Prevalence of cognitive impairment in acute ischaemic stroke and use of Alberta Stroke Programme Early CT Score (ASPECTS) for early prediction of post-stroke cognitive impairment

Risk factors and predictive markers of post-stroke cognitive decline-A mini review

Stroke is one of the top causes of death and disability worldwide. Cognitive impairments are found in more than 70% of individuals who have survived a stroke. Cognitive decline is a major contributor to disability, dependency, and morbidity. The prevalence and severity of dementia vary depending on different characteristics of the stroke and other clinical risk factors. Here we discuss the effects of stroke territory, patients' age, sex, cerebral blood flow, acute reperfusion therapy, and cognitive reserve of post-stroke cognitive decline. Potential predictive molecular and genetic biomarkers of post-stroke cognitive impairments are also discussed.

Plasminogen activator urokinase receptor as a diagnostic and prognostic biomarker in type 2 diabetic patients with cardiovascular disease

Introduction

Cardiovascular diseases are the main cause of death among type 2 diabetic patients. Higher levels of plasminogen activator urokinase receptor have been found to predict morbidity and mortality across acute and chronic diseases in the common populace. This study aims to explore the role of serum plasminogen activator urokinase receptor levels as a cardiometabolic risk factor among type 2 diabetic Iraqi patients.

Methods

Seventy type 2 diabetic patients (40 male and 30 female) (mean age: 46.20±7.56 years) participated in this study; 35 patients were with cardiovascular disease and 35 were without cardiovascular disease; their ages range was 40-55 years. In addition, 30 individuals who apparently healthy were selected as the control group.

Results

There were significant increases (P<0.05) in glycemic and lipid profiles in diabetic patients with cardiovascular disease as compared to those without cardiovascular disease and control group. The present results reveal high levels of plasminogen activator urokinase receptor (2500.72±12.36 ρg/mL versus 2255.32±10.15 ρg/mL) with OR=1.80, 95%CI 1.2, and P=0.0001 in type 2 diabetic patients with and without cardiovascular disease respectively as compared to healthy control (229.00±14.48 ρg/mL).

Conclusion

It has been concluded that serum plasminogen activator urokinase receptor showed higher levels among type 2 diabetic patients with cardiovascular disease, this revealed it's critical role in cardiac disease. Therefore, it could be considered a more sensitive biomarker for the detection of cardiovascular events among type 2 diabetic patients who were at high-risk.

Importance of Retesting for the Final Diagnosis of Post-Stroke Cognitive Impairment

Background and Objectives: Post-stroke cognitive impairment (PSCI) has been defined as all problems in cognitive function that occur following a stroke. Studies published thus far on the prevalence of PSCI and post-stroke dementia (PSD) have shown conflicting estimates. The aim of this study was screening for cognitive impairment (CogI) in patients with an ischaemic stroke and finding the relationship between CogI (and its changes) and cardiovascular risk factors and imaging procedures-CT/MRI. Materials and Methods: We prospectively included patients with an ischaemic stroke admitted in the period from October 2019 to May 2022. In this period, 1328 patients were admitted, 305 of whom met the established inclusion criteria and underwent an examination of cognitive functions using the Montreal Cognitive Assessment (MoCA). Of these, 50 patients appeared for the control examination after 6 months. Results: In the retested group, CogI at discharge was diagnosed in 37 patients (74%). In follow-up testing after 6 months, CogI was present in 30 patients (60%). Only arterial hypertension (OR: 15; 95% CI; Pearson r: 0.001), lower education level (less than 13 years) (OR: 9.7; 95% CI 2.0-48.5; Pearson r: 0.002), and higher age were significantly associated with CogI after stroke. Conclusions: We established the prevalence of CogI and its course after 6 months in a well-defined group of patients after a mild ischaemic stroke (mean NIHSS: 2 and mean mRS: 1 at the discharge). Our results show that the prevalence of CogI after an ischaemic stroke at discharge is relatively high (74%), and it tends to be a spontaneous reduction. Cognitive functions were changed in 35% of patients. The definition of PSCI was completed in only 24% of individuals. Only an examination several months after a stroke can give us more accurate information about the true prevalence of persistent CogI after a stroke.

Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study

Background

Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia's Amhara region by 2022.

Methods

A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant.

Results

This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4-63.0%). The study participants' age with AOR; 7.12 (4.40-11.45), being hypertensive with AOR; 7.52 (3.46-16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49-12.05), less than three months after stroke with AOR; 4.83 (3.95-12.19), dominant hemisphere lesion with AOR; 4.83 (3.95-12.19) and being illiterate with AOR; 5.26 (4.43-18.64) were found significant factors.

Conclusion

Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.

Hematopoietic Stem Cell Transplantation in CSF1R-Related Leukoencephalopathy: Retrospective Study on Predictors of Outcomes

Mutations in the CSF1R gene are the most common cause of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP), a neurodegenerative disease with rapid progression and ominous prognosis. Hematopoietic stem cell transplantation (HSCT) has been increasingly offered to patients with CSF1R-ALSP. However, different therapy results were observed, and it was not elucidated which patient should be referred for HSCT. This study aimed to determine predictors of good and bad HSCT outcomes in CSF1R-ALSP. We retrospectively analyzed 15 patients, 14 symptomatic and 1 asymptomatic, with CSF1R-ALSP that underwent HSCT. Median age of onset was 39 years, and the median age of HSCT was 43 years. Cognitive impairment was the most frequent initial manifestation (43%), followed by gait problems (21%) and neuropsychiatric symptoms (21%). Median post-HSCT follow-up was 26 months. Good outcomes were associated with gait problems as initial (p = 0.041) and predominant (p = 0.017) manifestation and younger age at HSCT (p = 0.044). Cognitive impairment as first manifestation was a predictor of a bad outcome (p = 0.016) and worsening of cognition post-HSCT (p = 0.025). In conclusion, gait problems indicated a milder phenotype with better response to HSCT and good therapy outcomes. In contrast, patients with a higher burden of cognitive symptoms were most likely not to benefit from HSCT.

Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors

INTRODUCTION

Stroke survivors are routinely screened for cognitive impairment with tools that often fail to detect subtle impairments. The Oxford Cognitive Screen-Plus (OCS-Plus) is a brief tablet-based screen designed to detect subtle post-stroke cognitive impairments. We examined its psychometric properties in two UK English-speaking stroke cohorts (subacute: <3 months post-stroke, chronic: >6 months post-stroke) cross-sectionally.

PATIENTS AND METHODS

This study included 347 stroke survivors (mean age = 73 years; mean education = 13 years; 43.06% female; 74.42% ischaemic stroke). The OCS-Plus was completed by 181 sub-acute stroke survivors and 166 chronic stroke survivors. All participants also completed the Oxford Cognitive Screen (OCS) and a subset completed the Montreal Cognitive Assessment (MoCA) and further neuropsychological tests.

RESULTS

First, convergent construct validity of OCS-Plus tasks to task-matched standardized neuropsychological tests was confirmed (r > 0.30). Second, we evaluated divergent construct validity of all OCS-Plus subtasks (r < 0.19). Third, we report the sensitivity and specificity of each OCS-Plus subtask compared to neuropsychological test performance. Fourth, we found that OCS-Plus detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS (98.50%).

DISCUSSION AND CONCLUSION

The OCS-Plus provides a valid screening tool for sensitive detection of subtle cognitive impairment in stroke patients. Indeed, the OCS-Plus detected subtle cognitive impairment at a similar level to validated neuropsychological assessments and exceeded detection of cognitive impairment compared to standard clinical screening tools.

