Post-Stroke Cognitive Impairment and Dementia

Circulation Research, Journal Year: 2022, Volume and Issue: 130(8), P. 1252 - 1271

Published: April 14, 2022

Poststroke cognitive impairment and dementia (PSCID) is a major source of morbidity mortality after stroke worldwide. PSCID occurs as consequence ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive manifesting clinical categorized vascular even in people with comorbid neurodegenerative pathology, which common elderly individuals can contribute to the expression PSCID. Manifestations cerebral small vessel disease, such covert brain infarcts, white matter lesions, microbleeds, cortical microinfarcts, are also patients likewise outcomes. Although studies historically varied approach timing methods diagnosis, most them demonstrate that older age, lower educational status, socioeconomic disparities, premorbid functional decline, life-course exposure risk factors, history prior increase Stroke characteristics, particular severity, lesion volume, location, multiplicity recurrence, influence risk. Understanding complex interaction between an acute event preexisting pathology remains priority will be critical for developing strategies personalized prediction, prevention, targeted interventions, rehabilitation. Current challenges field relate lack harmonization definition classification PSCID, approaches neurocognitive assessment, duration follow-up stroke. However, evolving knowledge on pathophysiology, neuroimaging, biomarkers offers potential applications may inform trials. Preventing cornerstone any strategy achieve optimal health. We summarize recent developments discuss future directions closing call action systematically include outcome assessment into poststroke outcome.

Language: Английский

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European stroke organisation (ESO) guideline on cerebral small vessel disease, part 2, lacunar ischaemic stroke

European Stroke Journal, Journal Year: 2024, Volume and Issue: 9(1), P. 5 - 68

Published: Feb. 21, 2024

A quarter of ischaemic strokes are lacunar subtype, typically neurologically mild, usually resulting from intrinsic cerebral small vessel pathology, with risk factor profiles and outcome rates differing other stroke subtypes. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations to assist clinical decisions about management prevent adverse outcomes. The was developed according ESO standard operating procedures Grading Recommendations, Assessment, Development, Evaluation (GRADE) methodology. We addressed acute treatment (including progressive stroke) secondary prevention in stroke, prioritised the interventions thrombolysis, antiplatelet drugs, blood pressure lowering, lipid lifestyle, their potential effects on outcomes recurrent dependency, major cardiovascular events, death, cognitive decline, mobility, gait, or mood disorders. systematically reviewed literature, assessed evidence where feasible formulated recommendations, expert concensus statements. found little direct evidence, mostly low quality. recommend that patients suspected receive intravenous alteplase, drugs avoid lowering current guidelines. For prevention, we single long-term, control, smoking cessation, regular exercise, healthy lifestyle modifications, obesity for general health benefits. cannot make any recommendation concerning drugs. Large randomised controlled trials clinically important endpoints, including a priority stroke.

Language: Английский

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Incidence of post-stroke cognitive impairment in patients with first-ever ischemic stroke: a multicenter cross-sectional study in China

The Lancet Regional Health - Western Pacific, Journal Year: 2023, Volume and Issue: 33, P. 100687 - 100687

Published: Jan. 14, 2023

Post-stroke cognitive impairment (PSCI) is a common sequela after stroke. China has large population of stroke survivors, but large-scale survey on the incidence and risk factors for PSCI not been undertaken. We aimed to calculate vascular symptoms among first-ever survivors in through multicenter cross-sectional study.From May 1, 2019 November 30, 2019, patients with clinical diagnosis ischemic were recruited from 563 hospitalized-based center networks 30 provinces China. Cognitive was measured by 5-min National Institute Neurological Disease Stroke-Canadian Stroke Network (NINDS-CSN) at 3-6 months indexed Stepwise multivariate regression stratified analysis performed assess association between demographic variables.A total 24,055 enrolled, an average age 70.25 ± 9.88 years. The as per NINDS-CSN 78.7%. Age ≥75 years old (OR: 1.887, 95%CI: 1.391-2.559), western regional residence 1.620, 1.411-1.860) lower education level associated increased risk. Hypertension might be related non-PSCI 0.832, 0.779-0.888). For under 45 old, unemployment independent factor 6.097, 1.385-26.830). who residents southern region 1.490, 1.185-1.873) non-manual workers 2.122, 1.188-3.792), diabetes PSCI.PSCI Chinese stroke, many are occurrence PSCI.The Beijing Hospitals Authority Youth Program (No. QMS20200801); Natural Science Foundation 81801142); Key Project Technology Development Railway Corporation K2019Z005); Capital Health Research Special 2020-2-2014); Innovation 2030-Major 2021ZD0201806).

