Neuropsychological Outcome and its Predictors Across the First Year after Ischaemic Stroke

2016 ◽  
Vol 17 (2) ◽  
pp. 111-122 ◽  
Author(s):  
Suzanne Barker-Collo ◽  
Rita Krishnamurthi ◽  
Valery Feigin ◽  
Amy Jones ◽  
Alice Theadom ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Verbal Memory ◽  
Vital Signs ◽  
Population Based ◽  
Neurological Deficits ◽  
First Year ◽  
Psychomotor Speed ◽  
Post Stroke

Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.

Prospective analysis of neuropsychological deficits following resection of benign skull base meningiomas

2017 ◽  
Vol 127 (6) ◽  
pp. 1242-1248 ◽  
Author(s):  
Klaus Zweckberger ◽  
Eveline Hallek ◽  
Lidia Vogt ◽  
Henrik Giese ◽  
Uta Schick ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Verbal Memory ◽  
Verbal Learning ◽  
Neuropsychological Deficits ◽  
Neurological Deficits ◽  
Skull Base Meningiomas

OBJECTIVEResection of skull base tumors is challenging. The introduction of alternative treatment options, such as radiotherapy, has sparked discussion regarding outcome in terms of quality of life and neuropsychological deficits. So far, however, no prospective data are available on this topic.METHODSA total of 58 patients with skull base meningiomas who underwent surgery for the first time were enrolled in this prospective single-center trial. The average age of the patients was 56.4 ± 12.5 years. Seventy-nine percent of the tumors were located within the anterior skull base. Neurological examinations and neuropsychological testing were performed at 3 time points: 1 day prior to surgery (T1), 3–5 months after surgery (T2), and 9–12 months after surgery (T3). The average follow-up duration was 13.8 months. Neuropsychological assessment consisted of quality of life, depression and anxiety, verbal learning and memory, cognitive speed, attention and concentration, figural memory, and visual-motor speed.RESULTSFollowing surgery, 23% of patients showed transient neurological deficits and 12% showed permanent new neurological deficits with varying grades of manifestation. Postoperative quality of life, however, remained stable and was slightly improved at follow-up examinations at T3 (60.6 ± 21.5 vs 63.6 ± 24.1 points), and there was no observed effect on anxiety and depression. Long-term verbal memory, working memory, and executive functioning were slightly affected within the first months following surgery and appeared to be the most vulnerable to impairment by the tumor or the resection but were stable or improved in the majority of patients at long-term follow-up examinations after 1 year.CONCLUSIONSThis report describes the first prospective study of neuropsychological outcomes following resection of skull base meningiomas and, as such, contributes to a better understanding of postoperative impairment in these patients. Despite deterioration in a minority of patients on subscales of the measures used, the majority demonstrated stable or improved outcome at follow-up assessments.

scholarly journals Stroke in systemic lupus erythematosus: a Swedish population-based cohort study

2017 ◽  
Vol 76 (9) ◽  
pp. 1544-1549 ◽  
Author(s):  
Elizabeth V Arkema ◽  
Elisabet Svenungsson ◽  
Mia Von Euler ◽  
Christopher Sjöwall ◽  
Julia F Simard
Keyword(s):  
Systemic Lupus Erythematosus ◽  
General Population ◽  
Ischaemic Stroke ◽  
Lupus Erythematosus ◽  
Haemorrhagic Stroke ◽  
Population Based ◽  
Incidence Rates ◽  
First Year ◽  
Systemic Lupus ◽  
Swedish Population

