Post-stroke cognitive impairment: epidemiology, mechanisms and management

Changes in cerebrovascular reactivity as a marker of cognitive impairment risk: a transcranial Doppler study

INTRODUCTION

Post-stroke cognitive impairment (PSCI) and dementia affect short- and long-term outcome after stroke and can persist even after recover from a physical handicap. The process underlying PSCI is not yet fully understood. Transcranial Doppler ultrasound (TCD) is a feasible method to investigate cerebrovascular aging or dementia, through the pulsatility index (PI), the cerebrovascular reactivity (e.g. the Breath-Holding Index (BHI)) and the functional Transcranial Doppler sonography (fTCD). Aim of the study was to assess the usefulness of PI, BHI, Resistance Index (RI) and fTCD in evaluating the risk of cognitive impairment evolution in patients with minor stroke (MS), compared to patients with transient ischemic attack (TIA) and to healthy controls (HC).

MATERIAL AND METHODS

PI, RI, BHI and fTCD were evaluated in the middle cerebral artery (MCA) of MS patients, TIA and HC. Patients with MS and TIA were enrolled within six days from the cerebrovascular event (acute phase) and the tests were repeated after 180±15 days from t0 (control phase). During the TCD recording, particular sections of MoCA test and FAB test were performed.

RESULTS

43 subjects were enrolled: 13 MS, 16 TIA and 14 HC. MFV analysis in the acute phase demonstrated no difference between MFVs at rest vs MFVs during MoCA/FAB tests in TIA and MS (acute phase), a significant increase of MFVs during MoCA/FAB tests vs MFVs at rest in HC (p<0.01), a statistically significant difference in the PI of MS vs HC at rest (p=0.048) and in BHI between HC vs MS (p<0.001) and HC vs TIA (p<0.01). In the control phase the absence of a statistically significant difference in MFVs was observed only in MS patients (MFVs at rest vs MFVs during MoCA) and PI and BHI values were in the normal range both in MS and TIA. No correlation was observed between MoCA test results and MFV, PI or RI, in any of the three groups.

CONCLUSION

A different cerebral vasoreactivity, in terms of no increase in MFV, was found when performing cognitive tasks in patients with MS and TIA compared to HC in the acute phase. TCD is a fundamental tool to study cerebral vasoreactivity.

M. P, Pushparajan L. Pharmacotherapy for Poststroke Cognitive Impairment and Poststroke Cognitive Impairment With Dementia: A Review

Poststroke cognitive impairment (PSCI) refers to any level of cognitive decline occurring after a stroke, ranging from mild to severe impairments, while PSCI with dementia describes a more severe form where the cognitive decline significantly affects daily functioning and meets the clinical criteria for dementia. PSCI occurs in more than half of individuals who have had a stroke. Despite its high prevalence, the pharmacotherapeutic options for PSCI are limited. Several pharmacotherapeutic options like cholinesterase inhibitors (e.g., donepezil, galantamine, and rivastigmine) and N-methyl-d-aspartate receptor antagonists (e.g., memantine) have shown potential in improving cognitive functions. However, their overall effectiveness remains inconsistent across different studies and patient populations. Newer drugs such as citicoline, cilostazol, and antidepressants have shown promise, but further research is needed to validate their efficacy and safety specifically for PSCI management.

High serum glial fibrillary acidic protein levels are associated with increased risk of post-stroke cognitive impairment

Background and purpose

The correlation between glial fibrillary acidic protein (GFAP) and cognitive impairment in acute ischemic stroke patients remains uncertain. We aimed to evaluate GFAP in serum as predictor of post-stroke cognitive impairment (PSCI) at 90 days.

Methods

From March 2022 to February 2023, patients with first-ever ischemic stroke were prospectively enrolled. Serum GFAP concentrations were measured within 24 h after admission using an enzyme-linked immunosorbent assay. Cognitive function measurement was performed at the 90 days follow-up using the Mini-mental state examination (MMSE). A MMSE score <27 was defined as PSCI. Multiple logistic regression and restricted cubic spline were performed to examine the association between GFAP and cognitive impairment.

Results

A total of 336 patients (mean age: 66.3 ± 9.0 years; 58.3% male) with acute ischemic stroke were included. The median GFAP levels were 0.73 ng/mL (interquartile range, 0.38-1.09 ng/mL). During the 3-month follow-up, 164 participants (48.8%) experienced PSCI. Higher GFAP levels were independently associated with PSCI after adjusting for potential confounders (per 1-unit increase, odds ratio: 3.91; 95% confidence interval: 2.24-6.82; p = 0.001). Additionally, restricted cubic spline confirmed a linear relationship between serum GFAP concentrations and PSCI risk (P for linearity = 0.001).

Conclusion

This study demonstrated that higher levels of GFAP were associated with PSCI, suggesting that GFAP could be a promising and straightforward screening indicator of cognitive impairment after stroke.

Lipoprotein-a and white matter abnormalities: predicting small vessel disease in young patients with ischemic cerebrovascular events

INTRODUCTION

Post-stroke cognitive impairment (PSCI) affects 15-70% of ischemic stroke survivors, with vascular dementia contributing significantly to long-term disability. Lipoprotein(a) [Lp(a)] has emerged as a key risk factor for cardiovascular and cerebrovascular diseases, but its role in cerebral small vessel disease (cSVD) remains unclear. This study investigates the association between elevated Lp(a) levels and Fazekas scores (≥ 2), a marker of white matter hyperintensities (WMHs) indicative of cSVD, in young patients (< 65 years) with ischemic stroke or transient ischemic attack (TIA).

METHODS

We retrospectively analysed data of 217 patients with ischemic stroke/TIA, age 18-65, and Lp(a) measurement within four weeks of the event. Data included clinical history, imaging (MRI Fazekas scores), and Lp(a) levels (> 50 mg/dL). Multivariable logistic regression and ROC analysis were performed to identify predictors of higher Fazekas scores.

RESULTS

Elevated Lp(a) levels were independently associated with Fazekas scores ≥ 2 (OR 2.83, 95% CI 1.13-7.10, p = 0.03) alongside older age, hypertension, prior stroke/TIA, and elevated non-HDL cholesterol. The predictive model demonstrated high accuracy (AUC = 0.81). Patients with elevated Lp(a) exhibited greater WMH burden, indicating advanced small vessel damage.

CONCLUSIONS

Elevated Lp(a) levels are a significant biomarker for WMHs and cSVD in young stroke patients, offering prognostic value beyond traditional risk factors. Incorporating Lp(a) testing into routine stroke evaluations could enable early identification and tailored management strategies to mitigate further vascular damage and cognitive decline.

Protocol for detection and monitoring of post-stroke cognitive impairment through AI-powered speech analysis: a mixed methods pilot study

Introduction

Post-stroke cognitive impairment (PSCI) affects up to 75% of stroke survivors but remains challenging to detect with traditional neuropsychological assessments. Recent advances in artificial intelligence and natural language processing have opened new avenues for cognitive screening through speech analysis, yet their application to PSCI remains largely unexplored. This study aims to characterize speech markers of PSCI in the first-year post-stroke and evaluate their utility for predicting cognitive outcomes in a Singapore cohort.

Methods

This prospective mixed-methods study will recruit 30 stroke survivors from the Alexandra Hospital and National University Hospital in Singapore. Participants will be assessed at four timepoints: baseline (within 6 weeks of stroke onset), 3-, 6-, and 12-months post-stroke. At each visit, participants will complete the Montreal Cognitive Assessment (MoCA) and a standardized speech protocol comprising picture description and semi-structured conversation tasks. Speech recordings will be automatically transcribed using automated speech recognition (ASR) systems based on pretrained acoustic models, and comprehensive linguistic and acoustic features will be extracted. Machine learning models will be developed to predict MoCA-defined cognitive impairment. Statistical analysis will include correlation analysis between speech features and MoCA scores, as well as machine learning classification and regression models to predict cognitive impairment. Linear mixed-effects models will characterize trajectories of MoCA scores and speech features over time. Qualitative analysis will follow an inductive thematic approach to explore acceptability and usability of speech-based screening.

Discussion

This study represents a critical step toward developing speech-based digital biomarkers for PSCI detection that are sensitive, culturally appropriate, and clinically feasible. If validated, this approach could transform current models of PSCI care by enabling remote, frequent, and naturalistic monitoring of cognitive health, potentially improving outcomes through earlier intervention.

Potential Inflammatory Biomarkers and Differential Gut Microbiota in Cognitive Impairment After Ischemic Stroke

Objective

Ischemic stroke, one of the main public health problems worldwide, causes a variety of physiological dysfunction, including cognitive impairment. Although studies have been focused on posted-stroke cognitive impairment (PSCI), its pathological mechanism remains unclear.

Methods

Here, we enrolled 66 participants stratified into three groups: healthy controls (HC, n=15), post-stroke patients without cognitive impairment (PSWCI, n=15), and PSCI patients (n=36). We analyzed clinical parameters and changes of several cytokines and gut microbiota profiles.

Results

We found that compared with healthy control (HC) group, levels of low-density lipoprotein (LDL) cholesterol, total cholesterol (TC), homocysteine (Hcy), CRP and IL-6 were significantly increased in PSWCI and PSCI patients. Of them, levels of Hcy and IL-6 in PSCI group were significantly higher than that in PSWCI. ROC curve analysis identified Hcy and IL-6 as potential diagnostic biomarkers for PSCI. Furthermore, 16S rRNA sequencing of gut microbiota shows that the abundance of blaut, bifidobacterium and macromonas increased, while the abundance of bacteroides and bifidobacterium brevis decreased significantly.

Conclusion

These findings suggest that elevated Hcy and IL-6 levels may serve as risk factors for PSCI, with gut microbiota dysregulation potentially contributing to its pathogenesis.