Soluble Urokinase Plasminogen Activator Receptor Levels Correlation with Other Inflammatory Factors in Prognosis of Disability and Death in Patients with Ischemic Stroke

Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker elevated in cardiovascular diseases. The aim of this 3-year follow-up prospective study was to evaluate suPAR levels in patients with a first ischemic stroke in correlation with CRP, PCT, NT-proCNP and endothelin 1-21 and to investigate the impact of suPAR on the outcome. Fifty-one patients (mean age 73.7+ = 11.9 years, 26 female and 25 male) were included. Samples were collected on the first (suPAR 1), third (suPAR 3) and seventh days after stroke onset (suPAR 7). Plasma samples were analyzed using ELISA. A phone interview was conducted to collect follow-up information after 24 and 36 months (modified Rankin Scale, mRS). A positive correlation between suPAR levels and other inflammatory biomarkers (except endothelin 3) was observed. A positive correlation between suPAR 3 and mRS score at 24 months was observed (p = 0.042). The logistic regression model revealed no significant effect of suPAR on death occurrence in the first 24 months: suPAR 1 (p = 0.8794), suPAR 3 (p = 0.2757), and suPAR 7 (p = 0.3652). The suPAR level is a potential inflammatory marker in ischemic stroke, and there is a correlation with other markers. There is no major impact on mortality. However, the suPAR level is associated with a degree of disability or dependence in daily activities 2 years after a stroke.

Relationship of Alberta Stroke Program Early CT Score (ASPECTS) with the outcome of ischemic stroke and the neurocognitive stroke biomarkers

Background

Reliable and acceptable biomarkers are needed to anticipate the outcome and cognitive impairment following ischemic stroke. The goal of this research is to examine the association of ASPECTS with cognitive decline, biomarkers of stroke, and acute ischemic stroke outcomes. This study included 120 patients with ischemic stroke in the middle cerebral artery region. The initial NIHSS, non-contrast CT brain assessed by ASPECTS, and the biomarkers of cognitive decline such as ESR, CRP, S100B, MMP9, and glutamate were investigated. The Montreal Cognitive Assessment and modified Rankin scale (mRS) were evaluated after 3 months. Correlations between ASPECTS, MoCA, biomarkers of cognitive impairment, and mRS were done by Spearman correlation.

Results

The incidence of cognitive impairment in our patients was 25.8%. Stroke biomarkers (ESR, CRP, S100B, MMP9, and glutamate) were significantly increased in cognitively disabled individuals with significantly lower mean MoCA scores than in cognitively intact patients. There was a strong direct correlation linking the initial ASPECTS and total MoCA test score after 3 months follow-up. Cases with unfavorable outcomes were older, more incidence of hypertension, and had higher average initial NIHSS (P < 0.05). While the average ASPECTS scores for the favorable outcome group of patients were significantly higher and there was a significant negative correlation between the initial ASPECTS and modified Rankin Scale score.

Conclusions

ASPECTS is a reliable scale to identify the extent of acute ischemic injury and could participate in assessing the outcome. ASPECTS and particular neurocognitive stroke biomarkers will enable the early detection of post-stroke cognitive impairment.

Trial registration Registration of Clinical Trial Research: ClinicalTrials.gov ID: NCT04235920

Dual Task Effects on Speed and Accuracy During Cognitive and Upper Limb Motor Tasks in Adults With Stroke Hemiparesis

Background

Adults with stroke need to perform cognitive-motor dual tasks during their day-to-day activities. However, they face several challenges owing to their impaired motor and cognitive functions.

Objective

This case-controlled pilot study investigates the speed and accuracy tradeoffs in adults with stroke while performing cognitive-upper limb motor dual tasks.

Methods

Ten adults with stroke and seven similar-aged controls participated in this study. The participants used a robotic arm for the single motor task and participated in either the serial sevens (S7) or the controlled oral word association test (COWAT) for single-cognitive task. For the dual task, the participants performed the motor and cognitive components simultaneously. Their speed and accuracy were measured for the motor and cognitive tasks, respectively.

Results

Two-sample t-statistics indicated that the participants with stroke exhibited a lower motor accuracy in the cross task than in the circle task. The cognitive speed and motor accuracy registered by the subjects with stroke in the dual task significantly decreased. There was a negative linear correlation between motor speed and accuracy in the subjects with stroke when the COWAT task was performed in conjunction with the cross task (ρ = -0.6922, p = 0.0388).

Conclusions

This study proves the existence of cognitive-upper limb motor interference in adults with stroke while performing dual tasks, based on the observation that their performance during one or both dual tasks deteriorated compared to that during the single task. Both speed and accuracy were complementary parameters that may indicate clinical effectiveness in motor and cognitive outcomes in individuals with stroke.