ObjectiveTo study the occurrence of ischaemic and haemorrhagic stroke in systemic lupus erythematosus (SLE) compared with the general population by age, sex and time since SLE diagnosisMethodsAdults with incident SLE were identified from the Swedish National Patient Register (NPR, n=3390) and general population comparators from the Total Population Register were matched on age, sex and county (n=16730). Individuals were followed prospectively until first of death, December 2013, emigration or incident stroke (identified from the NPR, Cause of Death Register and the Stroke Register). Incidence rates, rate differences and HR were estimated comparing SLE with non-SLE. Estimates were stratified by sex, age and time since diagnosis.ResultsWe observed 126 strokes in SLE and 304 in the general population. Individuals with SLE had a twofold increased rate of ischaemic stroke compared with the general population (HR 2.2; 95% CI 1.7 to 2.8). The HR for intracerebral haemorrhage was 1.4 (95% CI 0.7 to 2.8). There was effect modification by sex and age, with the highest HRs for females and individuals <50 years old. The HR for ischaemic stroke was highest in the first year of follow-up (3.7; 95% CI 2.1 to 6.5).ConclusionsThe relative risk of ischaemic stroke in SLE was more than doubled compared with the general population, and importantly, the highest relative risks were observed within the first year after SLE diagnosis. Thus, the first encounter with patients presents an opportunity for rheumatologists to screen for risk factors and intervene.

scholarly journals Differential cerebrovascular risks in glioblastoma and meningioma patients: a population-based matched cohort study in Wales (United Kingdom)

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Michael T C Poon ◽  
Kai Jin ◽  
Paul M Brennan ◽  
Jonine Figueroa ◽  
Cathie Sudlow
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Ischaemic Stroke ◽  
Population Based ◽  
Parametric Models ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Hazard Ratios ◽  
History Of

Abstract Aims There is limited evidence on cerebrovascular risks in glioblastoma and meningioma patients. We aimed to compare cerebrovascular risks of these patients with the general population. Method We used population-based routine healthcare and administrative data linkage in this matched cohort study. Cases were adult glioblastoma and meningioma patients diagnosed in Wales 2000-2014 identified in the cancer registry. Controls from cancer-free general population were matched to cases (5:1 ratio) on age (±5 years), sex and GP practice. Factors included in multivariable models were age, sex, index of multiple deprivation, hypertension, diabetes, high cholesterol, history of cardiovascular disease, and medications for cardiovascular diseases. Outcomes were fatal and non-fatal haemorrhagic and ischaemic stroke. We used flexible parametric models adjusting for confounders to calculate the hazard ratios (HR). Results Final analytic population was 16,921 participants, of which 1,340 had glioblastoma and 1,498 had meningioma. The median follow-up time was 0.5 year for glioblastoma patients, 4.9 years for meningioma patients, and 6.6 years for controls. The number of haemorrhage and ischaemic stroke was 154 and 374 in the glioblastoma matched cohort, respectively, and 180 and 569 in the meningioma matched cohort, respectively. The adjusted HRs for haemorrhagic and ischaemic stroke were 3.74 (95%CI 1.87-6.57) and 5.62 (95%CI 2.56-10.42) in glioblastoma patients, respectively, and were 2.42 (95%CI 1.58-3.52) and 1.86 (95%CI 1.54-2.23) in meningioma patients compared with their controls. Conclusion Glioblastoma and meningioma patients had higher cerebrovascular risks; these risks were even higher for glioblastoma patients. Further assessment of these potentially modifiable risks may improve survivorship.

scholarly journals Short-term health-related quality of life in patients with ischaemic stroke after PFO closure

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
G Christopoulou ◽  
E Sigala ◽  
D Aragiannis ◽  
E Stamatopoulou ◽  
P Manthou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischaemic Stroke ◽  
Physical Function ◽  
Health Related Quality ◽  
Short Term ◽  
Related Quality ◽  
Health Related ◽  
Pfo Closure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS.  Method In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up.  Results Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram.  The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023). Conclusions The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.