Transcranial Magnetic Stimulation Alleviates Spatial Learning and Memory Impairment by Inhibiting the Expression of SARM1 in Rats with Cerebral Ischemia-Reperfusion Injury

The cognitive impairment resulting from stroke is purported to be associated with impaired neuronal structure and function. Transcranial Magnetic Stimulation (TMS) modulates neuronal or cortical excitability and inhibits cellular apoptosis, thereby enhancing spatial learning and memory in middle cerebral artery occlusion/reperfusion (MCAO/R) rats. In this study, we aimed to investigate whether Sterile alpha and Toll/interleukin receptor motif-containing protein 1 (SARM1), a pivotal Toll-like receptor adaptor molecule and its related mechanisms are involved in the ameliorating effect of TMS on cognitive function post-cerebral ischemia. We evaluated hippocampal injury in MCAO/R rats after one week of treatment with 10-Hz TMS at an early stage. The effect of SARM1 was more effectively assessed through lentivirus-mediated SARM1 overexpression. Various techniques, including FJB staining, HE staining, western blot, immunofluorescence, imunohistochemistry, and transmission electron microscopy, were employed to investigate the molecular biological and morphological alterations of axons, myelin sheaths and apoptosis in the hippocampus. Ultimately, Morris Water Maze was employed to evaluate the spatial learning and memory capabilities of the rats. We observed that TMS significantly reduced the levels of SARM1, NF-κB, and Bax following MCAO/R, while elevating the levels of HSP70, Bcl-2, GAP-43, NF-200, BDNF, and MBP. Overexpression of SARM1 not only reversed the neuroprotective effects induced by TMS but also exacerbated spatial learning and memory impairments in rats. Our results demonstrate that TMS mitigates hippocampal cell apoptosis via the SARM1/HSP70/NF-κB signaling pathway, thus fostering the regeneration of hippocampal axons and myelin sheaths, as well as the improvement of spatial learning and memory.

Serum neurofilament heavy chain predicts post-stroke cognitive impairment

Serum phosphorylation neurofilament heavy chain (p-NfH) is a marker of axonal injury, and previous research has shown an association between p-NfH and both Alzheimer's disease and frontotemporal dementia. However, there have been no reports on its relationship with post-stroke cognitive impairment (PSCI). The purpose of this study is to investigate whether p-NfH can serve as a predictive biomarker for PSCI following acute ischemic stroke (AIS). From July 2020 to September 2021, a total of 58 cases of first-time acute ischemic stroke (AIS) patients were admitted to the Department of Neurology in the Second Hospital of Hebei Medical University. Additionally, 30 healthy volunteers were randomly selected as the control group. Demographic data, medical history, NIHSS scores, cerebral infarction volume, Fazekas scores for white matter and the serum p-NfH were collected. Follow-up assessments were conducted at 6 and 12 months after AIS. Cognitive function was evaluated using a multi-domain cognitive assessment scale, and patients were categorized into the post-stroke cognitive impairment group (PSCI) and non-post-stroke cognitive impairment group (N-PSCI). Further stratification was done into the progression group (MoCA score decline) and stable group (MoCA score unchanged or improved) based on the difference in MoCA scores between 12 and 6 months. The serum p-NfH levels in the AIS group were significantly higher than those in the control group (p < 0.01). Additionally, p-NfH levels were positively correlated with NIHSS scores and infarct volume. Furthermore, AIS patients with moderate to severe cerebral white matter lesions (Fazekas score ≥ 2) showed higher p-NfH levels compared to AIS patients with no or mild white matter lesions (Fazekas score 0 or 1) (p < 0.01). The PSCI group demonstrated higher p-NfH levels compared to the N-PSCI group, even after accounting for variables such as age, education level, NIHSS, infarct volume, and Fazekas grading (OR = 1.06, 95% CI 1.004-1.11, p = 0.03). Furthermore, the progression group exhibited significantly elevated p-NfH levels in comparison to the stable group. The ROC curve analysis revealed that the ideal cutoff point for p-NfH was determined to be at 166.03 pg/ml. This cutoff point exhibited a sensitivity of 0.774 and a specificity of 0.926 (p < 0.01). Furthermore, the area under the curve was calculated to be 0.881 (95% CI 0.791-0.97, p < 0.01). Serum p-NfH is a potential biomarker for predicting PSCI. Further investigation should explore its potential as an indicator for timely cognitive intervention in stroke patients during follow-up.

Assessing the utility of Fronto-Parietal and Cingulo-Opercular networks in predicting the trial success of brain-machine interfaces for upper extremity stroke rehabilitation

For stroke participants undergoing motor rehabilitation, brain-machine/computer interfaces (BMI/BCI) can potentially improve the efficacy of robotic or exoskeleton-based therapies by ensuring patient engagement and active participation, through monitoring of motor intent. In such interventions, exploring the network-level understanding of the source space, in terms of various cognitive dimensions such as executive control versus reward processing is fruitful in both improving the existing therapy protocols as well as understanding the subject-level differences. This contrasts to traditional approaches that predominantly investigate rehabilitation from resting state data. Moreover, conventional BMIs used for stroke rehabilitation barely accommodate people suffering from moderate to severe cognitive impairments. In this first-of-the-kind study, we explore the cognitive dimensions of a BMI trial by probing the networks that are core to the BMI performance and propose a network connectivity-based measurement with the potential to characterize the cognitive impairments in patients for closed-loop intervention. Specifically, we tease apart the extent of cognitive evaluation versus executive control aspects of impairments in these patients, by measuring the activation power of a major cognitive evaluation network- the Cingulo-Opercular Network (CON) and a major executive control circuit- the Fronto-Parietal network (FPN), and the connectivity between FPN-CON. We test our hypothesis in a previously collected dataset of electroencephalography (EEG) and structural imaging performed on stroke patients with upper limb impairments, while they underwent an exoskeleton-based BMI intervention for about 12 sessions over 4 weeks. Our logistic regression modeling results suggest that the connectivity between FPN and CON networks and their source powers predict trial failure accurately to about 84.2%. In the future, we aim to integrate these observations into a closed-loop design to adaptively control the cognitive difficulty and passively increase the subject's motivation and attention factor for effective BMI learning.

Inflammation, Anti-inflammatory Interventions, and Post-stroke Cognitive Impairment: a Systematic Review and Meta-analysis of Human and Animal Studies

The pathophysiology and treatment of post-stroke cognitive impairment (PSCI) are not clear. Stroke triggers an inflammatory response, which might affect synapse function and cognitive status. We performed a systematic review and meta-analysis to assess whether patients with PSCI have increased levels of inflammatory markers and whether anti-inflammatory interventions in animals decrease PSCI. We systematically searched PubMed, EMBASE, and PsychInfo for studies on stroke. For human studies, we determined the standardized mean difference (SMD) on the association between PSCI and markers of inflammation. For animal studies, we determined the SMD of post-stroke cognitive outcome after an anti-inflammatory intervention. Interventions were grouped based on proposed mechanism of action. In patients, the SMD of inflammatory markers for those with versus those without PSCI was 0.46 (95% CI 0.18; 0.76; I2 = 92%), and the correlation coefficient between level of inflammation and cognitive scores was - 0.25 (95% CI - 0.34; - 0.16; I2 = 75%). In animals, the SMD of cognition for those treated with versus those without anti-inflammatory interventions was 1.43 (95% CI 1.12; 1.74; I2 = 83%). The largest effect sizes in treated animals were for complement inhibition (SMD = 1.94 (95% CI 1.50; 2.37), I2 = 51%) and fingolimod (SMD = 2.1 (95% CI 0.75; 3.47), I2 = 81%). Inflammation is increased in stroke survivors with cognitive impairment and is negatively correlated with cognitive functioning. Anti-inflammatory interventions seem to improve cognitive functioning in animals. Complement inhibition and fingolimod are promising therapies on reducing PSCI.

Comparative Evaluation of the Montreal Cognitive Assessment Basic Scale Against the Mini-Mental State Examination for Post-Stroke Cognitive Impairment

Background

The Montreal Cognitive Assessment Basic scale (MoCA-B) is more sensitive than the Mini-Mental State Examination (MMSE) for detecting mild cognitive impairment due to Alzheimer's disease (AD). To explore the diagnostic efficacy of the Chinese version of the MoCA-B against the MMSE for post-stroke cognitive impairment (PSCI).

Methods

Eighty four patients with acute cerebral infarction were grouped into a post-stroke cognitive normal (PSCN) or a PSCI group based on their scores on the Clinical Dementia Rating scale (CDR), the gold standard for diagnosing PSCI. They were evaluated by using the MMSE and MoCA-B scales, then the area under the receiver operating characteristic (ROC) curve (AUC) was used for evaluation.

Results

Most factors of the MoCA-B were significantly different between the two groups, and the PSCN group completed the MoCA-B faster (p < 0.05). The AUC analysis showed that for the MoCA-B with a cut-off total score of 23, sensitivity = 85.71%, specificity = 61.22%, Youden's J Index = 0.469, and AUC = 0.832. For the MMSE with a cut-off total score of 25, sensitivity = 70.59%, specificity = 93.75%, Youden's J Index = 0.643, and AUC = 0.885. The AUC of the MMSE was higher than that of the MoCA-B (p > 0.05). The MoCA-B had greater sensitivity and negative predictive value than the MMSE. When considering the cutoffs for identifying mild cognitive impairment (MCI) across different education levels, the MoCA-B had a higher positive rate for PSCI identification (51.2% vs 25%, p < 0.001), indicating that the MoCA-B is suitable for identifying PSCI.

Conclusion

The MoCA-B demonstrates higher sensitivity and negative predictive value compared with the MMSE in the screening of post-stroke cognitive impairment patients.

Network dynamics in post-stroke cognitive impairment: insights from effective connectivity analysis

This study investigates post-stroke cognitive impairment (PSCI) by utilizing spectral dynamic causal modeling (spDCM) to examine changes in effective connectivity (EC) within the default mode, executive control, dorsal attention, and salience networks. Forty-one PSCI patients and 41 demographically matched healthy controls underwent 3D-T1WI and resting-state functional magnetic resonance imaging on a 3.0T MRI. The study compared EC among eight representative regions of interest using spDCM and analyzed the correlation between altered EC and cognitive test scores. Subgroup analysis was conducted based on lesion location. The study found a significant increase in EC in the PSCI group, specifically from the posterior cingulate cortex (PCC) to the left and right dorsolateral prefrontal cortex (L_DLPFC and R_DLPFC, respectively), and from the right insula to R_DLPFC (p < 0.05). These changes were significantly negatively correlated with cognitive scores. Subgroup analysis showed increased executive control in PSCI patients with left anterior circulation lesions. Validation through low-order functional connectivity analysis indicated abnormalities dominated by large-scale intra- and inter-network functional connectivity increases in patients with PSCI. The study suggests an increase in effective connectivity between networks, particularly within the triple network model. The findings implicate the PCC and R_DLPFC in the pathophysiology of PSCI, shedding light on its cognitive implications. This study emphasizes the importance of understanding network changes in PSCI from various perspectives, enhancing our understanding of the neural mechanisms underlying PSCI, and establishing a foundation for future research.

