Cognitive Impairment After Ischemic and Hemorrhagic Stroke: A Scientific Statement From the American Heart Association/American Stroke Association

Stroke, Journal Year: 2023, Volume and Issue: 54(6)

Published: May 1, 2023

Cognitive impairment is a common consequence of stroke and has direct implications for poststroke functioning quality life, including the ability to maintain job, live independently, sustain interpersonal relationships, drive vehicle. In this scientific statement, we critically appraise literature on prevalence, diagnosis, management cognitive (PSCI) provide framework clinical care while highlighting gaps that merit further study.We performed scoping review randomized controlled trials, prospective retrospective cohort studies, case-control guidelines, articles, editorials incidence natural history, PSCI. Scoping reviews determine scope body given topic indicate volume studies currently available an overview its focus.PSCI after stroke, especially in first year, ranges from mild severe. Although reversible some cases early up one-third individuals with develop dementia within 5 years. The pathophysiology not yet fully elucidated but likely attributable acute precipitating series pathological events, often setting preexisting microvascular neurodegenerative changes. Screening associated comorbidities interdisciplinary are integral components There need evaluating individual trajectory PSCI role vascular event predisposition Alzheimer disease related dementias, as well high-quality, trials focused management.

Language: Английский

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Post-Stroke Cognitive Impairment: Epidemiology, Risk Factors, and Management

Journal of Alzheimer s Disease, Journal Year: 2022, Volume and Issue: 86(3), P. 983 - 999

Published: Feb. 11, 2022

Stroke, characterized as a neurological deficit of cerebrovascular cause, is very common in older adults. Increasing evidence suggests stroke contributes to the risk and severity cognitive impairment. People with impairment following often face quality-of-life issues require ongoing support, which have profound effect on caregivers society. The high morbidity post-stroke (PSCI) demands effective management strategies, preventive strategies are more appealing, especially those targeting towards modifiable factors. In this review article, we attempt summarize existing knowledge gaps PSCI: elaborating heterogeneity current definitions, reporting inconsistent findings PSCI prevalence literature, exploring established or less predictors, outlining prevention treatment potentially currently being tested, proposing promising directions for future research.

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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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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Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions

International Journal of Stroke, Journal Year: 2024, Volume and Issue: 19(8), P. 838 - 856

Published: Sept. 16, 2024

Worldwide, around 50 million people live with dementia, and this number is projected to triple by 2050. It has been estimated that 20% of all dementia cases have a predominant cerebrovascular pathology, while perhaps another vascular diseases contribute mixed picture. Therefore, the contribution affects 20 currently will increase markedly in next few decades, particularly lower- middle-income countries. In review, we discuss mechanisms cognitive impairment (VCI) review management. VCI refers spectrum pathologies any degree impairment, ranging from subjective decline, mild dementia. While acute decline occurring soon after stroke most recognized form VCI, chronic disease, particular cerebral small-vessel can cause insidious absence stroke. Moreover, disease not only commonly co-occurs Alzheimer’s (AD) increases probability AD pathology result clinical but may also etiologically development pathologies. Despite its enormous health economic impact, neglected research area, adequately powered trials therapies, resulting proven treatments. Current management emphasizes prevention treatment risk factors, evidence for intensive hypertension control. Reperfusion therapies attenuate VCI. Associated behavioral symptoms such as apathy poststroke emotionalism are common. We highlight novel strategies hopefully lead new course-modifying therapies. Finally, importance including endpoints large cardiovascular need an increased focus funding important area.

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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Canadian Stroke Best Practice Recommendations: Vascular cognitive impairment, 7th edition practice guidelines update, 2024

Alzheimer s & Dementia, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 16, 2025

The Canadian Stroke Best Practice Recommendations (CSPR) 7th edition includes this new module on the diagnosis and management of vascular cognitive impairment (VCI) with or without neurodegenerative disease. An expert writing group people VCI lived experience (PWLE) reviewed current evidence. Existing recommendations were revised, added. Sections include definitions, signs symptoms, screening, assessment, diagnosis, pharmacological non-pharmacological management, secondary prevention, rehabilitation, end-of-life care. PWLE actively involved in all aspects development, ensuring their experiences are integrated. A unique journey map, developed by PWLE, is included, helped to motivate anchor recommendations. We encourage it be displayed across healthcare settings raise awareness support persons VCI. These CSBPRs emphasize need for integrated multidisciplinary care continuum. Evidence continues emerge gaps knowledge should drive future research. HIGHLIGHTS: This focuses specifically using a structured framework validated methodology. comprehensive set evidence-based presented that addresses continuum from symptom onset end life. consider individuals who because stroke other pathologies such as atrial fibrillation heart failure. map an individual's has been experience. It valuable guide inform educational content, approaches caring families VCI, systems planning.

Language: Английский

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Efficacy and Safety of High-Dose and personalized TBS on Post-stroke Cognitive Impairment: A Randomized Controlled Trial

Brain stimulation, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

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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Constituent isoflavones of Puerariae radix as a potential neuroprotector in cognitive impairment: Evidence from preclinical studies

Ageing Research Reviews, Journal Year: 2023, Volume and Issue: 90, P. 102040 - 102040

Published: Aug. 23, 2023

Language: Английский

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