O188 Baseline quality of life and all-cause mortality in 10-year follow-up in a Chinese population-based cohort

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e45
Author(s):  
Gaoqiang Xie ◽  
Daniel T. Laskowitz ◽  
Elizabeth L. Turner ◽  
Joseph R. Egger ◽  
Ying Li ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chinese Population ◽  
Population Based ◽  
All Cause Mortality

Abstract P162: The Baseline Ankle Brachial Index (ABI), but Not Change in the ABI, is Associated With 11-Year Change in the SF-36: The San Diego Population Study (SDPS)

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christina L Wassel ◽  
Matthew A Allison ◽  
Joachim H Ix ◽  
Julie O Denenberg ◽  
Dena E Rifkin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Physical Functioning ◽  
Ankle Brachial Index ◽  
Population Based ◽  
Component Score ◽  
Lower Baseline ◽  
Sf 36

Background: Lower extremity peripheral artery disease (PAD) affects approximately 9 million people in the US. Less well-recognized is that PAD, even when asymptomatic, is associated with decreased functional status and quality of life. Previous studies have largely examined associations of the ankle brachial index (ABI) and quality of life in participants with PAD. To our knowledge no studies have examined the impact of ABI and change in ABI on change in quality of life in a population-based setting. Methods: The SDPS is a population-based prospective study that evaluated non-Hispanic White, African-American, Hispanic and Asian men and women for lower extremity PAD at two examinations approximately 11 years apart. Participants completed the SF-36 questionnaire, and 802 participants had ABI and SF-36 data available at both examinations. Analyses were restricted to these participants who also had a baseline ABI<1.4. Growth curve models were used to assess the associations of baseline ABI and change in the ABI with change in the SF-36 physical component score (PCS) and mental component score (MCS) over time. Change in the ABI was defined as (follow-up ABI - baseline ABI)/baseline ABI. Results: Participants were on average 57±9 years of age at baseline, and 69±9 at follow-up. At baseline, nearly 2 percent had ABI≤0.90, and the mean±SD ABI was 1.12±0.10. After adjustment for age, sex, race/ethnicity, BMI, ever smoking, physical activity, hypertension, diabetes, and dyslipidemia, each SD lower baseline ABI was significantly associated with an average change of -0.63 points (95% CI (-0.10, -1.17), p=0.02) on the PCS. This association was marginally significant for the MCS (-0.54 points (0.14, 1.22), p=0.12). Lower baseline ABI was also associated with negative change in two SF-36 subscales, physical functioning (p=0.02) and vitality (p=0.01). Change in the ABI over 11 years was not associated with change in the MCS (p=0.97) or PCS (p=0.41). Results were similar when excluding participants with ABI≤0.90. Conclusions: A lower ABI at baseline is associated with a significantly worse physical functioning quality of life approximately 11 years later. However change in the ABI was not significantly associated with change in quality of life over this time period. Additional studies are warranted in larger samples, especially to confirm the lack of findings for change in ABI.

The Nature stroke study; NASTRU - A randomised controlled trial of nature-based post-stroke fatigue rehabilitation

2019 ◽  
Author(s):  
Anna María Pálsdóttir ◽  
Kjerstin Stigmar ◽  
Bo Norrving ◽  
Patrik Grahn ◽  
Ingemar F Petersson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomised Controlled Trial ◽  
Standard Care ◽  
Controlled Trial ◽  
Perceived Value ◽  
Control Group ◽  
Post Stroke ◽  
Randomised Controlled

Abstract Fatigue is common after stroke and contributes to disability and impaired quality of life. Currently, there is insufficient evidence on the efficacy of any intervention for post-stroke fatigue. The aim of the study was to examine whether 10 weeks Nature-based rehabilitation (NRB) as add-on to standard care may improve post-stroke fatigue, perceived value of everyday occupations, function, activity and participation compared to standard care only (Clinical Trial.gov Identifier: NCT02435043, 2012/352, 05-06-2015). The study was carried out as a single blinded two-armed randomised controlled trial. Stroke survivors identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke > 1 year earlier) were randomised to Standard care + NBR or Standard care only. Blinded evaluations were conducted at follow-up 8 and 14 months after randomisation. The primary outcomes were post-stroke fatigue (Mental Fatigue Scale, total score) and perceived value of everyday occupations (Oval-pd) 8 months after randomisation. About a quarter of the screened patients were eligible; half accepted to participate and 101 were randomised, mean age 67 years, 60% female. The patients with sub-acute stroke were highly compliant with the intervention. Fatigue decreased to a value below the suggested cut-off for mental fatigue (<10.5) in the intervention group but not in the control group; no statistically significant differences were found though between the groups. Conclusion: NASTRU is the first randomised study on NBR for patients with post stroke fatigue. NBR was feasible and well tolerated. The study was underpowered due to difficulties in recruiting participants. No significant differences were detected between intervention and control group. A larger RCT is warranted. Keywords: clinical trial, enriched environment, everyday occupations, horticulture therapy, quality of life.