PEMOCS: effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-a randomized, controlled trial

Purpose

Motor-cognitive exergames may be beneficial for addressing both motor and cognitive residual impairments in chronic stroke, however, effective training schedules are yet to be determined. Therefore, this study investigates the effects of a concept-guided, personalized, motor-cognitive exergame training on cognitive functions and gait in chronic stroke survivors.

Methods

In this single-blind, randomized, controlled trial, stroke survivors (at least six-months post-stroke and able to perform step-based exergaming) were allocated either to the intervention (usual care + concept-guided, personalized, motor-cognitive exergame training) or the control group (usual care only). Global cognitive functioning was primarily targeted, while health-related quality of life (HRQoL), cognitive functions, mobility, and gait were evaluated secondarily. Analyses were performed with linear-mixed effect models.

Results

Effects on global cognitive functioning were non-significant, with no differences between responders (participants exhibiting a clinically relevant change) and non-responders (participants exhibiting no clinically relevant change). Among secondary outcomes, the mobility domain of the HRQoL questionnaire, intrinsic visual alertness, cognitive flexibility, working memory, and outdoor walking speed as well as swing width (unaffected side) showed significant interaction effects in favour of the exergame group.

Discussion

Additional exergaming helped maintaining global cognitive functioning and showed encouraging effects in mobility and cognitive outcomes. Responders and non-responders did not differ in adherence, baseline values or age. Enhancing the frequency and intensity of sessions could unlock more substantial benefits. Adopting a blended therapy approach may be key to maximizing positive effects.

Clinical trial registration

clinicaltrials.gov, identifier NCT05524727.

Potential Biomarkers of Post-stroke Cognitive Impairment in Chinese Population: a Systematic Review and Meta-Analysis

It is still controversial whether peripheral blood biomarkers have the potential to be diagnostic, prognostic, and therapeutic targets for post-stroke cognitive impairment (PSCI). All studies reporting the correlation between peripheral blood biomarkers and PSCI in Chinese acute ischemic stroke (AIS) patients were screened in eight databases and meta-analyses were performed to explore their predictive value for PSCI. The results showed that the levels of C-reactive protein (CRP), fasting blood glucose (FBG), homocysteine (Hcy), and cystatin C (CysC) were significantly higher in the PSCI group than in the post-stroke cognitive impairment no dementia (PSNCI) group. However, the differences in glycosylated hemoglobin (HbA1c), creatinine (Cr), blood urea nitrogen (BUN), and uric acid (UA) levels were not significant. The correlation between Hcy and PSCI applies to all AIS patients, whereas the correlation between CRP (p < 0.001), FBG (p = 0.005), CysC (p = 0.005), and PSCI is generalizable only to first-onset AIS. CRP may be a biomarker of cognitive impairment 3-6 months after AIS (3 months: p < 0.001; 6 months: p = 0.030) and does not appear to have a correlation in the long term. However, the correlation between FBG and PSCI may be significant 6 months to 1 year after AIS (6 months: p = 0.032; 1 year: p = 0.004), whereas the correlation between Hcy and PSCI may be significant 3 months to 1 year after AIS (3 months: p = 0.002; 6 months: p = 0.004; 1 year: p = 0.004). CRP, FBG, Hcy, and CysC may be potential biomarkers for PSCI, whereas the correlation between Cr, BUN, UA, and PSCI has not been confirmed.

Post-Stroke Cognitive Impairment: A Narrative Review of the Comprehensive Screening and Detecting Process

PURPOSE

To examine screening procedures and tools for post-stroke cognitive impairment (PSCI) to guide future practices and research.

METHOD

Searches in PubMed, CINAHL, PsycINFO, and Google Scholar included articles from 2013 to 2023 focusing on individuals with first ever ischemic stroke and confirming PSCI within 1 year. Thematic analysis was synthesized narratively.

RESULTS

Eight studies (two cross-sectional and six prospective cohorts) with 25,443 participants were reviewed. Screening for PSCI was typically performed within 3 to 6 months post-stroke. Montreal Cognitive Assessment and Mini-Mental State Examination were the most commonly used tools, but cutoff scores varied widely. Screening involved pre- and post-stroke cognitive screening and identifying risk factors.

CONCLUSION

Significant variability exists in PSCI assessment tools, cutoff, and timing. Further research is needed to standardize screening protocols, focusing on criteria, timing, accuracy, and feasibility. Early and repeated screening with risk management can improve PSCI prevention. [Journal of Gerontological Nursing, 51(3), 19-27.].

Adaptation of Oxford Cognitive Screen into Turkish (OCS-TR): Validity and reliability study in stroke survivors

BACKGROUND

The existing cognitive screening tests used to assess cognitive disorders after stroke in Türkiye face limitations in scope and user applicability. Therefore, this study aimed to address these limitations by adapting the stroke-specific cognitive screening test, the Oxford Cognitive Screen (OCS), into Turkish. Additionally, validity and reliability studies were conducted.

METHODS

A total of 114 stroke survivors and 92 healthy individuals participated in the study. Data were collected using the "Participant Information Form," "Oxford Cognitive Screen Turkish Version (OCS-TR)," "Aphasia Language Assessment Test (ADD)," "Montreal Cognitive Assessment Test- Turkish (MOCA-TR)," "Barthel Activities of Daily Living Index (BGYAI)" and "Beck Depression Scale." The team followed an established and detailed step by step process guided by the OCS Concept Elaboration document. Statistical analyses were conducted with IBM SPSS Statistics. Validity and reliability studies, including content validity, known-groups validity, convergent and divergent validity, concurrent validity, internal consistency reliability, test-retest reliability, inter-rater reliability, intra-rater reliability, and parallel forms reliability were conducted to assess the robustness of the measurement instruments.

RESULTS

The language and cultural adaptation process underwent content analysis, adhering to ISPOR and ISOQOL guidelines, resulting in minimal content changes post-pilot study. Notable differences in subtest scores between healthy and stroke participants in both A and B forms of OCS-TR demonstrate known-groups validity, emphasizing superior performance in healthy participants. Strong convergent validity was evidenced by significant correlations with MOCA-TR (rs=0.18 to 0.81) and BGYAI (rs=0.19 to 0.51), while divergent validity was supported by weak correlations with overall BGYAI scores. Noteworthy correlations between specific subtests of OCS-TR and ADD underscore concurrent validity, with high inter- and intra-rater reliability,  internal consistency (α = 0.90 for stroke, α = 0.65 for healthy) and test-retest reliability (rs=0.89 to 0.99). Parallel forms reliability was high in both healthy and stroke participants, though significant differences were observed on specific subtests.

CONCLUSION

The results confirm that the OCS-TR scale can be considered a valid and reliable instrument for assessing cognitive functions in stroke survivors. This stroke-specific tool offers clinicians a comprehensive and inclusive brief cognitive screening tool tailored to the needs of stroke patients.

Post stroke sexual dysfunction - a current review

INTRODUCTION

Sexual dysfunction manifests as various challenges during sexual activity and is a prevalent condition that significantly impacts quality of life. Post stroke sexual dysfunction (PSSD) is particularly concerning, yet it is often overlooked by both healthcare providers and patients.

METHODS

We conducted a comprehensive literature review, examining research and reports related to sexual dysfunction following stroke. Our aim is to synthetize an extensive, detailed and up-to-date overview of its prevalence, underlying mechanisms, and interventions.

RESULTS AND CONCLUSION

PSSD, often underestimated among stroke survivors, has a high incidence but remains poorly understood in terms of its neurobiological mechanisms. Swift and accurate diagnosis, coupled with timely rehabilitative intervention, is crucial. However, the development of comprehensive guidelines is impeded by a lack of high-quality literature. This review seeks to present recent advances in understanding PSSD, and to advocate for a structured strategy in terms of the long-term rehabilitation of stroke survivors.

Exploring the Relationship Between Serum Neuronal Pentraxin 2 and Poststroke Cognitive Impairment in Patients With First-Episode Acute Ischemic Stroke

BACKGROUND AND OBJECTIVE

Neuronal pentraxin 2 (NPTX2) is associated with cognitive impairment in some neurodegenerative diseases. However, few studies focused on the association between NPTX2 and poststroke cognitive impairment (PSCI). Hence, this study aimed to investigate the association between serum NPTX2 levels and PSCI.

METHODS

A total of 134 participants with acute ischemic stroke (AIS) and 42 normal controls were enrolled in this study. Admission baseline information was collected, and serum NPTX2 levels were determined within 24 h using enzyme-linked immunosorbent assay (ELISA) at hospital admission. All subjects were evaluated for cognitive function using the MoCA (Montreal Cognitive Assessment) scale at 3 months after stroke onset, and patients with AIS were divided into PSCI and PSNCI (poststroke no cognitive impairment) groups, with a total MoCA score < 26 defined as PSCI. This study analyzed the relationship between serum NPTX2 and MoCA score and the risk factors of PSCI. The receiver operating characteristic (ROC) curve was to evaluate the diagnostic value of serum NPTX2 levels on PSCI.