Language: Английский

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Repetitive transcranial magnetic stimulation combined with cognitive training for cognitive function and activities of daily living in patients with post-stroke cognitive impairment: A systematic review and meta-analysis

Ageing Research Reviews, Journal Year: 2023, Volume and Issue: 87, P. 101919 - 101919

Published: April 1, 2023

Language: Английский

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Prediction of post-stroke cognitive impairment after acute ischemic stroke using machine learning

Alzheimer s Research & Therapy, Journal Year: 2023, Volume and Issue: 15(1)

Published: Aug. 31, 2023

Post-stroke cognitive impairment (PSCI) occurs in up to 50% of patients with acute ischemic stroke (AIS). Thus, the prediction outcomes AIS may be useful for treatment decisions. This PSCI cohort study aimed determine applicability a machine learning approach predicting after stroke.This retrospective used prospective AIS. Demographic features, clinical characteristics, and brain imaging variables previously known associated were included analysis. The primary outcome was at 3-6 months, defined as an adjusted z-score less than - 2.0 standard deviation least one four domains (memory, executive/frontal, visuospatial, language), using Korean version Vascular Cognitive Impairment Harmonization Standards-Neuropsychological Protocol (VCIHS-NP). We developed models (logistic regression, support vector machine, extreme gradient boost, artificial neural network) compared their accuracies variables.A total 951 (mean age 65.7 ± 11.9; male 61.5%) this study. area under curve boost network highest (0.7919 0.7365, respectively) among according VCIHS-NP definition. most important features include presence cortical infarcts, mesial temporal lobe atrophy, initial severity, history, strategic lesion infarcts.Our findings indicate that machine-learning algorithms, particularly models, can best predict stroke.

Language: Английский

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Domain-specific cognitive impairment 6 months after stroke: The value of early cognitive screening

International Journal of Stroke, Journal Year: 2023, Volume and Issue: 19(3), P. 331 - 341

Published: Sept. 26, 2023

Background: Cognitive screening following stroke is widely recommended, yet few studies have considered the prognostic value of acute domain-specific function for longer-term cognitive outcome. Identifying which post-stroke impairments more commonly occur, recover, and persist, hold value, could inform care planning, resource allocation. Aims: This study aimed to determine prevalence impairment acutely at 6 months, assess proportion change in performance, examine screening. Methods: A prospective cohort completed Oxford Screen (⩽2 weeks) months post-stroke. We determined 6-month performance from months. Hierarchical multivariable regression was used predict global adjusted demographic/vascular factors, severity, lesion volume. Results: total 430 survivors (mean/SD age 73.9/12.5 years, 46.5% female, median/interquartile range (IQR) National Institute Health Stroke Scale (NIHSS) 5/2–10) follow-up. Acutely, were highly prevalent ranging 26.7% ( n = 112) praxis 46.8% 183) attention. At recovery highest 73, 71%) lowest language 89, 46%) memory 82, 48%). Severity best predicted by addition (adj R 2 0.298, p < 0.0001) over demographic clinical factors alone 0.105, 0.0001). Acute strongest predictor 0.0001), significantly overall severity Conclusion: Post-stroke across all domains acutely, while language, memory, attention predominate Early can provide valuable information outcomes.