Barrett’s Registry Collaboration of academic centers in Ireland reveals high progression rate of low-grade dysplasia and low risk from nondysplastic Barrett’s esophagus: report of the RIBBON network

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Lisa M O’Byrne ◽  
Jolene Witherspoon ◽  
Roy J J Verhage ◽  
Marie O’Brien ◽  
Cian Muldoon ◽  
...  
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
Population Based ◽  
First Year ◽  
Progression Rate ◽  
Low Grade ◽  
Female Ratio ◽  
Ablative Therapies ◽  
Low Grade Dysplasia

Summary Barrett’s esophagus (BE) is the main pathological precursor of esophageal adenocarcinoma (EAC). Progression to high-grade dysplasia (HGD) or EAC from nondysplastic BE (NDBE), low-grade dysplasia (LGD) and indefinite for dysplasia (IND) varies widely between population-based studies and specialized centers for many reasons, principally the rigor of the biopsy protocol and the accuracy of pathologic definition. In the Republic of Ireland, a multicenter prospective registry and bioresource (RIBBON) was established in 2011 involving six academic medical centers, and this paper represents the first report from this network. A detailed clinical, endoscopic and pathologic database registered 3,557 patients. BE was defined strictly by both endoscopic evidence of Barrett’s epithelium and the presence of specialized intestinal metaplasia (SIM). A prospective web-based database was used to gather information with initial and follow-up data abstracted by a data manager at each site. A total of 2,244 patients, 1,925 with no dysplasia, were included with complete follow-up. The median age at diagnosis was 60.5 with a 2.1:1 male to female ratio and a median follow-up time of 2.7 years (IQR 1.19–4.04), and 6609.25 person years. In this time period, 125 (5.57%) progressed to HGD/EAC, with 74 (3.3%) after 1 year of follow-up and 38 (1.69%) developed EAC, with 20 (0.89%) beyond 1 year. The overall incidence of HGD/EAC was 1.89% per year; 1.16% if the first year is excluded. The risk of progression to EAC alone overall was 0.57% per year, 0.31% excluding the first year, and 0.21% in the 1,925 patients who had SIM alone at diagnosis. Low-grade dysplasia (LGD) progressed to HGD/EAC in 31% of patients, a progression rate of 12.96% per year, 6.71% with the first year excluded. In a national collaboration of academic centers in Ireland, the progression rate for NDBE was similar to recent population studies. Almost one in two who progressed was evident within 1 year. Crucially, LGD diagnosed and confirmed by specialist gastrointestinal pathologists represents truly high-risk disease, highlighting the importance of expertise in diagnosis and management, and providing indirect support for ablative therapies in this context.

scholarly journals Projecting the Number of Posttransplant Clinic Visits With a Rise in the Number of Kidney Transplants: A Case Study From Ontario, Canada

2020 ◽  
Vol 7 ◽  
pp. 205435811989855
Author(s):  
Shawna Mann ◽  
Kyla L. Naylor ◽  
Eric McArthur ◽  
S. Joseph Kim ◽  
Greg Knoll ◽  
...  
Keyword(s):  
Care Delivery ◽  
Population Based ◽  
Annual Number ◽  
First Year ◽  
Kidney Transplants ◽  
Kidney Transplant Recipients ◽  
The Mean ◽  
Current Health Care System ◽  
Clinic Visits