RESULTS

Among the 134 AIS participants, 53 (38.8%) patients suffered from PSCI at 3 months after stroke onset. The serum levels of NPTX2 in the PSCI group, PSNCI group, and normal controls group were significantly different (p < 0.05). The serum NPTX2 levels in the PSCI and PSNCI groups were higher than normal control group, and the serum NPTX2 levels in the PSCI group were lower than PSNCI group (p < 0.05). Serum NPTX2 levels were positively correlated with the total score of MoCA (r = 0.329, p < 0.01), and also positively correlated with some subcognitive domains of MoCA (visuospatial and executive functions, naming, delayed memory, and attention). ROC curve indicated that serum NPTX2 predicted cognitive impairment in AIS patients. Multivariate Logistic regression analysis indicated serum NPTX2 was an independent protective factor for PSCI (odds ratio [OR] = 0.075, 95% CI 0.010-0.812, p < 0.01).

CONCLUSIONS

Lower serum NPTX2 levels were associated with PSCI within 3 months in patients with first-episode AIS. Lower levels of serum NPTX2 may be associated with impairment in visuospatial and executive functions, naming, delayed memory, and attention, while a further larger-scale study is needed to verify our findings.

Adapting the stroke therapy outcome measure for use by Multidisciplinary Teams: considering reliability

PURPOSE

The Therapy Outcome Measure (TOM) comprises many profession and client group-specific adapted scales based on the International Classification of Functioning Model, used by different Health Care Professionals (HCPs). A new Multidisciplinary stroke TOM scale (MDT Stroke TOMs) was developed by amalgamating the relevant scales. This study aimed to develop a scale to describe patients' abilities and improve communication and collaboration within the stroke Multidisciplinary Team (MDT). The present study investigated the inter-rater and intra-rater reliability of this adaptation.

MATERIALS AND METHODS

The MDT Stroke TOM Scale was developed by combining and rewording four profession-specific adapted TOM scales following iterative trials and discussions leading to an agreed version. 150 stroke Allied Health Professional (AHPs) and nurses were trained virtually in TOM and the MDT Stroke TOM Scale. Ten AHP and nursing raters from five professions evaluated ten composite stroke case studies for inter-rater reliability. Six participated in the intra-rater reliability review of the same three case studies at different time points. Reliability was quantified using intraclass correlation coefficients and measurement error using the smallest detectable change.

RESULTS

There was good to excellent concordance between the raters in terms of scoring. Raters' scores were also consistent. The MDT Stroke TOMs is being used consistently across the South West London Stroke Network.

CONCLUSION

The Stroke MDT TOMs is psychometrically robust and should assist with improving team work in the rehabilitation of stroke patients and their carers. Future research may use MDT Stroke TOM to promote interprofessional team working and facilitate communication in Stroke Rehabilitation.

High Plasma Polyamine Levels Are Associated With an Increased Risk of Poststroke Cognitive Impairment: A Multicenter Prospective Study From CATIS

BACKGROUND

Polyamines have been suggested to play pivotal roles in ischemic stroke and neurodegenerative disorders, but the associations of plasma polyamines with poststroke cognitive impairment (PSCI) remain unclear. We aimed to prospectively investigate the associations of plasma putrescine, spermidine, and spermine with PSCI among patients with ischemic stroke in a multicenter cohort study.

METHODS AND RESULTS

We measured plasma polyamine levels at baseline among 619 patients with ischemic stroke from a preplanned ancillary study of CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). We used the Mini-Mental State Examination and Montreal Cognitive Assessment to evaluate cognitive function at 3-month follow-up after ischemic stroke, and PSCI was defined as Mini-Mental State Examination score <27 or Montreal Cognitive Assessment score <25. According to the Mini-Mental State Examination score, plasma polyamines were positively associated with PSCI. The adjusted odds ratios of PSCI for the highest versus lowest quartile of putrescine, spermidine, and spermine were 1.81 (95% CI, 1.09-3.00), 1.81 (95% CI, 1.09-3.01), and 1.92 (95% CI, 1.15-3.20), respectively. In addition, plasma putrescine (net reclassification improvement, 32.08%; P<0.001; integrated discrimination improvement, 1.62%; P=0.002), spermidine (net reclassification improvement, 25.29%; P=0.002; integrated discrimination improvement, 1.22%; P=0.006), and spermine (net reclassification improvement, 16.54%; P=0.045; integrated discrimination improvement, 1.36%; P=0.004) could significantly improve the risk reclassification of PSCI beyond established risk factors. There were similar significant relationships when PSCI was defined by Montreal Cognitive Assessment score.

CONCLUSIONS

Higher plasma polyamine levels were associated with increased risk of PSCI among patients with ischemic stroke. Our findings suggest that plasma polyamines should be implicated in the pathophysiologic processes of PSCI and may be the potential intervention targets for PSCI.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

Plasma Human Cartilage Glycoprotein-39 and Cognitive Impairment After Acute Ischemic Stroke

BACKGROUND

Our study aimed at evaluating the association between plasma human cartilage glycoprotein-39 (YKL-40) and cognitive impairment at 3 months among patients with acute ischemic stroke.

METHODS AND RESULTS

Plasma YKL-40 levels were measured in 604 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. Cognitive impairment outcomes were assessed at 3 months poststroke using the Mini-Mental State Examination and the Montreal Cognitive Assessment. According to the Mini-Mental State Examination score, patients in the highest quartile of YKL-40 had a 2.01-fold (95% CI, 1.23-3.29; P for trend=0.009) risk of poststroke cognitive impairment compared with those in the lowest quartile. Each 1 SD difference of logarithm-transformed YKL-40 was associated with a 28% (95% CI, 7-53) increased risk for the outcome. The multiple-adjusted spline regression model confirmed dose-response relationships between YKL-40 and poststroke cognitive impairment (P for linearity=0.01). Adding YKL-40 to a model containing conventional risk factors significantly improved the discriminatory power (area under the receiver operating characteristic curve improved by 0.02, P=0.03). When cognitive impairment was defined using the Montreal Cognitive Assessment score, similar findings were observed.

CONCLUSIONS

Elevated YKL-40 levels were associated with an increased risk of cognitive impairment at 3 months among patients with acute ischemic stroke.

REGISTRATION

URL: clinicaltrials.gov; Unique Identifier: NCT01840072.

A Comparison of Test-Retest Reliability and Practice Effects of Short Portable Mental State Questionnaire and Montreal Cognitive Assessment in Patients with Stroke

OBJECTIVE

To compare the test-retest reliabilities and minimal detectable change (MDC) of the Short Portable Mental State Questionnaire (SPMSQ) and the Montreal Cognitive Assessment (MoCA) in patients with stroke.

METHODS

63 patients were recruited from 1 medical center. The SPMSQ and MoCA were administered twice, 2 weeks apart.

RESULTS

Both measures showed high intraclass correlation coefficients (SPMSQ: 0.87; MoCA: 0.89) and acceptable MDC%s (SPMSQ: 14.8%; MoCA: 19.6%). A small correlation (r = 0.30) was found between the absolute difference and average in each pair of assessments in the SPMSQ, which was close to the criterion of heteroscedasticity. A small practice effect was observed in the MoCA (Cohen's d = 0.30).

CONCLUSION

The SPMSQ demonstrated smaller random measurement error and an absence of practice effect. When comparing the psychometric properties of the SPMSQ and MoCA as outcome measures for assessing cognitive function in patients with stroke, the SPMSQ appears to be a more suitable choice than the MoCA.

Development and validation of a novel model to predict post-stroke cognitive impairment within 6 months after acute ischemic stroke

Background

Cognitive decline following acute ischemic stroke (AIS), termed post-stroke cognitive impairment (PSCI), is a prevalent phenomenon that significantly elevates disability and mortality rates among affected patients. The objective of this investigation was to develop a robust clinical prediction model capable of forecasting PSCI within six months post-AIS and subsequently validate its effectiveness.

Methods

A cohort of 573 AIS patients was stratified into two groups: those with PSCI (260 cases) and those who remained cognitively normal (CN) (313 cases). These patients were further subdivided into three distinct cohorts: a development cohort comprising 193 AIS patients, an internal validation cohort with 193 AIS patients, and an external validation cohort encompassing 187 AIS patients. A thorough multifactor logistic regression analysis was conducted to identify independent predictors of PSCI, which were subsequently incorporated into the prediction model for comprehensive analysis and validation. The discriminatory power, calibration accuracy, and clinical net benefits of the prediction model were rigorously evaluated using the area under the receiver operating characteristic curve (AUC-ROC), calibration plots, and decision curve analyses, respectively.

Results

Utilizing a meticulously selected panel of variables, including smoking status, alcohol consumption, female gender, low educational attainment, NIHSS score at admission, stroke progression, diabetes mellitus, atrial fibrillation, stroke localization, HCY levels, and Lp-PLA2 levels, a clinical prediction model was formulated to predict the occurrence of PSCI within six months of AIS. The model demonstrated AUC-ROC values of 0.898 (95%CI, 0.853-0.942), 0.847 (95%CI, 0.794-0.901), and 0.849 (95%CI, 0.7946-0.9031) in the development, internal validation, and external validation cohorts, respectively. Further validation through calibration curve analyses, Hosmer-Lemeshow goodness-of-fit tests, and additional metrics confirmed the model's impressive predictive performance.

Conclusion

The proposed model exhibits strong discriminative ability for predicting PSCI and holds considerable promise for guiding clinical decision-making. However, ongoing optimization with multicenter data is necessary to bolster its robustness and broaden its applicability.

Remote ischaemic conditioning for neurological disorders-a systematic review and narrative synthesis

INTRODUCTION

Remote ischaemic conditioning (RIC) refers to the use of controlled transient ischemic and reperfusion cycles, commonly of the upper or lower limb, to mitigate cellular damage from ischaemic injury. Preclinical studies demonstrate that RIC may have a neuroprotective effect and therefore could represent a novel therapeutic option in the management of neurological disorders. The aim of this review is to comprehensively describe the current clinical evidence of RIC in neurological disorders.

METHODS

A computerised search of EMBASE and OVID MEDLINE was conducted from 2002 to October 2023 for randomised controlled trials (RCTs) investigating RIC in neurological diseases.

RESULTS

A total of 46 different RCTs in 12 different neurological disorders (n = 7544) were included in the analysis. Conditions included acute ischaemic stroke, symptomatic intracranial stenosis and vascular cognitive impairment. The most commonly used RIC protocol parameters in the selected studies were as follows: cuff pressure at 200 mmHg (27 trials), 5-min cycle length (42 trials), 5 cycles of ischaemia and reperfusion (24 trials) and the application to the upper limb unilaterally (23 trials).

