-9. [PMID: 25138477 DOI: 10.1007/s00415-014-7469-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/08/2014] [Accepted: 08/10/2014] [Indexed: 12/01/2022]
Abstract
Data on determinants of prognosis after intracerebral hemorrhage (ICH) in young adults are scarce. Our aim was to identify clinical determinants of prognosis after ICH in adults aged 18-50. We investigated 98 consecutive patients with an ICH, aged 18-50 years, admitted to our hospital between 1980 and 2010. Collected ICH characteristics included presenting symptoms, etiology, location, severity and Glasgow Coma Scale (GCS). Outcomes were case-fatality (death within 30 days), poor functional outcome (modified Rankin Scale >2), long-term mortality and recurrent ICH. We assessed discriminatory power of factors associated with case-fatality [area under receiver operating curve (AUC)]. Case-fatality was 20.4 % (n = 20) and well predicted by the GCS (AUC 0.83). Among 30-day survivors, a poor functional outcome at discharge was present in 51.3 %. During a mean follow-up of 11.3 years mortality was only increased in patients aged 40-50 years [standardized mortality ratio 4.8 (95 % CI 2.3-8.6)], but not in patients aged 18-40 years. Recurrent ICH occurred in 6 patients [10-year cumulative incidence 12.2 % (95 % CI 1.5-22.9 %)], all with the index ICH attributable to structural vascular malformations. Prognosis after ICH in young adults is poor, mainly due to high case-fatality, that is well predicted by the GCS. An exception is 30-day survivors <40 years, who have a similar risk of dying as the general population. Recurrence risk is especially present in patients with structural vascular malformations, whereas risk seems to be very low in other patients.
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Affiliation(s)
- Loes Ca Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Wilbers J, Kappelle AC, Kessels RP, Steens SC, Meijer FJ, Kaanders JH, Haast RA, Versteeg LE, Tuladhar AM, de Korte CL, Hansen HH, Hoebers FJ, Boogerd W, van Werkhoven ED, Nowee ME, Hart G, Bartelink H, Dorresteijn LD, van Dijk EJ. Long term cerebral and vascular complications after irradiation of the neck in head and neck cancer patients: a prospective cohort study: study rationale and protocol. BMC Neurol 2014; 14:132. [PMID: 24942263 PMCID: PMC4077148 DOI: 10.1186/1471-2377-14-132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 05/28/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Successful treatment options for cancer result in more young long-term survivors prone for long-term complications. Carotid artery vasculopathy is a potential long-term complication after radiotherapy of the neck, resulting in cerebrovascular events and probably deficits in cognitive and motor functioning. Better insight into the underlying pathofysiology of radiotherapy induced carotid artery vasculopathy is needed for prognostic purposes and to develop preventive strategies. METHODS/DESIGN The current study is a prospective cohort study on the long-term cerebral and vascular complications after radiotherapy of the neck, in 103 patients treated for head and neck cancer, included in our study database between 2002 and 2008. Baseline protocol (before radiotherapy) included screening for cerebrovascular risk factors and intima media thickness measurement of carotid arteries by ultrasonography. Follow-up assessment more than 5 years after radiotherapy included screening of cerebrovascular risk factors, cerebrovascular events, neurological examination with gait and balance tests, extensive neuropsychological examination, self-report questionnaires, ultrasonography of the carotid arteries with measurement of intima media thickness and elastography, magnetic resonance imaging of the brain and magnetic resonance angiography of the carotid arteries. DISCUSSION The current study adds to the understanding of the causes and consequences of long-term cerebral and vascular changes after radiotherapy of the neck. These data will be helpful to develop a protocol for diagnostic and preventive strategies for long-term neurological complications in future head and neck cancer patients with anticipated radiotherapy treatment.
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Affiliation(s)
- Joyce Wilbers
- Department of Neurology, Radboud University Nijmegen Medical Center, Donders Institute for Brain, Cognition and Behaviour Centre for Neuroscience, PO box 9101, 6500 HB Nijmegen, The Netherlands.
