Post-stroke cognitive impairment remains highly prevalent and disabling despite state-of-the-art stroke treatment

International Journal of Stroke, Journal Year: 2024, Volume and Issue: 19(8), P. 888 - 897

Published: March 1, 2024

Background: State-of-the-art stroke treatment significantly reduces lesion size and severity, but it remains unclear whether these therapeutic advances have diminished the burden of post-stroke cognitive impairment (PSCI). Aims: In a cohort patients receiving modern state-of-the-art care including endovascular therapy, we assessed frequency PSCI pattern domain-specific deficits, identified risk factors for PSCI, determined impact acute on outcome. Methods: this prospective monocentric study, examined with first-ever anterior circulation ischemic without pre-stroke decline, using comprehensive neuropsychological assessment ⩽10 days after symptom onset. Normative data were stratified by demographic variables. We defined as at least moderate (<1.5 standard deviation) deficits in ⩾2 domains. Multivariable regression analysis was applied to define PSCI. Results: analyzed 329 non-aphasic admitted from December 2020 July 2023 (67.2 ± 14.4 years old, 41.3% female, 13.1 2.7 education). Although most had mild (median National Institutes Health Stroke Scale (NIHSS) 24 h = 1.00 (0.00; 3.00); 87.5% NIHSS ⩽ 5), 69.3% them presented 2.0 post-stroke. The severely often affected domains verbal learning, episodic memory, executive functions, selective attention, constructive abilities (39.1%–51.2% patients), whereas spatial neglect less frequent (18.5%). reduced more education (odds ratio (OR) 0.47, 95% confidence interval (CI) 0.23–0.99) right hemisphere lesions (OR CI 0.26-0.84), increased severity (NIHSS h, OR 4.19, 2.72-6.45), presence hyperlipidemia 1.93, 1.01–3.68), not influenced age. After adjusting depressive symptoms, associated poor functional outcome (modified Rankin > 2, F 13.695, p < 0.001) worse global cognition (Montreal Cognitive Assessment (MoCA) score, 20.069, 3 months Conclusion: Despite therapy many strokes having phase prevalent learning memory deficits. reserve operationalized independently protects cognition.

Language: Английский

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Lesion mapping in neuropsychological research: A practical and conceptual guide

Cortex, Journal Year: 2023, Volume and Issue: 170, P. 38 - 52

Published: Oct. 20, 2023

Language: Английский

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How Do the Timing of Early Rehabilitation Together with Cognitive and Functional Variables Influence Stroke Recovery? Results from the CogniReMo Italian Multicentric Study

Healthcare, Journal Year: 2025, Volume and Issue: 13(3), P. 316 - 316

Published: Feb. 4, 2025

Background: The time lapse between the acute event and beginning of rehabilitation seems to play a significant role in determining effectiveness together with severity neurological deficits impairments motor cognitive functions. present study aims further explore prognostic functions, concerning different times neurorehabilitation. Methods: A secondary examination was conducted by applying cluster analysis on data 386 stroke patients subacute phase who were enrolled Cognitive Recovery Motor Functions (CogniReMo) study. Results: Barthel Index at admission predicts clinical outcome: if BI 0, it average 28.7 ± 24.1 discharge. For <15 discharge, discriminant unaltered executive functions having an output 61.3 instead 45.5. In range 16 45, variable have NIHSS ≤ 5 obtain high outcome (BI = 75.4 61.9). Subjects >45 best responders rehabilitation, mean discharge 85 they alteration spatial attention, 95.3 no attention. Also, for inpatients hospitalized period ranging from 20th 37th day after stroke, attention poor 34.3) vs. good one 76.7). Conclusions: algorithm identified hierarchical decision tree that might assume clinicians defining appropriate pathway, depending deficits.