Background: In Ontario, kidney transplants have risen by 4% annually in recent years. An understanding of how this will affect the future annual number of posttransplant follow-up visits informs how to organize and deliver care. Objective: We projected the required number of annual posttransplant follow-up nephrology visits to inform posttransplant care delivery. Design: Population-based retrospective cohort study. Setting: Linked databases from Ontario, Canada (population 14 million). Patients: Incident kidney transplant recipients from years 2008 to 2013. Measurements: Frequency, distance traveled, and current and projected visits for posttransplant follow-up. Methods: Assuming a graft survival of 13 years and using the mean number of posttransplant clinic visits in years 1, 2, and 3, we forecasted the number of clinic visits needed in the year 2027. Results: Using data from 2443 recipients, the mean (SD) number of clinic visits per recipient was 14.0 (9.2) in the first year after transplant, and 3.9 (6.2) and 3.0 (5.3) in the second and third year, respectively. If transplant rates rise by 4% per year until 2027, the estimated annual visits number will increase from 30 622 to 43 948. The median (25th, 75th percentile) distance between transplant center and patient’s home was 30 (13, 65) km. The median round-trip travel distance for these visits in the first year after transplantation was 603 km per recipient, and median driving cost was Can$344 (2017). Limitations: Regarding patient expense, limitations include that distances traveled were calculated orthodromically, and we did not account for patient cost of follow-up beyond that of vehicular travel. Regarding follow-up projections, limitations include the assumption that graft life span will not change, follow-up patterns do not differ between donor kidney type, and we did not survey stakeholders as to their preferred method of follow-up. Conclusion: We quantified the increase in posttransplant visits when regional annual rates of transplantation rise. Strategies recognizing the burden of these visits may enhance patient-centered care, as it is unclear how some patients manage costs, nor how the current health care system will manage the demand.

scholarly journals Indications and outcomes of paediatric tracheotomy: a descriptive study using a Japanese claims database

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e031816 ◽  
Author(s):  
Kayoko Mizuno ◽  
Masato Takeuchi ◽  
Yo Kishimoto ◽  
Koji Kawakami ◽  
Koichi Omori
Keyword(s):  
Descriptive Analysis ◽  
Upper Airway ◽  
Population Based ◽  
Claims Database ◽  
Mechanical Ventilation Duration ◽  
Study Population ◽  
Underlying Diseases

ObjectiveTo examine the incidence of and indications for paediatric tracheotomy to clarify the disease burden relevant to tracheotomy in a population-based context.DesignA descriptive analysis of a retrospective cohort.SettingThis study utilised a nationwide claims database in Japan constructed by JMDC (Tokyo, Japan). The database includes claims data for approximately 3.75 million insured persons (approximately 3.1% of the population of Japan) comprising mainly company employees and their family members.ParticipantsWe identified children registered to have undergone tracheotomy from 2005 to 2017 among about 1.2 million children aged 0–15 years.Main outcome measuresThe characteristics of the study population, and indications for tracheotomy, duration of hospital stay, duration of mechanical ventilation, duration of tracheotomy dependence, complications related to tracheotomy and death were assessed. When there were multiple indications, classification for a child into multiple groups was allowed.ResultsThe study included 215 children (120 males, 56%). The median age at tracheotomy was 0.8 years. The most common age at tracheotomy was less than 12 months (n=127, 59.1%). The most common indications for tracheotomy were chronic lung disease (n=79, 36.7%), followed by neuromuscular disease (n=77, 35.8%), cardiovascular disease (n=53, 24.3%), upper airway obstruction (n=43, 20%), premature birth and related conditions (n=34, 15.8%), trauma (n=16, 7.4%), prolonged ventilation due to other causes (n=12, 5.6%) and malignancy (n=9, 4.2%). The median duration of tracheotomy dependence was 17.2 months. During the follow-up period, decannulation was achieved in 84 children (39.1%), and the median time from tracheotomy to decannulation was 12.0 months.ConclusionsMost paediatric tracheotomies were performed due to chronic underlying diseases, and the mean duration of tracheotomy dependence was nearly 1-½ years. The long-term duration of tracheotomy dependence might have some impacts on patients’ physical and mental development and the quality of life.

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