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Maaijwee NAMM, Rutten-Jacobs LCA, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10:315-25. [PMID: 24776923 DOI: 10.1038/nrneurol.2014.72] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Contrary to trends in most other diseases, the average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among 'young' individuals (under 50 years of age). This Review provides a critical overview of the risk factors and aetiology of young ischaemic stroke and addresses its long-term prognosis, including cardiovascular risk, functional outcome and psychosocial consequences. We highlight the diminishing role of 'rare' risk factors in the pathophysiology of young stroke in light of the rising prevalence of 'traditional' vascular risk factors in younger age groups. Long-term prognosis is of particular interest to young patients, because of their long life expectancy and major responsibilities during a demanding phase of life. The prognosis of young stroke is not as favourable as previously thought, with respect either to mortality or cardiovascular disease or to psychosocial consequences. Therefore, secondary stroke prevention is probably a life-long endeavour in most young stroke survivors. Due to under-representation of young patients in past trials, new randomized trials focusing on this age group are needed to confirm the benefits of long-term secondary preventive medication. The high prevalence of poor functional outcome and psychosocial problems warrants further study to optimize treatment and rehabilitation for these young patients.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Loes C A Rutten-Jacobs
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
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Maaijwee NAMM, Schaapsmeerders P, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, van Dijk EJ, Kessels RPC, de Leeuw FE. Subjective cognitive failures after stroke in young adults: prevalent but not related to cognitive impairment. J Neurol 2014; 261:1300-8. [PMID: 24740819 DOI: 10.1007/s00415-014-7346-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/29/2014] [Accepted: 04/05/2014] [Indexed: 02/08/2023]
Abstract
Few studies exist on subjective cognitive failures after a stroke in young adults (≤50 years) and their relation to objective cognitive performance is unknown. Therefore, we investigated the prevalence of subjective cognitive failures in patients with a stroke in young adulthood and their relation with objective cognitive impairment. This study is part of the "Follow-Up of Transient ischemic attack and stroke patients and Unelucidated Risk factor Evaluation"-study (FUTURE study), including patients, aged 18-50 years, admitted to our hospital between 1980 and 2010 with a first-ever TIA or ischemic stroke. The prevalence of subjective cognitive failures in patients was determined and compared with 146 age- and sex-matched stroke-free controls. The relation of subjective failures with objective cognitive performance was investigated with linear and logistic regression analysis. 160 patients with a TIA and 277 with an ischemic stroke were included. After a mean follow-up of 10.1 (SD 8.3) years, the prevalence of subjective memory failures was 86.4% and that of subjective executive failures was 67.4% in patients, versus 69.7% (p = 0.008) and 41.4% (p = 0.002) in controls. A weak association between subjective memory failures and objective immediate (beta -0.12, p = 0.011) and delayed memory performance (beta -0.13, p = 0.010) was observed in patients. Subjective cognitive failures are prevalent after stroke in young adults, but not strongly related to objective cognitive impairment. Therefore, extensive neuropsychological assessment is essential for determination of objective cognitive impairment. However, it is important that subjective cognitive failures are recognized as they may indicate underlying psychosocial problems.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands,
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Ikama SM, Nsitou BM, Ossou-Nguiet PM, Otiobanda GF, Matali E. [Contribution of vascular ultrasonography in patients with ischemic strokes in Brazzaville (Congo)]. JOURNAL DES MALADIES VASCULAIRES 2014; 39:178-82. [PMID: 24680313 DOI: 10.1016/j.jmv.2014.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/10/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the prevalence of the carotid lesions during ischemic strokes. METHODS This was a descriptive cross-sectional study, conducted in Brazzaville from January 2011 to June 2012 in a consecutive series of 73 patients, victims of a transient ischemic attack or ischemic stroke, documented by a brain computed tomography. All patients underwent vascular ultrasonography of the supra-aortic trunks, carried out within the framework of etiological assessment. The examination searched for plaques, parietal infiltration (measurement of intima-media thickness), and carotid stenosis or occlusion. RESULTS There were 49 men (67%) and 24 women (33%), mean age 58.7 ± 11.8 years. Eleven patients (15%) had a transient ischemic attack and 62 (85%) an ischemic stroke. The identified independent vascular risk factors were known and treated hypertension (n=66, 90.4%), dyslipidemia (n=16, 22%), diabetes mellitus (n=9, 12.3%), and smoking (n=5, 6.8%), with on average 2.5 factors per individual. Vascular ultrasonography of the supra-aortic trunks, normal in 44 patients (60.3%) was pathological in the other 29 (39.7%). The main anomalies were atheromatous plaque (n=10, 13.7%), parietal infiltration (n=19, 26%). On average intima-media thickness was 0.86 ± 0.11 mm on the left and 0.83 ± 0.11 mm on the right. Two cases of moderate stenosis were noted on the right and left internal carotids, respectively. CONCLUSION This preliminary study confirms the existence of carotid atherosclerosis anomalies during ischemic strokes. These lesions, though non-significant, must nevertheless be taken into consideration when searching for the cause of stroke in high-risk vascular patients.