CONCLUSIONS

The comprehensive analysis of the included studies reveals promising results regarding the safety and therapeutic effect of RIC as an option for managing neurological diseases. Particularly, the strongest evidence supports its potential use in chronic stroke patients and vascular cognitive impairment. The neuroprotective effects of RIC, as demonstrated in preclinical studies, suggest that this therapeutic approach could extend its benefits to various other diseases affecting the nervous system. However, to establish the efficacy of RIC across different neurological disorders, further trials with larger sample sizes and more diverse patient populations are warranted. Upcoming trials are expected to provide valuable evidence that will not only confirm the efficacy of RIC in neurological disease management but also help identify the most optimal RIC regimen for specific conditions.

Association between Visceral Fat Content and Obesity-Related Indicators with Cognitive Impairment after Intracerebral Hemorrhage

BACKGROUND

Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality, often leading to long-term cognitive impairment that significantly diminishes the quality of life. This study investigated the relationship between visceral fat content, obesity-related indicators, and cognitive dysfunction following ICH.

METHODS

A total of 388 subjects with ICH who were admitted to the Neurosurgery Department of the Hospital and met the inclusion and exclusion criteria were included in this study. Obesity-related indicators, including body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), were measured. L3 level images were obtained by abdominal computerized tomography (CT). The visceral fat content was estimated using IMAGE J software, and adiponectin levels were assessed via enzyme-linked immunosorbent assay (ELISA). The Mini-Mental State Examination (MMSE) was used to evaluate the cognitive level of patients within 2 weeks of onset, and the shortened version of the Montreal Cognitive Assessment (miniMoCA) was used to evaluate the cognitive level of patients 6 months after ICH. Univariate and multivariate analyses were used to analyze the correlations of BMI, WC, WHtR, abdominal fat, and adiponectin with cognitive impairment after ICH.

RESULTS

BMI, WC, and WHtR were lower in the cognitive impairment group (p < 0.01). Overweight patients exhibited higher MMSE scores than normal-weight patients (p < 0.05) and higher miniMoCA scores than obese patients (p = 0.014). Abdominal obesity, assessed by WC and WHtR, was associated with higher MMSE scores (p = 0.022 and 0.003, respectively). Multivariate analysis indicated that WHtR was associated with cognitive impairment risk post-ICH (odds ratio (OR) = 0.233, 95% confidence interval (CI) (0.071, 0.762); p = 0.016). Although no overall association was found between adiponectin levels and cognitive impairment, subgroup analysis revealed lower adiponectin levels in overweight patients with cognitive impairment (p = 0.040).

CONCLUSION

WHtR is independently and inversely associated with cognitive impairment after ICH. There is no significant correlation between adiponectin with cognitive impairment after ICH, while subgroup analysis indicates that adiponectin levels are lower in overweight patients with cognitive impairment.

Cognitive Training Using Virtual Reality: An Assessment of Usability and Adverse Effects

Objective

To evaluate the usability and adverse effects associated with virtual reality (VR) cognitive training and identify factors influencing them.

Design

Survey-based observational study.

Setting

Department of Rehabilitation Medicine in the hospital.

Participants

Twenty rehabilitation professionals (mean [standard deviation] age; 30.0[4.8] years, men 8[40%], and women 12[60%]) and 10 patients with stroke (mean [SD] age; 64.1[13.6] years, men 2[20%] and women 8[80%]).

Interventions

The participants wore a head-mounted display (Meta Quest2) and consecutively underwent 5 custom-designed cognitive training.

Main Outcome Measures

After the training, participants completed 3 questionnaires: the systemic usability scale, user experience questionnaire (UEQ), and cybersickness in VR questionnaire.

Results

The mean systemic usability scale score was 55.1 and 52.3 for rehabilitation professionals and patients, respectively. For the UEQ, the mean score for each item, including attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty, were 0.9/0.2, 0.6/0.2, 0.5/-0.5, 1.2/0.8, 0.9/0.4, and 0.6/0.8 for rehabilitation professionals/patients, respectively. Rehabilitation professionals had slightly higher scores in most UEQ items. The mean cybersickness in VR questionnaire scores were 18.6 and 19.0 for rehabilitation professionals and patients, respectively.

Conclusions

Participants reported moderate usability and a generally below-average user experience, with mild-to-moderate VR sickness during VR cognitive training. The rehabilitation professionals rated usability higher than the patient group, while patients experienced more severe VR sickness. These findings may serve as a significant insight for developing VR cognitive training for application to patients in the future.

Effectiveness of Transcranial Magnetic Stimulation on Executive Function, Attention, and Memory in Stroke Patients: A Systematic Review and Meta-Analysis

Transcranial magnetic stimulation (TMS) is an effective intervention for improving cognitive impairment in patients with stroke. However, its effectiveness in the subdomains of cognition is conflicting and not clearly established. This systematic review assessed the efficacy of TMS in improving executive function, attention, and memory in this population. Seven databases, including PubMed, Scopus, Cochrane Library, Cumulated Index in Nursing and Allied Health Literature, NeuroBITE, Physiotherapy Evidence Database, and OTseeker, were searched for indexed literature until July 2024 to identify all randomized controlled trials (RCTs) of this effect in stroke patients. This systematic review was performed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Handbook of the Cochrane Library and evaluated the quality of evidence using the Risk of Bias 2 tools and grading of recommendations assessment, development, and evaluation (GRADE) systems. Meta-analyses were performed using standardized mean difference (SMD) (Hedge's g) as the effect measure, and subgroups were performed to explore potential outcomes. The research included 13 RCTs involving 496 patients with stroke. The results indicated that TMS could affect executive function (six RCTs with SMD = 0.55; 95% confidence interval, CI = 0.04-1.05) and memory (nine RCTs with SMD = 0.57; 95% CI = 0.25-0.89) in patients with stroke. However, the effectiveness of TMS on attention (five RCTs with SMD = 0.32; 95% CI = -0.1 to 0.75) was not clear. The quality of the results varied between very low and low according to the GRADE approach. In conclusion, TMS may affect executive function and memory, but not attention. The quality of the evidence for the outcomes varied from very low to low owing to heterogeneity and bias; therefore, the results should be considered with caution, and more rigorous evidence is needed.

Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis

BACKGROUND

Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes.

OBJECTIVE

This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes.

METHODS

A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores.

RESULTS

Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=-0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills.

CONCLUSIONS

This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study's reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke.

Effects of repetitive transcranial magnetic stimulation on cognitive function and hormone levels in early stroke patients with low thyroid hormone levels

Background

This study aimed to observe the effects of repetitive transcranial magnetic stimulation (rTMS) on cognitive function and thyroid hormone levels in early older stroke patients with low thyroid hormone levels, and to investigate the correlation between the changes in thyroid hormone levels and the improvements in cognitive function after stroke.

Methods

Forty older stroke patients who met the inclusion criteria were recruited and randomized into a magnetic-stimulation group (rTMS group) and a sham-stimulation group (Sham group). The rTMS group received low-frequency true stimulation and the Sham group received low-frequency sham stimulation. Patients' cognitive scores, activity of daily living(ADL) scores, and their levels of triiodothyronine (T3), free triiodothyronine (FT3), thyroxin (T4), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were assessed before the intervention, after the 4-week intervention, and after an additional 4 weeks of follow-up; Repeated measurement analysis of variance was used to compare the changes of each index in the two groups at different times and the correlations between patiens' cognitive function scores and their changing hormone levels were subsequently investigated.

Results

Thirty-one patients were included in this study: 16 patients in rTMS group and 15 patients in the Sham group. Repeated-measures ANOVA showed that patients' T3,FT3 and TSH levels tended to increase at 4-week intervention and at the follow up (p < 0.05), and that the rTMS group had a better effect on improving T3 than the Sham group (Fgroup = 5.319, p = 0.028); The cognitive scale at different time points in both groups showed an upward trend (p < 0.05), and the MoCA, DSF, DSB scores in the rTMS group were statistically higher than those in the Sham group at the end of the 4-week intervention and at the follow-up (p < 0.05); The changes in the levels of T3 before and after 4-week intervention were positively correlated with the changes in the MoCA scores (r = 0.638, p < 0.05). And the difference in T3 level change was positively correlated with the difference in delayed recall, attention and naming score change (r = 0.562, p < 0.05; r = 0.562, p < 0.05; r = 0.531, p < 0.05); and the difference in FT3 level change was positively correlated with the visuospatial and executive function (r = 0.514, p < 0.05).

Conclusion

Repetitive transcranial magnetic stimulation improved cognitive function and elevated T3 levels in older patients with post-stroke cognitive dysfunction who had low thyroid hormone levels. Within the normal range, increases in T3 levels are positively correlated with changes in cognitive function.

Dynamic changes in Beclin-1, LC3B, and p62 in aldose reductase-knockout mice at different time points after ischemic stroke

Ischemic stroke is a brain injury caused by cerebral blood circulation disorders and is closely related to oxidative stress. Aldose reductase (AR) is a critical enzyme involved in oxidative stress. Autophagy has previously been found to play a key role in cerebral ischemia‒reperfusion injury. However, it is still unclear how autophagy molecules change after cerebral ischemia‒reperfusion injury in AR knockout mice (AR-/-). A transient middle cerebral artery occlusion (tMCAO) model was generated in AR-/- mice, and the neurological deficit scores of the mice were observed and recorded on Days 1, 3 and 5 after tMCAO. Neuronal damage in the ischemic penumbra was observed by TTC, HE, and Nissl staining. The expression of the autophagy-related molecules Beclin-1, LC3II/I, and P62 as well as that of molecules related to inflammation, oxidative stress, and neurological damage was detected by RT‒qPCR, western blotting, and immunofluorescence. Autophagosomes were observed using a transmission electron microscope. Cerebral ischemia‒reperfusion injury caused neurological deficits and ischemic infarction in tMCAO mice (P < 0.01). Beclin-1, Bcl2/Bax, SOD, GSH-px, P62, PSD95, and TOM20 levels decreased (P < 0.05), while IL-6, LC3II/I, and GFAP levels increased (P < 0.01) in the AR-/- tMCAO-1d group and the AR-/- tMCAO-3d group, compared to those in the sham group. Beclin-1, Bcl2/Bax, NOX4, GSH-px, P62, and PSD95 levels increased (P < 0.01), while IL-6, LC3II/I, and GFAP levels decreased (P < 0.01) in the AR-/- tMCAO-5d group compared to those in the AR-/- tMCAO-1d group. Autophagosome formation was observed in tMCAO mice. In summary, the changes in autophagy proteins in the brain tissue of the AR-/- mice after tMCAO were more obvious on Days 1 and 3 after tMCAO. The expression of Beclin-1 and P62 decreased, and the expression of LC3B increased after cerebral ischemia‒reperfusion injury in AR-/- mouse brain tissue.