Language: Английский

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Revisiting the core principles of physical rehabilitation after stroke: It’s not only what you do but how you do it that matters

British Journal of Occupational Therapy, Journal Year: 2025, Volume and Issue: unknown

Published: March 31, 2025

Language: Английский

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Electroacupuncture alleviated post-stroke cognitive impairment via the mTOR/NLRP3-mediated autophagy-inflammatory pathway

European journal of medical research, Journal Year: 2024, Volume and Issue: 29(1)

Published: Nov. 5, 2024

Post-stroke cognitive impairment (PSCI) severely reduces quality of life patients with stroke. This study aimed to assess the effects electroacupuncture (EA) on PSCI and role mTOR/NLRP3-mediated autophagy-inflammatory pathway in this process. The rat focal cerebral ischemia model was established using middle artery occlusion (MCAO). Following successful induction model, EA applied bilateral Fengchi, Fengfu, Dazhui acupoints, brain tissue samples were collected day 15. Cognitive function assessed Morris water maze test. Cerebral infarct volume quantified by Triphenyltetrazolium chloride (TTC) staining. Hematoxylin–eosin TUNEL staining performed evaluate pathological changes apoptosis rates. Apoptosis-, inflammation-, autophagy-related biomarkers measured, autophagosomes visualized transmission electron microscopy. MCAO rats exhibited slower weight gain, reduced mobility, increased size, damage, apoptosis, confirming establishment model. treatment, displayed faster improved shorter escape latency. also area infarction alleviated damage rats. Furthermore, downregulated IL-1β, IL-18, NLRP3, LC3 II/LC3 I expression upregulated p62, mTOR, Beclin-1 treatment decreased number these effectively mitigates post-stroke reducing inflammation, autophagy through regulation pathway, offering valuable therapeutic insights for stroke rehabilitation.

Language: Английский

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White matter integrity and functional connectivity of the default mode network in acute stroke are associated with cognitive outcome three months post-stroke

Journal of the Neurological Sciences, Journal Year: 2024, Volume and Issue: 462, P. 123071 - 123071

Published: May 31, 2024

Language: Английский

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Acute post-stroke screening for a cognitive care pathway

The Lancet Healthy Longevity, Journal Year: 2023, Volume and Issue: 5(1), P. e4 - e5

Published: Dec. 12, 2023

The systematic review and meta-analysis by Jule Filler colleagues1Filler J Georgakis MK Dichgans M Risk factors for cognitive impairment dementia after stroke: a meta-analysis.Lancet Healthy Longev. 2023; (published online Dec 12.)https://doi.org/10.1016/S2666-7568(23)00217-9Google Scholar is the first, to our knowledge, risk associated with both post-stroke (PSCI) (PSD) same approach. extensive showed that most predictive factor in PSCI PSD acute impairment, which adds previous reviews often did not consider baseline cognition. This Comment elaborates on complexity of changes challenges this poses discusses domain-specific screening as potential solution. importance understanding varying trajectories, including recovery post-stroke, highlighted future research avenue, clinical implications part care pathway stroke are explored. Understanding nature trajectories major challenge field, colleagues have literature. Earlier approaches equated PSD; operationally defined score below cut-off (MOCA, MMSE, neuropsychological test batteries etc) presence history stroke. More recent include domain-general deficits, severities trajectories. highly heterogeneous because acutely incurred focal, impairments, degenerating brain health preceding stroke.2Rost NS Brodtmann A Pase MP et al.Post-stroke dementia.Circ Res. 2022; 130: 1252-1271Crossref PubMed Scopus (117) Google heterogeneity has how we do screening. New guidelines increasingly emphasise tools sensitive impairments different domains, without excessive confounding from language attentional impairments.3National Clinical Guideline StrokeNational Stroke UK Ireland. Intercollegiate Working Party, London2023Google For example, patients who left hemisphere will show marked affect scores verbal tests designed dementia.4Demeyere N Riddoch MJ Slavkova ED al.Domain-specific versus generalized stroke.J Neurol. 2016; 263: 306-315Crossref (75) As reviews, here again, there were noticeable associations PSD, probably—at least part—a confound rather than dementia. stroke-specific allow inclusive testing aphasia neglect, reducing confounds. Our 2023 study found such be key predictor severity at 6 months more so demographic factors,5Milosevich ET Moore Pendlebury ST Demeyere Domain-specific value early screening.Int Stroke. Sep 25.)https://doi.org/10.1177/17474930231205787Crossref (0) line findings review. routine use standard, screen would aid avoiding difficulties had synthesising available literature many diagnostic tools, made it impossible domain-specific, continuous scores. In addition, predictions degree add valuable information trajectory modelling. could further only poor outcomes (in persistent or degenerative PSCI), but also positive outcomes, recovery. Paralleling motor stroke, improve over initial period can continue long term.6Moss Nicholas Language rehabilitation chronic time postonset: single-subject data.Stroke. 2006; 37: 3043-3051Crossref (91) Early-stage now widely recommended identify impairment,7Quinn TJ Richard E Teuschl Y al.European Organisation European Academy Neurology joint impairment.Eur 2021; 28: 3883-3920Crossref (45) although much guidance these practice research. By highlighting a—if the—risk longer term used should extend its focus medication management secondary prevention monitoring. Within pathway, having pragmatically implementable prediction capitalise easily prove clinicians, help survivors their families understand process an individual level,8Hobden G Tang Cognitive assessment qualitative patients' experiences.BMJ Open. 13e072501Crossref (2) possible Because cognition active area research, current generation cohort studies paying attention detailed assessments issues, crucial evidence synthesis regularly updated. ND developer Oxford Screen, does receive any renumneration use. meta-analysisOur results highlight phase long-term PSD. Treatable diabetes, atrial fibrillation, markers cerebral small vessel disease (ie, white matter hyperintensities lacunes). Future trials explore targets Full-Text PDF Open Access

