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Nájar AM, López Azcárate C, Domínguez Ruiz C, Núñez-Jurado D, de Torres R, López R, Camino-Moya M, Magni E, Montero-Ramirez E, Bocero A, Laviana Á, Busquier Cerdán T, León A, del Rio C, Montaner J, Pérez-Sánchez S. Evaluating the Clinical Impact of a Polyphenol-Rich Extract from Salicornia ramosissima on Patients with Transient Ischemic Attack and Minor Stroke. Nutrients 2024; 16:4307. [PMID: 39770931 PMCID: PMC11679598 DOI: 10.3390/nu16244307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 01/11/2025] Open
Abstract
Transient ischemic attack (TIA) is a well-established risk factor for future strokes, making interventions that target recovery and vascular risk crucial. This study aimed to assess the safety and clinical effects of a polyphenol-rich Salicornia ramosissima extract in post-TIA patients. A randomized, triple-blind, placebo-controlled trial was conducted with participants who had a history of TIA or minor stroke and who received 1 g of Salicornia extract or placebo over 11 months. Biochemical analyses, neuropsychological assessments (MOCA test), and gait and aerobic performance tests were conducted at the beginning and the end of the study. A total of 118 individuals were screened, with 80 finally included. Importantly, no significant adverse events were reported throughout the study. A neurological analysis showed an improvement in MOCA scores in patients treated with the Salicornia extract for 11 months. The treatment did not affect spatiotemporal gait parameters, but it significantly reduced blood pressure at baseline and after the aerobic performance test. Biochemically, both groups exhibited mild hyperhomocysteinemia at baseline; however, Salicornia treatment significantly lowered homocysteine levels, bringing them within the normal range. These findings highlight the safety of the Salicornia extract in patients at a high cerebrovascular risk and suggest it as a potential therapeutic option for managing vascular risk factors, such as hyperhomocysteinemia and hypertension. However, further studies are required to confirm the underlying mechanisms and explore broader clinical applications.
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Affiliation(s)
- Ana M. Nájar
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
| | - Cristina López Azcárate
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
| | - Carmen Domínguez Ruiz
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
| | - David Núñez-Jurado
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
- Department of Biochemistry, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
| | - Reyes de Torres
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
| | - Reyes López
- Department of Psychology and Human Neuroscience, Universidad Loyola Andalucía, 41704 Seville, Spain;
| | - Miriam Camino-Moya
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
| | - Eleonora Magni
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
- Research Group CTS969: “Care Innovation and Health Determinants”, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Sevilla, Spain
| | - Emilio Montero-Ramirez
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain (A.B.); (Á.L.)
| | - Antonio Bocero
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain (A.B.); (Á.L.)
| | - Álvaro Laviana
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain (A.B.); (Á.L.)
| | | | - Antonio León
- Department of Biochemistry, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
| | - Carmen del Rio
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | - Joan Montaner
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain (A.B.); (Á.L.)
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR), Hospital Vall d’Hebron, 08035 Barcelona, Spain
| | - Soledad Pérez-Sánchez
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (A.M.N.); (C.L.A.); (C.D.R.); (D.N.-J.); (R.d.T.); (M.C.-M.); (E.M.); (J.M.); (S.P.-S.)
- Department of Neurology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain (A.B.); (Á.L.)
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Zuo L, Dong Y, Pan Y, Yan H, Meng X, Li H, Zhao X, Wang Y, Wang Y, Liao X. Impact of Serum Cystatin C Level on Long-Term Cognitive Impairment After Acute Ischemic Stroke and Transient Ischemic Attack. Neuropsychiatr Dis Treat 2023; 19:1543-1554. [PMID: 37435549 PMCID: PMC10329915 DOI: 10.2147/ndt.s412825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/08/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Cognitive impairment after stroke/transient ischemic attack (TIA) has a high prevalence. Cystatin C (CysC) has been found as a novel biomarker of neurodegenerative diseases, such as dementia and Alzheimer's disease. We aimed to explore the possible correlations of serum CysC level with cognitive impairment in patients who had mild ischemic stroke and TIA after 1 year. Methods We measured serum CysC level in 1025 participants with a minor ischemic stroke/TIA from enrolled from the Impairment of Cognition and Sleep (ICONS) study of the China National Stroke Registry-3 (CNSR-3). They were divided into four groups according to quartiles of baseline CysC levels. Patients' cognitive functions were assessed by Montreal Cognitive Assessment (MoCA)-Beijing at day 14 and at 1 year. Multiple logistic regression models were performed to evaluate the relationship between CysC and post-stroke cognitive impairment (PSCI) at 1-year follow-up. Results Cognitive impairment was defined as MoCA-Beijing ≤22. Most patients were in 60s (61.52±10.97 years old) with a median (interquartile range) National Institute of Health Stroke Scale(NIHSS) score of 3.00 (4.00) and greater than primary school level of education, and 743 participants (72.49%) were male. Among the 1025 participants, 331 participants (32.29%) patients suffered PSCI at 1-year follow-up. A U-shaped association was observed between CysC and 1-year PSCI [quartile (Q)1 vs Q3: adjusted odds ratio (aOR) 2.69, 95% CI 1.67-4.34, p < 0.0001; Q2 vs Q3: aOR 1.63, 95% CI 1.03-2.57, p = 0.0354; Q4 vs Q3: aOR 1.83, 95% CI 1.16-2.87, p = 0.009]. Moreover, the U-shaped trends were also found between CysC level and the subscores of attention, recall, abstraction and language in MoCA. Conclusion CysC showed a U-shaped correlation with 1-year overall cognitive function. It is probable that measurement of the serum CysC level would aid in the early diagnosis of PSCI.
