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Karisik A, Dejakum B, Moelgg K, Komarek S, Toell T, Mayer-Suess L, Pechlaner R, Kostner S, Sollereder S, Kiechl S, Rossi S, Schoenherr G, Lang W, Kiechl S, Knoflach M, Boehme C. Association between dysphagia and symptoms of depression and anxiety after ischemic stroke. Eur J Neurol 2024; 31:e16224. [PMID: 38308469 DOI: 10.1111/ene.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND AND PURPOSE Dysphagia is associated with poor outcome, higher mortality, reduced quality of life, and social isolation. We investigate the relationship between swallowing impairment and symptoms of anxiety and depression after ischemic stroke. METHODS Consecutive patients with ischemic stroke participating in the prospective STROKE-CARD Registry study from 2020 to 2022 were assessed for dysphagia on hospital admission (clinical swallowing assessment) and for persistence until discharge and 3-month follow-up (SINGER Independency Index). Anxiety and depression symptoms were recorded using Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) at 3-month follow-up. RESULTS Of 648 patients, 19.3% had dysphagia on admission, persisting in 14.8% at discharge and 6.8% at 3-month follow-up. With the presence or duration of dysphagia (no dysphagia, dysphagia at baseline, at discharge, at 3 months), score (mean ± SD) increased on the BDI (7.9 ± 6.7, 12.5 ± 8.7, 13.5 ± 9.0, 16.5 ± 10.2), HADS-D (4.4 ± 3.7, 7.1 ± 4.2, 7.7 ± 4.4, 9.8 ± 4.3), and HADS-A (4.4 ± 3.5, 5.4 ± 3.6, 6.0 ± 3.6, 7.0 ± 3.6). In linear regression analysis adjusting for age, sex, diabetes, dementia, and either functional disability or stroke severity, BDI and HADS-D scores were significantly higher in patients with dysphagia across all points in time (admission, discharge, 3-month follow-up). An independent association with HADS-A scores was only evident in patients with persisting dysphagia after 3 months. Patients with dysphagia were more likely to receive antidepressants, antipsychotics, or benzodiazepines at discharge and 3-month follow-up. CONCLUSIONS Dysphagia after stroke is common and severely affects psychosocial functioning of individuals. Our results highlight swallowing impairment as an independent predictor for poststroke depressive and, to a lesser extent, anxiety symptoms.
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Affiliation(s)
- Anel Karisik
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Dejakum
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefanie Kostner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sophia Kiechl
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Hochzirl Hospital, Hochzirl, Austria
| | - Sonja Rossi
- ICONE-Innsbruck Cognitive Neuroscience, Department for Hearing, Speech, and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Schoenherr
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wilfried Lang
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Medical Faculty, Sigmund Freud Private University, Vienna, Austria
| | - Stefan Kiechl
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- VASCage-Center on Clinical Stroke Research, Innsbruck, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Komarek S, Dejakum B, Moelgg K, Boehme C, Karisik A, Toell T, Kiechl S, Knoflach M, Pechlaner R, Mayer-Suess L. No association between SARS-CoV-2 vaccination and ischaemic stroke or high-risk transient ischaemic attack. J Neurol Sci 2024; 456:120834. [PMID: 38134562 DOI: 10.1016/j.jns.2023.120834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Initiation of SARS-CoV-2 (Severe acute respiratory syndrome coronavirus type 2) vaccinations aroused scepticism within the general-public about risks including stroke. Our aim was to explore temporal associations between vaccination and cerebrovascular events through an analysis of a prospective large-scale cohort of consecutive stroke and high-risk TIA (transitory ischaemic attack) patients. METHODS We prospectively recruited a cohort of consecutive ischaemic stroke and high-risk TIA (ABCD2-Score ≥ 4) patients treated at the Innsbruck University Hospital (STROKE-CARD Registry Study, NCT04582825) from December 2020 until February 2022. SARS-CoV-2 vaccination status and the time of administration was ascertained by electronic health-data. A Cox model with vaccination status as time-dependent co-variable was employed to examine its association with ischaemic events. RESULTS Data on 572 participants were available with 355 (62.1%) vaccinated against SARS-CoV-2 before suffering cerebral ischaemia. In our cohort, no temporal association between vaccination and cerebrovascular event was detected (HR 1.06 [0.85-1.34; p = 0.60]) and this also applies to TIA (HR [0.82 0.37-1.85; p = 0.64]) or minor stroke (HR 1.18 [0.89-1.56; p = 0.26]) and subgroups defined by sex and age. Neither vector-based (HR 1.11 [0.79-1.56; p = 0.55]) nor mRNA-based (HR 1.06 [0.84-1.34; p = 0.61]) vaccinations were associated with the occurrence of cerebral ischaemia. CONCLUSION Among patients with stroke or high-risk TIA, SARS-CoV-2 vaccination was not associated with cerebral ischaemia.