Language: Английский

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MoCA Domain-Specific Pattern of Cognitive Impairment in Stroke Patients Attending Intensive Inpatient Rehabilitation: A Prospective Study

Behavioral Sciences, Journal Year: 2024, Volume and Issue: 14(1), P. 42 - 42

Published: Jan. 9, 2024

A domain-specific perspective to cognitive functioning in stroke patients may predict their recovery over time and target rehabilitation intervention. However, data about impairment after are still scarce. This study prospectively investigated the pattern of impairments, using classification proposed by Montreal Cognitive Assessment (MoCA), a cohort 49 at admission (T0), discharge (T1), six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value T0 domains T1 T2 was also investigated. Patients' T0, T1, assessed through MoCA for executive functioning, attention, language, visuospatial, orientation, memory. Different evolutionary trends domain impairments emerged across time-points. all decreased T1. Attention (42.9% 26.5% 10.2% 18.4%, respectively). Conversely, altered orientation increased between (16.3%, 36.7%, 40.8%, Additionally, patients' global predicted language phase (

Language: Английский

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The Korean Version of the Oxford Cognitive Screen (K-OCS) Normative Study

Annals of Rehabilitation Medicine, Journal Year: 2024, Volume and Issue: 48(1), P. 22 - 30

Published: Feb. 28, 2024

Objective: To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine impairment each subdomain. Post-stroke cognitive (PSCI) negatively impacts rehabilitation process independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, most clinics, psychological evaluation tools Alzheimer’s dementia have been used without such considerations. The OCS is assessment tool PSCI vascular can evaluate domains often affected by stroke, including language, attention, memory, praxis, numerical cognition. It comprises 10 subtasks enables quick evaluation. Methods: K-OCS, which considers Korea’s unique cultural linguistic characteristics, was developed with approval cooperation original author. Enrollment participants disabilities announced at Duksung Women’s University, Yongin Sevrance Hospital, CHA Bundang Medical Center. study conducted between September 2020 March 2022 on 97 male female aged ≥30 years.Results: All completed task. In this study, 5th percentile score presumed to be value score, values are provided here. subtask similar British version.Conclusion: We suggest usability K-OCS as providing subtask.

Language: Английский

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Domain-specific cognitive impairments, mood and quality of life 6 months after stroke

Disability and Rehabilitation, Journal Year: 2024, Volume and Issue: unknown, P. 1 - 10

Published: April 16, 2024

Purpose To identify which acute and 6-month domain-specific cognitive impairments impact mood, participation, stroke-related quality of life 6 months post-stroke.

Language: Английский

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