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Affiliation(s)
- S M Ikama
- Service de cardiologie et médecine interne, CHU de Brazzaville, BP 2234, Brazzaville, Congo.
| | - B M Nsitou
- Service de cardiologie et médecine interne, CHU de Brazzaville, BP 2234, Brazzaville, Congo
| | | | - G F Otiobanda
- Service de réanimation polyvalente, CHU de Brazzaville, Brazzaville, Congo
| | - E Matali
- Service de neurologie, CHU de Brazzaville, Brazzaville, Congo
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Synhaeve NE, Arntz RM, Maaijwee NAM, Rutten-Jacobs LCA, Schoonderwaldt HC, Dorresteijn LDA, de Kort PLM, van Dijk EJ, de Leeuw FE. Poor long-term functional outcome after stroke among adults aged 18 to 50 years: Follow-Up of Transient Ischemic Attack and Stroke Patients and Unelucidated Risk Factor Evaluation (FUTURE) study. Stroke 2014; 45:1157-60. [PMID: 24578210 DOI: 10.1161/strokeaha.113.004411] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Stroke in young adults has a dramatic effect on life; therefore, we investigated the long-term functional outcome after transient ischemic attack, ischemic stroke, or intracerebral hemorrhage in adults aged 18 to 50 years. METHODS We studied 722 young patients with first-ever stroke admitted between January 1, 1980, and November 1, 2010. Functional outcome was assessed by stroke subtype with the modified Rankin Scale and Instrumental Activities of Daily Living scale. RESULTS After a mean follow-up of 9.1 (SD, 8.2) years, 32.0% of all patients had a poor functional outcome (modified Rankin Scale, >2); for ischemic stroke, this was 36.5%, for intracerebral hemorrhage 49.3%, and for transient ischemic attack 16.8%. At follow-up, 10.8% of transient ischemic attack, 14.6% of ischemic stroke, and 18.2% of intracerebral hemorrhage patients had a poor outcome as assessed by Instrumental Activities of Daily Living (<8). CONCLUSIONS Ten years after ischemic stroke or intracerebral hemorrhage in young adults, 1 of 8 survivors is still dependent in daily life.
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Affiliation(s)
- Nathalie E Synhaeve
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands (N.E.S., R.M.A., N.A.M.M., L.C.A.R.-J., H.C.S., E.J.v.D., F.-E.d.L.); Department of Neurology, Elisabeth Hospital Tilburg, Tilburg, The Netherlands (N.E.S., P.L.M.d.K.); and Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands (L.D.A.D.)
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High incidence of diabetes after stroke in young adults and risk of recurrent vascular events: the FUTURE study. PLoS One 2014; 9:e87171. [PMID: 24466339 PMCID: PMC3900719 DOI: 10.1371/journal.pone.0087171] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Diabetes diagnosed prior to stroke in young adults is strongly associated with recurrent vascular events. The relevance of impaired fasting glucose (IFG) and incidence of diabetes after young stroke is unknown. We investigated the long-term incidence of diabetes after young stroke and evaluated the association of diabetes and impaired fasting glucose with recurrent vascular events. Methods This study was part of the FUTURE study. All consecutive patients between January 1, 1980, and November 1, 2010 with TIA or ischemic stroke, aged 18–50, were recruited. A follow-up assessment was performed in survivors between November 1, 2009 and January 1, 2012 and included an evaluation for diabetes, fasting venous plasma glucose and recurrent vascular events. The association of diabetes and IFG with recurrent vascular events was assessed by logistic regression analysis, adjusted for age, sex and follow-up duration. Results 427 survivors without a medical history of diabetes were included in the present analysis (mean follow-up of 10.1 (SD 8.4) years; age 40.3 (SD 7.9) years). The incidence rate of diabetes was 7.9 per 1000 person-years and the prevalence of IFG was 21.1%. Patients with diabetes and IFG were more likely to have experienced any vascular event than those with normal fasting glucose values (OR 3.5 (95%CI 1.5–8.4) for diabetes and OR 2.5 (95%CI 1.3–4.8) for IFG). Conclusions Diabetes or IFG in young stroke survivors is frequent and is associated with recurrent vascular events. Regular screening for IFG and diabetes in this population, yields potential for secondary prevention.