Language: Английский

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Guideline Recommendations on Behavioral and Psychological Symptoms of Dementia: A Systematic Review

Journal of the American Medical Directors Association, Journal Year: 2024, Volume and Issue: 25(5), P. 837 - 846.e21

Published: April 17, 2024

Language: Английский

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Time to consider health services dedicated for adults living with cerebral small vessel disease: Report of a ESO scientific seminar

European Stroke Journal, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

Purpose: Cerebral small vessel disease (cSVD) is a highly prevalent disorder leading to physical, cognitive and functional decline. We report key barriers in the management of individuals with cSVD, potential benefit cSVD-dedicated health services, evidence from existing models care for adults cSVD. Methods: examined information scientific seminar developed between seven experts cSVD during eighth European Stroke Organisation Conference that discussed optimal what services dedicated should include. Findings: Barriers include unrecognised symptoms modifiable risk factors, heterogeneity clinical presentations, inefficient inter/intra-clinical communication/organisation, uncertainties regarding assessments/treatments be routinely done, when by whom. However, research studies suggest Multi-step approaches can used identification aetiological workup including basic selected advanced evaluations, example, monogenic testing. Although current guidelines illlustrate limitations, there are recommendations on factors lifestyle considerations, as well pharmacological non-pharmacological interventions people Discussion conclusion: Existing healthcare do not provide Lack awareness heterogeneous presentations uncertainty threshold ‘burden’ referral specialist multidisciplinary challenges overcome. Creating may prevent underdiagnosing achieve standardised holistic improve outcomes adequate prevention early offered at all levels care.

Language: Английский

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Efficacy and Safety of DL-3-n-Butylphthalide in the Treatment of Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Frontiers in Pharmacology, Journal Year: 2022, Volume and Issue: 12

Published: Jan. 25, 2022

Background: Poststroke cognitive impairment (PSCI) is a common complication observed after stroke. Current pharmacologic therapies have no definitive evidence for recovery or disease progression. Recent studies verified the positive effect of DL-3-n-butylphthalide (NBP). However, clinical efficacy and safety are still unclear. The aim this study was to assess NBP its harmful in treatment PSCI. Method: Eligible randomized controlled trials (RCTs) were retrieved from inception June 2021 seven medical databases two registries. revised Cochrane risk bias tool (RoB 2.0) used methodological quality. RevMan v5.4.1 Collaboration statistical analysis, Hartung-Knapp-Sidik-Jonkman (HKSJ) method post hoc testing depend on number studies. This has been submitted PROSPERO with registration CRD42021274123. Result: We identified 26 total sample size 2,571 patients. results showed that as monotherapy combination therapy had better performance increasing MoCA (monotherapy: SMDN = 1.05, 95% CI [0.69, 1.42], p < 0.00001; SMDP 1.06, [0.59, 1.52], 0.00001. combination: SMDO 0.81, [0.62, 1.01], 0.90, [0.46, 1.33], 0.0001; SMDD 1.04, [0.71, 1.38], 0.00001), MMSE MDN 4.89, [4.14, 5.63]), 0.00001). 1.26, [0.97, 1.56], SMDC 1.63, [1.28, 1.98], 2.13, [1.52, 2.75], 0.00001) BI 13.53, HKSJ [9.84, 17.22], 0.014. 2.24, 95%CI [0.37, 4.11], 0.032; 3.36, [2.80, 3.93], 1.48, [1.13, 1.83], 0.00001); decreasing NIHSS -3.86, [-5.22, -2.50], -1.15, [-1.31, -0.98], -1.82, [-2.25, -1.40], CSS (combination: MDO -7.11, [-8.42, -5.80], serious adverse reactions observed. funnel plot possibility publication bias. Conclusion: maintains stable pattern promoting function abilities daily living, well reducing symptoms neurological deficits. there need more high-quality RCTs verify safety.

Language: Английский

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PRISMA Systematic Literature Review, including with Meta-Analysis vs. Chatbot/GPT (AI) regarding Current Scientific Data on the Main Effects of the Calf Blood Deproteinized Hemoderivative Medicine (Actovegin) in Ischemic Stroke

Biomedicines, Journal Year: 2023, Volume and Issue: 11(6), P. 1623 - 1623

Published: June 2, 2023

Stroke is a significant public health problem and leading cause of death long-term disability worldwide. Several treatments for ischemic stroke have been developed, but these limited effectiveness. One potential treatment this condition Actovegin

Language: Английский

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