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Affiliation(s)
- Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Anel Karisik
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Raimund Pechlaner
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
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Mayer-Suess L, Ibrahim A, Moelgg K, Cesari M, Knoflach M, Högl B, Stefani A, Kiechl S, Heidbreder A. Sleep disorders as both risk factors for, and a consequence of, stroke: A narrative review. Int J Stroke 2023:17474930231212349. [PMID: 37885093 DOI: 10.1177/17474930231212349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND PURPOSE Sleep disorders are increasingly implicated as risk factors for stroke, as well as a determinant of stroke outcome. They can also occur secondary to the stroke itself. In this review, we describe the variety of different sleep disorders associated with stroke and analyze their effect on stroke risk and outcome. METHODS A search term-based literature review ("sleep," "insomnia," "narcolepsy," "restless legs syndrome," "periodic limb movements during sleep," "excessive daytime sleepiness" AND "stroke" OR "cerebrovascular" in PubMed; "stroke" and "sleep" in ClinicalTrials.gov) was performed. English articles from 1990 to March 2023 were considered. RESULTS Increasing evidence suggests that sleep disorders are risk factors for stroke. In addition, sleep disturbance has been reported in half of all stroke sufferers; specifically, an increase is not only sleep-related breathing disorders but also periodic limb movements during sleep, narcolepsy, rapid eye movement (REM) sleep behavior disorder, insomnia, sleep duration, and circadian rhythm sleep-wake disorders. Poststroke sleep disturbance has been associated with worse outcome. CONCLUSION Sleep disorders are risk factors for stroke and associated with worse stroke outcome. They are also a common consequence of stroke. Recent guidelines suggest screening for sleep disorders after stroke. It is possible that treatment of sleep disorders could both reduce stroke risk and improve stroke outcome, although further data from clinical trials are required.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Abubaker Ibrahim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Kurt Moelgg
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Matteo Cesari
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage-Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- VASCage-Research Centre on Clinical Stroke Research, Innsbruck, Austria
| | - Anna Heidbreder
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
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Mayer-Suess L, Peball T, Komarek S, Dejakum B, Moelgg K, Kiechl S, Knoflach M. Disparities between guideline statements on acute and post-acute
management of cervical artery dissection. Rev Cardiovasc Med 2022; 23:9. [DOI: 10.31083/j.rcm2301009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/06/2022] Open
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Moelgg K, Jummun F, Humpel C. Spreading of Beta-Amyloid in Organotypic Mouse Brain Slices and Microglial Elimination and Effects on Cholinergic Neurons. Biomolecules 2021; 11:434. [PMID: 33804246 PMCID: PMC7999593 DOI: 10.3390/biom11030434] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 01/29/2023] Open
Abstract
The extracellular deposition of β-amyloid (Aβ) is one of the major characteristics in Alzheimer´s disease (AD). The "spreading hypothesis" suggests that a pathological protein (similar to prions) spreads over the entire brain. The aim of the present study was to use organotypic brain slices of postnatal day 8-10 mice. Using collagen hydrogels, we applied different Aβ peptides onto brain slices and analyzed spreading as well as glial reactions after eight weeks of incubation. Our data showed that from all tested Aβ peptides, human Aβ42 had the most potent activity to spread over into adjacent "target" areas. This effect was potentiated when brain slices from transgenic AD mice (APP_SweDI) were cultured. When different brain areas were connected to the "target slice" the spreading activity was more intense, originating from ventral striatum and brain stem. Reactive glial-fibrillary acidic protein (GFAP) astrogliosis increased over time, but Aβ depositions co-localized only with Iba1+ microglia but not with astrocytes. Application of human Aβ42 did not cause a degeneration of cholinergic neurons. We concluded that human Aβ42 spreads over into other "target areas", causing activation of glial cells. Most of the spread Aβ42 was taken up by microglia, and thus toxic free Aβ could not damage cholinergic neurons.
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Affiliation(s)
| | | | - Christian Humpel
- Laboratory of Psychiatry and Experimental Alzheimer’s Research, Department Psychiatry I, Medical University of Innsbruck, Anichstr 35, A-6020 Innsbruck, Austria; (K.M.); (F.J.)
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