Facilitation of motor adaptation using multiple gait rehabilitation interventions

Introduction

The rate of adjustment in a movement, driven by feedback error, is referred to as the adaptation rate, and the rate of recovery of a newly adapted movement to its unperturbed condition is called the de-adaptation rate. The rates of adaptation and de-adaptation are dependent on the training mechanism and intrinsic factors such as the participant's sensorimotor abilities. This study investigated the facilitation of the motor adaptation and de-adaptation processes for spatiotemporal features of an asymmetric gait pattern by sequentially applying split-belt treadmill (SBT) and asymmetric rhythmic auditory cueing (ARAC).

Methods

Two sessions tested the individual gait characteristics of SBT and ARAC, and the remaining four sessions consisted of applying the two interventions sequentially during training. The adjustment process to the second intervention is referred to as "re-adaptation" and is driven by feedback error associated with the second intervention.

Results

Ten healthy individuals participated in the randomized six-session trial. Spatiotemporal asymmetries during the adaptation and post-adaptation (when intervention is removed) stages were fitted into a two-component exponential model that reflects the explicit and implicit adaptation processes. A double component was shown to fit better than a single-component model. The decay constants of the model were indicative of the corresponding timescales and compared between trials. Results revealed that the explicit (fast) component of adaptation to ARAC was reduced for step length and step time when applied after SBT. Contrarily, the explicit component of adaptation to SBT was increased when it was applied after ARAC for step length. Additionally, the implicit (slow) component of adaptation to SBT was inhibited when applied incongruently after ARAC for step time.

Discussion

These outcomes show that the role of working motor memory as a translational tool between different gait interventions is dependent on (i) the adaptation mechanisms associated with the interventions, (ii) the targeted motor outcome of the interventions; the effects of factors (i) and (ii) are specific to the explicit and implicit components of the adaptation processes; these effects are unique to spatial and temporal gait characteristics.

Transcutaneous auricular vagus nerve stimulation for long-term post-stroke cognitive impairment: a DTI case report

Purpose

Long-term post-stroke cognitive impairment (PSCI) exhibits an accelerated rate of long-term cognitive decline, which can impair communication, limit social engagement, and increase rate of institutional dependence. The aim of this case report is to provide evidence for the potential of home-based transcutaneous auricular vagus nerve stimulation (taVNS) for home-bound patients with severe, long-term PSCI.

Methods

A 71-year-old male suffered a stroke two and a half years ago, which imaging reported foci of cerebral infarction visible in the left temporal and parietal lobes. The patient was performed taVNS twice a day for 30 min, 5 times a week for 8 weeks. The patient was evaluated the changes of cognitive function and brain white matter at 4 time points: baseline (t0), 4 weeks without taVNS after baseline (t1), 4 weeks of intervention (t2), and 8 weeks of intervention (t3). The effect of taVNS on white matter changes was visualized by DTI.

Results

After 8 weeks of taVNS treatment, the scores of Montreal cognitive assessment improved and the time to complete the shape trails test decreased. The DTI results showed that white matter in bilateral dorsal lateral prefrontal cortex remodeled after taVNS.

Conclusion

Eight-week home-based taVNS may be beneficial to long-term PSCI. Further studies of home-based taVNS treating patients with long-term PSCI are needed.

WORD PROCESSING ABILITIES IN SUBJECTS AFTER STROKE OR TRAUMATIC BRAIN INJURY

Acquired language disorder is a common consequence of stroke and traumatic brain injury (TBI). Following the logogen model, this study investigated word processing abilities of post-stroke and post-TBI patients. Within- and between-group differences in word comprehension, naming, and reading were observed, as well as predominant errors in performance. Twenty-two post-stroke and 22 post-TBI patients were tested using tasks from the Comprehensive Aphasia Test-HR (CAT-HR). Post-TBI patients outperformed post-stroke patients in naming and reading. Both groups exhibited neologisms, phonological, semantic and unrelated errors, although in different proportions. In word comprehension and naming, post-TBI patients primarily exhibited semantic errors, whereas post-stroke patients had equally distributed phonological and semantic errors. In reading, both groups predominantly produced phonological errors. Error distribution differed only in naming, with post-TBI patients exhibiting more semantic errors than post-stroke patients. Therefore, performance in naming differentiated these groups most. Although error analysis is rather insightful, one cannot expect a particular profile of language disturbances in post-stroke and post-TBI patients. The findings obtained bear concrete clinical implications, especially those related to the role and meaning of the errors produced by the patient to determine the exact location of the processing deficits.

Effect of Acupuncture on Cognitive Function in Patients With Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

AIMS AND OBJECTIVE

To investigate the impact of acupuncture on post-stroke cognitive impairment (PSCI).

BACKGROUND

PSCI is a major barrier to stroke patients' rehabilitation, and acupuncture is one of the treatments. However, the benefit of acupuncture on PSCI is unclear.

DESIGN

A meta-analysis and systematic review of randomized controlled trials (RCTs).

METHODS

Up to February 1, 2024, databases in PubMed, MEDLINE, Scopus, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, VIP, and Wanfang Data were searched. The risk of bias was investigated using the Cochrane Handbook for systematic reviews of treatments. Random-effect and fix-effect models were used to report the effects.

RESULTS

There were 29 randomized clinical trials with 2477 participants included. The findings demonstrated that the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scores were higher in the acupuncture group than medicine group (mean difference [MD] = 1.74, 95% confidence interval (CI) CI [1.26, 2.23], I2 = 59%, p < 0.01). Compared to medicine group, the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) score exhibited a significant decrease and demonstrated improvement in the acupuncture group. Statistically significant outcomes were observed in the Barthel Index scores and P300 event-related potential (ERP). According to subgroup analysis, acupuncture was superior to conventional therapy for improving cognitive function in PSCI patients at 4 weeks after treatment.

CONCLUSION

Acupuncture therapy has shown promise in ameliorating cognitive deficits and enhancing daily functional abilities in individuals diagnosed with PSCI. But future research should focus on the duration and implement large sample, high-quality RCTs.

RELEVANCE TO CLINICAL PRACTICE

Clinical workers in practical clinical work can select appropriate acupoints according to the actual conditions of patients, as well as confirm the treatment course of PSCI patients, while paying attention to observing and evaluating the therapeutic efficacy of acupuncture, to improve the health outcomes of patients in a patient-centered way.

Poststroke Cognitive Impairment and the Risk of Recurrent Stroke and Mortality: Systematic Review and Meta-Analysis

BACKGROUND

Poststroke cognitive impairment (PSCI) occurs in about 60% of patients with stroke in the first year after stroke. However, the question regarding risks of recurrent stroke and mortality in patients with PSCI remains controversial. The goal of this study was to conduct a meta-analysis of published literature to estimate the risks of stroke recurrence and mortality associated with PSCI.

METHODS AND RESULTS

Electronic databases were screened for eligible studies published from 1990 to 2023. The primary end points of this study were recurrent stroke and mortality. Pooled estimates were calculated as hazard ratios (HR) with 95% CIs. Meta-regression analyses evaluated moderating effects of PSCI severity, study design, and study period on recurrent stroke and mortality. Pooled data from 27 studies comprised 39 412 patients with ischemic stroke. Nine studies evaluated the association between PSCI and risk of stroke recurrence that showed the hazard of recurrent stroke risk was significantly higher in patients with PSCI compared with those without it (HR, 1.59 [95% CI, 1.29-1.94]; I2=52.2%). Eighteen studies examined the impact of PSCI on mortality risk. The pooled hazard of mortality was significantly higher in the group with PSCI relative to the non-PSCI group (HR, 2.07 [95% CI, 1.65 -2.59]; I2=89.3%). Meta-regressions showed that the average effect of PSCI on mortality risk differed across study period and study design.

CONCLUSIONS

Based on this meta-analysis PSCI was statistically significantly associated with increased risks of recurrent stroke and all-cause mortality. Poststroke neurocognitive assessment may identify patients at a higher risk who may require more aggressive interventions for secondary prevention.

Design and application of pneumatic rehabilitation glove system based on brain-computer interface

Stroke has been the second leading cause of death and disability worldwide. With the innovation of therapeutic schedules, its death rate has decreased significantly but still guides chronic movement disorders. Due to the lack of independent activities and minimum exercise standards, the traditional rehabilitation means of occupational therapy and constraint-induced movement therapy pose challenges in stroke patients with severe impairments. Therefore, specific and effective rehabilitation methods seek innovation. To address the overlooked limitation, we design a pneumatic rehabilitation glove system. Specially, we developed a pneumatic glove, which utilizes ElectroEncephaloGram (EEG) acquisition to gain the EEG signals. A proposed EEGTran model is inserted into the system to distinguish the specific motor imagination behavior, thus, the glove can perform specific activities according to the patient's imagination, facilitating the patients with severe movement disorders and promoting the rehabilitation technology. The experimental results show that the proposed EEGTrans reached an accuracy of 87.3% and outperformed that of competitors. It demonstrates that our pneumatic rehabilitation glove system contributes to the rehabilitation training of stroke patients.