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Rutten-Jacobs LCA, Maaijwee NAM, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, van der Vlugt MJ, van Dijk EJ, de Leeuw FE. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann Neurol 2013; 74:592-601. [DOI: 10.1002/ana.23953] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/07/2013] [Accepted: 05/18/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Loes C. A. Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Noortje A. M. Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Renate M. Arntz
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Henny C. Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | | | | | - Ewoud J. van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
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Schaapsmeerders P, Maaijwee NAM, van Dijk EJ, Rutten-Jacobs LCA, Arntz RM, Schoonderwaldt HC, Dorresteijn LDA, Kessels RPC, de Leeuw FE. Long-term cognitive impairment after first-ever ischemic stroke in young adults. Stroke 2013; 44:1621-8. [PMID: 23652272 DOI: 10.1161/strokeaha.111.000792] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Up to 14% of all ischemic strokes occur in young adults (<50 years). Poststroke cognitive performance is a decisive determinant of their quality of life. However, virtually no studies report on cognition after young stroke, especially not on the long term. This long-term perspective is important because young patients have a long life expectancy during which they start forming a family, have an active social life, and make decisive career moves. We aimed to evaluate the long-term cognitive outcome. METHODS All consecutive patients between January 1, 1980, and November 1, 2010, with a first-ever young ischemic stroke were recruited for cognitive assessment, using a matched stroke-free population as a reference. Composite Z scores for 7 cognitive domains were calculated and the ANCOVA model was used (Bonferroni correction). A below average performance was defined as >1.0 SD below the age-adjusted mean of the controls and cognitive impairment as >1.5 SD. RESULTS Two hundred seventy-seven patients and 146 matched controls completed cognitive assessment (mean follow-up, 11.0 years, SD, 8.2; age, 50.9 years, SD, 10.3). Long-term cognitive outcome after an ischemic stroke was worse in most cognitive domains compared with a nonstroke population. Up to 50% of the patients had a below average performance or cognitive impairment. Deficits in processing speed, working memory, and attention were most common. CONCLUSIONS Even 11 years after ischemic stroke in young adults, a substantial proportion of patients must cope with permanent cognitive deficits. These results have implications for information given to patients and rehabilitation services.
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Affiliation(s)
- Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour. PO Box 9101, 6500 HB Nijmegen, the Netherlands
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Arntz R, Rutten-Jacobs L, Maaijwee N, Schoonderwaldt H, Dorresteijn L, van Dijk E, de Leeuw FE. Post-stroke epilepsy in young adults: a long-term follow-up study. PLoS One 2013; 8:e55498. [PMID: 23390537 PMCID: PMC3563638 DOI: 10.1371/journal.pone.0055498] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/23/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Little is known about the incidence and risk of seizures after stroke in young adults. Especially in the young seizures might dramatically influence prognosis and quality of life. We therefore investigated the long-term incidence and risk of post-stroke epilepsy in young adults with a transient ischemic attack (TIA), ischemic stroke (IS) or intracerebral hemorrhage (ICH). METHODS AND FINDINGS We performed a prospective cohort study among 697 consecutive patients with a first-ever TIA, IS or ICH, aged 18-50 years, admitted to our hospital between 1-1-1980 till 1-11-2010. The occurrence of epilepsy was assessed by standardized questionnaires and verified by a neurologist. Cumulative risks were estimated with Kaplan-Meier analysis. Cox proportional hazard models were used to calculate relative risks. After mean follow-up of 9.1 years (SD 8.2), 79 (11.3%) patients developed post-stroke epilepsy and 39 patients (5.6%) developed epilepsy with recurrent seizures. Patients with an initial late seizure more often developed recurrent seizures than patients with an initial early seizure. Cumulative risk of epilepsy was 31%, 16% and 5% for patients with an ICH, IS and TIA respectively (Logrank test ICH and IS versus TIA p<0.001). Cumulative risk of epilepsy with recurrent seizures was 23%, 8% and 4% respectively (Logrank ICH versus IS p = 0.05, ICH versus TIA p<0.001, IS versus TIA p = 0.01). In addition a high NIHSS was a significant predictor of both epilepsy and epilepsy with recurrent seizures (HR 1.07, 95% CI 1.03-1.11 and 1.08, 95% CI 1.02-1.14). CONCLUSIONS Post-stroke epilepsy is much more common than previously thought. Especially patients with an ICH and a high NIHSS are at high risk. This calls upon the question whether a subgroup could be identified which benefits from the use of prophylactic antiepileptic medication. Future studies should be executed to investigate risk factors and the effect of post-stroke epilepsy on quality of life.
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Affiliation(s)
- Renate Arntz
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | - Loes Rutten-Jacobs
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | - Noortje Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | - Hennie Schoonderwaldt
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | | | - Ewoud van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, The Netherlands
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