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Affiliation(s)
- Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore, 117597, Singapore
| | - Yuesong Pan
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hongyi Yan
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xia Meng
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hao Li
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Reid M, Tadros GS, McDougall CC, Reaume N, McDougall B, Sah RG, Wang M, Smith EE, Frayne R, Coutts S, Sajobi T, Longman RS, d'Esterre CD, Barber P. Arterial spin labelling reveals multi-regional cerebral hypoperfusion in patients with transient ischemic attack that are unrelated to ischemia location: A proof-of-concept study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 4:100164. [PMID: 37124951 PMCID: PMC10130071 DOI: 10.1016/j.cccb.2023.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
Background and Aims Patients with transient ischemic attack (TIA) have a substantially increased risk of early dementia. In this exploratory study, we aim to determine whether patients with TIA have 1) measurable regional cerebral hypoperfusion unrelated to the location of ischemia, and 2) determine the relationship of regional cerebral blood flow (rCBF) with their cognitive profiles. Methods Patients with TIA (N = 49) and seventy-nine (N = 79) age and sex matched controls underwent formal neuropsychological testing and MRI. Quantitative arterial spin labelling rCBF maps (mL/min/100 g) were registered to the corresponding high resolution T1-weighted image. Linear regression was used to determine the association between demographic, clinical and cognitive variables and rCBF. Results Patients with TIA had significantly (p < 0.05) lower cognitive scores in the MMSE, MOCA, ACE-R, WAIS-IV DS Coding and Trail Making Tests A and B compared to controls. TIA patients had significantly lower rCBF in the left entorhinal cortex (p = 0.03), right posterior cingulate (p = 0.04), and right precuneus (p = 0.05), after adjusting for age and sex, that were unrelated to the regional anatomical volume and DWI positivity. Regional hypoperfusion in the right posterior cingulate and right precuneus was associated with impaired visual memory (BVMT total, p = 0.05 for both regions) and slower processing speed (TMT A, p = 0.04 and p = 0.01), respectively after adjusting for age and sex. Conclusions TIA patients have patterns of regional hypoperfusion in multiple cortical regions unrelated to the parcellated regional anatomical volume or the presence of a DWI lesion. Regional hypoperfusion in patients with TIA may be an early marker conferring risk of future cognitive decline that needs to be confirmed by future studies.
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Affiliation(s)
- Meaghan Reid
- Department of Medical Sciences, University of Calgary, Calgary, AB, Canada
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - George S. Tadros
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Connor C. McDougall
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Department of Mechanical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Noaah Reaume
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Brooklyn McDougall
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
| | - Rani Gupta Sah
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Eric E. Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Richard Frayne
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Shelagh Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - R. Stewart Longman
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Neuropsychology Service, Foothills Medical Centre, Calgary, AB, Canada
| | - Christopher D. d'Esterre
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Mechanical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Philip Barber
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, Calgary, AB, Canada
- Seaman Family MR Center, Foothills Medical Centre, Calgary, AB, Canada
- Department of Mechanical Engineering, Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Correspond author at: Calgary Stroke Program, Departments of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
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Liao X, Zuo L, Dong Y, Pan Y, Yan H, Meng X, Li H, Zhao X, Wang Y, Shi J, Wang Y. Persisting cognitive impairment predicts functional dependence at 1 year after stroke and transient ischemic attack: a longitudinal, cohort study. BMC Geriatr 2022; 22:1009. [PMID: 36585624 PMCID: PMC9805269 DOI: 10.1186/s12877-022-03609-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/11/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Minor stroke or transient ischemic attack (TIA) usually have mild and nondisabling symptoms, and these functional deficits may recover fully e.g., TIA, however, part of them still suffer from cognitive impairment and poor outcomes. We conducted a study to determine the relationship between cognition evaluated by Montreal Cognitive Assessment (MoCA) and poor functional outcomes assessed by the Modified Rankin Scale (mRS) (mRS ≥ 2) and Stroke Impact Scale (SIS)-16(SIS-16<25%). METHODS The data of this study come from the impairment of cognition and Sleep (ICONS) after acute ischemic stroke or transient ischemic attack in Chinese patients study. A total of 1675 minor stroke patients and TIA patients were finally recruited. Patients' cognition were evaluated by Montreal Cognitive Assessment (MoCA) scale at 2-week (2w), 3 months (3 m) and 1 year(1y). Cognitive impairment (CI) was defined as MoCA score ≤ 22. According to MoCA score, patients were divided into 4 groups: no PSCI group: with MoCA-2w>22 and MoCA-3 m>22; improved PSCI group: with MoCA-2w ≤ 2 and MoCA-3 m>22;delayed PSCI group: MoCA-2w>22 and MoCA-3 m ≤ 22; persisting PSCI group: with MoCA-2w ≤ 22 and MoCA-3 m ≤ 22. RESULTS A total of 1675 stroke patients were recruited in this study. There were 818 patients (48.84%) who had PSCI at baseline. Of these, 123 patients (15%) had mRS ≥2 at 3 months. The persisting PSCI group was a significant predictor of functional dependence at 3 months and 1 year after stroke and when adjusted for covariates such as gender, age, history of stroke, depression and intracranial atherosclerotic stenosis, stroke subtype and acute infarction type. CONCLUSION Persisting PSCI increased the risk of poor functional outcome after 3 months and 1 year follow-up. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcome.
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Affiliation(s)
- Xiaoling Liao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Lijun Zuo
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yanhong Dong
- grid.4280.e0000 0001 2180 6431Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, Level 2, 10 Medical Dr., Singapore, 117597 Singapore
| | - Yuesong Pan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongyi Yan
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yilong Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Jiong Shi
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China
| | - Yongjun Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, Beijing, 100070 China ,grid.24696.3f0000 0004 0369 153XNational Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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