Poststroke cognitive impairment among stroke survivors in Sub-Saharan Africa: a systematic review and meta-analysis

INTRODUCTION

Stroke is the leading cause of death and disability among adults and elderly individuals worldwide. Although several primary studies have been conducted to determine the prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa, these studies have presented inconsistent findings. Therefore, this study aimed to determine the pooled prevalence of poststroke cognitive impairment and identify its associated factors among stroke survivors in sub-Saharan Africa.

METHODS

The studies were retrieved from the Google Scholar, Scopus, PubMed, and Web of Science databases. A manual search of the reference lists of the included studies was performed. A random-effects DerSimonian-Laird model was used to compute the pooled prevalence of poststroke cognitive impairment among stroke survivors in sub-Saharan Africa.

RESULTS

A total of 10 primary studies with a sample size of 1,709 stroke survivors were included in the final meta-analysis. The pooled prevalence of PSCI was obtained from the 9 included studies with a sample size of 1,566. In contrast, the data regarding the associated factors were obtained from all the 10 included studies with a sample size of 1,709. The pooled prevalence of poststroke cognitive impairment among stroke survivors was 59.61% (95% CI: 46.87, 72.35); I2 = 96.47%; P < 0.001). Increased age (≥ 45 years) [AOR = 1.23, 95% CI: 1.09, 1.40], lower educational level [AOR = 4.35, 95% CI: 2.87, 6.61], poor functional recovery [AOR = 1.75, 95% CI: 1.42, 2.15], and left hemisphere stroke [AOR = 4.88, 95% CI: 2.98, 7.99] were significantly associated with poststroke cognitive impairment.

CONCLUSIONS

The pooled prevalence of poststroke cognitive impairment was considerably high among stroke survivors in sub-Saharan Africa. Increased age, lower educational level, poor functional recovery, and left hemisphere stroke were the pooled independent predictors of poststroke cognitive impairment in sub-Saharan Africa. Stakeholders should focus on empowering education and lifestyle modifications, keeping their minds engaged, staying connected with social activities and introducing rehabilitative services for stroke survivors with these identified factors to reduce the risk of developing poststroke cognitive impairment.

PEMOCS: Evaluating the effects of a concept-guided, PErsonalised, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-study protocol for a randomised controlled trial

BACKGROUND

Many stroke survivors remain with residual cognitive and motor impairments despite receiving timely acute and sub-acute rehabilitation. This indicates that rehabilitation following stroke should be continuous to meet the needs of individual stroke patients. Both cognitive and motor functions are essential for mastering daily life and, therefore, should be aimed at with rehabilitation. Exergames, motor-cognitive exercises performed using video games, are an auspicious method to train both motor and cognitive functions and at the same time may foster the long-term motivation for training. This study aims to assess the effect of concept-guided, personalised, motor-cognitive exergame training on cognitive and motor functions in chronic stroke survivors.

METHODS

This study is a single-blinded, randomised controlled trial. Assessments are performed at baseline, after a 12-week intervention, and at a 24-weeks follow-up. Chronic stroke patients (≥ 18 years old, ≥ 6 months post-stroke) able to stand for 3 min, independently walk 10 m, follow a two-stage command, and without other neurological diseases apart from cognitive deficits or dementia are included. Participants in the intervention group perform the exergame training twice per week for 30 (beginning) up to 40 (end) minutes additionally to their usual care programme. Participants in the control group receive usual care without additional intervention(s). Global cognitive functioning (total Montreal Cognitive Assessment (MoCA) score) is the primary outcome. Secondary outcomes include health-related quality of life, specific cognitive functions, single- and dual-task mobility, and spatiotemporal gait parameters. The target sample size for this trial is 38 participants. Linear mixed models with the post-outcome scores as dependent variables and group and time as fixed effects will be performed for analysis.

DISCUSSION

Superior improvements in global cognitive functioning and in the abovementioned secondary outcomes in the intervention group compared to the control group are hypothesised. The results of this study may guide future design of long-term rehabilitation interventions after stroke.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05524727). Registered on September 1, 2022.

A systematic review of major evaluation metrics for simulator-based automatic assessment of driving after stroke

Background: Simulator-based driving assessments (SA) have recently been used and studied for various purposes, particularly for post-stroke patients. Automating such assessment has potential benefits especially on reducing financial cost and time. Nevertheless, there currently exists no clear guideline on assessment techniques and metrics available for SA for post-stroke patients. Therefore, this systematic review is conducted to explore such techniques and establish guidelines for evaluation metrics. Objective: This review aims to find: (a) major evaluation metrics for automatic SA in post-stroke patients and (b) assessment inputs and techniques for such evaluation metrics. Methods: The study follows the PRISMA guideline. Systematic searches were performed on PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library for articles published from January 1, 2010, to December 31, 2023. This review targeted journal articles written in English about automatic performance assessment of simulator-based driving by post-stroke patients. A narrative synthesis was provided for the included studies. Results: The review included six articles with a total of 239 participants. Across all of the included studies, we discovered 49 distinct assessment inputs. Threshold-based, machine-learning-based, and driving simulator calculation approaches are three primary types of assessment techniques and evaluation metrics identified in the review. Discussion: Most studies incorporated more than one type of input, indicating the importance of a comprehensive evaluation of driving abilities. Threshold-based techniques and metrics were the most commonly used in all studies, likely due to their simplicity. An existing relevant review also highlighted the limited number of studies in this area, underscoring the need for further research to establish the validity and effectiveness of simulator-based automatic assessment of driving (SAAD). Conclusions: More studies should be conducted on various aspects of SAAD to explore and validate this type of assessment.

Astaxanthin and improvement of dementia: A systematic review of current clinical trials

Worldwide, the incidence of neurodegenerative diseases especially dementia is steadily increasing due to the aging population. Abundant research emerges on the probability of combating or preventing the degeneration process, with the most established one being to tackle the existence of oxidative stress and free radicals production due to their nature of aggravating dementia. Astaxanthin, a marine carotenoid, was proven to be a protective agent of cerebral ischemia through many animal model clinical trials. This review summarizes the evidence of Astaxanthin's benefits for cognitive function across clinical trials done in older age. The results are of interest as its supplementation does not exhibit unwanted issues on the consumer based on physical and laboratory examinations. Despite not being supported statistically, however, subjective and objective cognitive amelioration were reported according to the majority of this review's trial subjects. Although there is no clear and direct mechanism for cognitive improvement by Astaxanthin activity in the body systems, the encouragement of Astaxanthin supplementation should be considered as the elderly with dementia may highly benefit from the improved cognitive function.

Network meta-analysis of non-pharmacological interventions for cognitive impairment after an ischemic stroke

Objective

This study aims to evaluate the effectiveness of non-pharmacological interventions in improving cognitive function in patients with ischemic stroke through network meta-analysis.

Methods

We searched databases including the Cochrane Library, PubMed, EmBase, and Web of Science for randomized controlled trials (RCTs) on non-pharmacological treatments to improve cognitive impairment following ischemic stroke. The publication date was up to 15 March 2023. Due to the insufficiency of included studies, supplementary searches for high-quality Chinese literature were performed in databases such as CNKI, WanFang Data, and VIP Chinese Science Journals Database. Two reviewers independently went through the literature, extracted data, and assessed the risk of bias in the included studies using the risk of bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. By utilizing R 4.2.3 RStudio software and the GeMTC package, a Bayesian network meta-analysis was conducted to assess the improvement in Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores under a variety of non-pharmacological interventions.

Results

A total of 22 RCTs involving 2,111 patients and 14 different non-pharmacological treatments were included. These interventions were transcranial direct current stimulation (tDCS), reminiscence therapy (RT), remote ischemic conditioning (RIC), physical fitness training (PFT), intensive patient care program (IPCP), moderate-intensity continuous training + high-intensity interval training (MICT + HIIT), medium intensity continuous training (MICT), grip training (GT), acupuncture, cognitive behavioral therapy (CBT), cognitive rehabilitation training (CRT), high pressure oxygen (HPO), moxibustion, and repetitive transcranial magnetic stimulation (rTMS). The results of the network meta-analysis indicated that rTMS had the highest likelihood of being the most effective intervention for improving MMSE and MoCA scores.

Conclusion

The evidence from this study suggests that rTMS holds promise for improving MMSE and MoCA scores in patients with cognitive impairment following ischemic stroke. However, further high-quality research is needed to confirm and validate this finding.

Effects of exercise dose based on the ACSM recommendations on patients with post-stroke cognitive impairment: a systematic review and meta-analyses

Purpose

This review aimed to assess the impact of different exercise dosages on cognitive function in individuals with post-stroke cognitive impairment (PSCI).

Methods

Four electronic databases-Embase, PubMed, Web of Science, and Cochrane Library-were systematically searched from inception to 01 January 2024, focusing on the impact of exercise therapy on cognitive function in individuals with PSCI. Only randomized controlled trials meeting the criteria were included. The exercise therapy dose and adherence were evaluated following the American College of Sports Medicine (ACSM) guidelines, categorized into a high compliance group with ACSM recommendations and a low or uncertain compliance group. A random-effects model compared the effect of ACSM compliance on cognitive function in individuals with PSCI, with the effect size represented by the standardized mean difference (SMD) and a 95% confidence interval (CI).

Results

In total, 18 studies meeting the criteria were included, with data from 1,742 participants. The findings suggested a beneficial effect of exercise on cognitive function in individuals with PSCI [SMD = 0.42, 95% CI (0.20, 0.65)]. Ten studies were categorized as the "high adherence group" and eight in the "low or uncertain adherence group" based on the ACSM recommendations. The subgroup analysis revealed that the SMD of the high compliance group was 0.46 (95% CI: 0.10, 0.82) (p = 0.01), while the SMD of the low or uncertain compliance group was 0.38 (95% CI: 0.07, 0.70) (p = 0.02).

Conclusion

Our study indicates the beneficial impact of exercise for patients with PSCI over no exercise. Furthermore, high adherence to the exercise dose recommended by ACSM guidelines demonstrated a more substantial improvement in cognitive function than low or uncertain adherence in patients with PSCI. Systematic Review Registration: https:// www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42023487915.

A Review of Post-Stroke Cognitive Impairment and the Potential Benefits of Stingless Bee Honey Supplementation

Post-stroke cognitive impairment (PSCI) is a common decline in cognitive abilities that occurs within 3 months after a stroke. During recovery, stroke survivors often experience varying degrees of cognitive decline, with some patients experiencing permanent cognitive deficits. Thus, it is crucial to prioritise recovery and rehabilitation after a stroke to promote optimal protection of and improvement in cognitive function. Honey derived from stingless bees has been linked to various therapeutic properties, including neuroprotective effects. However, scientific evidence for the mechanisms through which these honey supplements enhance cognitive function remains limited. This narrative review aims to provide an overview of the causes of PSCI, current treatments, the biomarkers influencing cognition in post-stroke patients and the potential of stingless bee honey (SBH) as a neuroprotective agent against the progression of PSCI.

Post-stroke cognitive impairment: exploring molecular mechanisms and omics biomarkers for early identification and intervention

Post-stroke cognitive impairment (PSCI) is a major stroke consequence that has a severe impact on patients' quality of life and survival rate. For this reason, it is especially crucial to identify and intervene early in high-risk groups during the acute phase of stroke. Currently, there are no reliable and efficient techniques for the early diagnosis, appropriate evaluation, or prognostication of PSCI. Instead, plenty of biomarkers in stroke patients have progressively been linked to cognitive impairment in recent years. High-throughput omics techniques that generate large amounts of data and process it to a high quality have been used to screen and identify biomarkers of PSCI in order to investigate the molecular mechanisms of the disease. These techniques include metabolomics, which explores dynamic changes in the organism, gut microbiomics, which studies host-microbe interactions, genomics, which elucidates deeper disease mechanisms, transcriptomics and proteomics, which describe gene expression and regulation. We looked through electronic databases like PubMed, the Cochrane Library, Embase, Web of Science, and common databases for each omics to find biomarkers that might be connected to the pathophysiology of PSCI. As all, we found 34 studies: 14 in the field of metabolomics, 5 in the field of gut microbiomics, 5 in the field of genomics, 4 in the field of transcriptomics, and 7 in the field of proteomics. We discovered that neuroinflammation, oxidative stress, and atherosclerosis may be the primary causes of PSCI development, and that metabolomics may play a role in the molecular mechanisms of PSCI. In this study, we summarized the existing issues across omics technologies and discuss the latest discoveries of PSCI biomarkers in the context of omics, with the goal of investigating the molecular causes of post-stroke cognitive impairment. We also discuss the potential therapeutic utility of omics platforms for PSCI mechanisms, diagnosis, and intervention in order to promote the area's advancement towards precision PSCI treatment.

Systemic immune-inflammation index upon admission correlates to post-stroke cognitive impairment in patients with acute ischemic stroke

BACKGROUND

The purpose of this prospective study was to evaluate the association of systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), with PSCI in patients with acute ischemic stroke (AIS).

METHODS

First-onset AIS patients were consecutively included from January 1, 2022 to March 1, 2023. The baseline information was collected at admission. Fasting blood was drawn the next morning. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCA) 3 months after onset. Logistic regression analysis was performed to explore the correlation between SII, SIRI, and PSCI. Receiver operating characteristic (ROC) was conducted to evaluate the predictive ability of SII.

RESULTS

332 participants were recruited, and 193 developed PSCI. Compared with patients without PSCI, the patients with PSCI had higher SII (587.75 (337.42, 988.95) vs. 345.66 (248.44, 572.89), P<0.001) and SIRI (1.59 (0.95, 2.84) vs. 1.02 (0.63, 1.55), P=0.007). SII and SIRI negatively correlated with MoCA scores (both P<0.05). The multivariable logistic regression analysis indicated that SII was independently associated with PSCI (P<0.001), while SIRI was not. The optimal cutoff for SII to predict PSCI was 676.83×109/L.

CONCLUSIONS

A higher level of SII upon admission was independently correlated to PSCI three months later in AIS patients.

Efficacy of intermittent theta burst stimulation (iTBS) on post-stroke cognitive impairment (PSCI): a systematic review and meta-analysis

BACKGROUND

Stroke is a significant global cause of mortality and morbidity, and post-stroke cognitive impairment (PSCI) affects up to half of stroke patients. Despite the availability of pharmacological and non-pharmacological interventions, there is a lack of definitive effective treatments for PSCI. Non-invasive brain stimulation, particularly intermittent theta burst stimulation (iTBS), has emerged as a promising therapy for the treatment of PSCI.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of iTBS in enhancing cognitive function among patients with PSCI.

METHODS

A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Scopus, Cochrane Library, and CNKI, to identify relevant randomized controlled trials published before April 2023. The primary outcome measured changes in global cognitive scales, while the secondary outcomes focused on improvements in attention, orientation, visual-spatial perception, and activities of daily living.

RESULTS

The meta-analysis encompassed six studies involving 325 patients. The results demonstrated that iTBS led to a significant improvement in global cognitive scales (SMD = 1.12, 95% CI = [0.59 to 1.65], P < 0.0001), attention (SMD = 0.48, 95% CI [0.13 to 0.82], P = 0.007), visual perception (SMD = 0.99, 95% CI [0.13 to 1.86], P = 0.02), and activities of daily living (SMD = 0.82, 95% CI [0.55 to 1.08], P < 0.00001). However, there was no significant effect on orientation (SMD = 0.36, 95% CI [- 0.04 to 0.76], P = 0.07). Subgroup analysis based on the number of sessions was conducted, revealing a significant improvement in global cognition among patients with PSCI across the three categories (10 sessions, 20 sessions, and 30 sessions) with no between-group difference (P = 0.28). None of the included studies reported any serious adverse effects.

CONCLUSION

In conclusion, iTBS appears to be a safe and effective non-invasive treatment that can enhance the cognitive abilities and daily living skills of patients with post-stroke cognitive impairment. However, our conclusion is constrained by the limited number of studies. Further high-quality, large-sample RCTs with extended follow-up periods are necessary to validate these findings. Integrating iTBS with brain imaging techniques, such as functional near-infrared spectroscopy and functional magnetic resonance, could aid in understanding the mechanism of iTBS action.

Cerebral hemodynamics and cognitive functions in the acute and subacute stage of mild ischemic stroke: a longitudinal pilot study

The association between cerebral hemodynamics and cognitive impairment has been reported in neurodegenerative and cerebrovascular disorders (CVD). However, it is still unclear whether changes occur in the acute phase of CVD. Here we investigated cognitive and hemodynamic parameters and their association in patients with CVD during the acute and subacute phases. Seventy-three patients with mild stroke, not undergoing endovascular treatment, were recruited. All subjects were devoid of intracranial or external carotid stenosis, significant chronic cerebrovascular pathology, dementia or non-compensated cardiovascular diseases. Patients were evaluated within 7 days from symptoms onset (T1) and after 3 months (T2). Clinical and demographic data were collected. NIHSS, MoCA, FAB, and Word-Color Stroop test (WCST) were used to evaluate disease severity and cognitive functions. Basal hemodynamic parameters in the middle cerebral artery were measured with transcranial Doppler. Differences between T2 and T1, correlations between cognitive and hemodynamic variables at T1 and T2, as well as correlations between the T2-T1 variation in cognitive and hemodynamic parameters were assessed. At T1, cognitive performance of MoCA, FAB, and WCST was lower compared with T2; and pulsatility index, a parameter reflecting distal vascular resistance, was higher. However, no correlations between the changes in cognitive and hemodynamic variables were found; therefore, the two seems to be independent phenomena. In the acute phase, the linear association between cerebral blood flow and cognitive performances was lost, probably due to a differential effect of microenvironment changes and vascular-specific phenomena on cognition and cerebral hemodynamics. This relationship was partially restored in the subacute phase.

Association between Blood Pressure and Post-Stroke Cognitive Impairment: A Meta-Analysis

Background

Post-stroke cognitive impairment (PSCI) represents a serious post-stroke complication with poor cognitive consequences. A vascular consequence after a stroke is that the occurrence and progression of PSCI may be closely related to blood pressure (BP). Thus, we systematically reviewed and performed a meta-analysis of the literature to examine the correlations between BP and PSCI.

Methods

We systematically queried databases, including PubMed, the Cochrane Library, Embase, and Scopus, and conducted meta-analyses on studies reporting odds ratios (ORs) related to the association between BP and PSCI. Two authors autonomously assessed all titles, abstracts, and full texts and extracted data following the Meta-Analysis of Observational Studies in Epidemiology guidelines. The quality of the studies was evaluated using the modified Newcastle-Ottawa scale.

Results

Meta-analyses incorporated 12 articles comprising a cumulative participant cohort of 21,732 individuals. The quality assessment indicated good in five studies, fair in one study, and poor in six. Through meta-analyses, we found that hypertension, systolic or diastolic BP (SBP or DBP) was significantly associated with PSCI (OR 1.53, 95% confidence interval (CI), 1.18-1.99; p = 0.001, I 2 = 66%; OR 1.13, 95% CI, 1.05-1.23; p = 0.002, I 2 = 52%; OR 1.38, 95% CI, 1.11-1.72; p = 0.004, I 2 = 90%, respectively). In the subgroup analysis, SBP < 120 mmHg, 120-139 mmHg, 140-159 mmHg, 160-179 mmHg, and DBP ≥ 100 mmHg highly predicted the occurrence of PSCI (OR 1.15, p = 0.0003; OR 1.26, p = 0.010; OR 1.15, p = 0.05; OR 1.02, p = 0.009; OR 1.96, p < 0.00001, respectively). However, the predictive effect of BP for PSCI declines when SBP ≥ 180 mmHg and DBP ≤ 99 mmHg (p > 0.05). Statistical heterogeneity was moderate to high, and publication bias was detected in SBP for PSCI.

Conclusions

Considering the multifactorial etiology of PSCI, it is difficult to conclude that BP is an independent risk factor for PSCI. Given the restricted inclusion of studies, caution is advised when interpreting the findings from this meta-analysis. Subsequent investigations with substantial sample sizes are essential to exploring BP as a prospective target for addressing PSCI.

Trial Registration Number

CRD42023437783 from PROSPERO.