scholarly journals The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

Author(s):  
Elisabeth Kliem ◽  
Elise Gjestad ◽  
Truls Ryum ◽  
Alexander Olsen ◽  
Bente Thommessen ◽  
...  

Abstract Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Janet Prvu Bettger ◽  
Xin Zhao ◽  
Cheryl Bushnell ◽  
Louise Zimmer ◽  
Ying Xian ◽  
...  

Background: Socioeconomic status (SES) is widely recognized as an area of inequity that affects health outcomes. However, social determinants of health are less frequently measured in longitudinal studies of acute stroke patients. The relationship of SES on disability 3-months post-stroke is unknown. Methods: We analyzed ischemic stroke patients in the AVAIL registry who were enrolled at 98 hospitals participating in Get With The Guidelines-Stroke. Patients who died (n=64) or did not complete a modified Rankin Scale (mRS) at 3-months (n=154) were excluded. Multivariable logistic regression was used to examine the relationship of SES (defined by level of education, work status, and perceived adequacy of household income to meet needs) and disability (mRS scores 3-5). Results: Among the 2092 stroke patients who met eligibility criteria, the mean age was 65.5 ± 13.7, 44.2% were female, and 82.7% were White. Fifty seven percent had a high school or less education, 11.4% were not working post-stroke and were home not by choice, and 25.7% were without an adequate household income. A third of the sample had some level of disability at 3-months (34.6% mRS 3-5). Those with disability were more likely to be older, non-White, female, single, less educated, have inadequate income, and were home not by choice. In the multivariable analysis, lower education, inadequate income, and being home but not by choice (compared with those who returned to work) were independently associated with disability (p<0.01; Table ). Conclusion: In this national cohort of stroke survivors, socioeconomic status as measured by level of education, work status, and income were independently associated with post-stroke disability.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Christine K Fox ◽  
Lori C Jordan ◽  
Mark T Mackay ◽  
Gabrielle deVeber ◽  

Introduction: Post-stroke epilepsy is common in children, but the relationship of childhood epilepsy with stroke outcome is poorly understood. Hypothesis: Children with epilepsy after arterial ischemic stroke have worse outcomes than those without epilepsy. Methods: We prospectively enrolled children (birth-18 years) with arterial ischemic stroke and identified remote seizures (occurring ≥ 7 days post-stroke). At one-year, patients with active epilepsy (≥ 1 remote seizure + maintenance anti-convulsant) were identified and Pediatric Stroke Outcome Measure (PSOM) was scored. Total PSOM scores range from 0-10; higher values reflect more severe neurologic deficits. Ordinal logistic regression was used to evaluate the relationship between clinical factors and PSOM scores. PSOM scores were categorized 0-1, 1.5-3, 3.5-6, 6.5-10 to depict stratified distribution. Results: Among 94 children (54% male; 20% Hispanic; 25% neonatal strokes; median age for childhood strokes 6.1 years, IQR 1.3-12), 12 had ≥ 1 remote seizure during the first year post-stroke. At one-year follow-up, 19 children were taking a maintenance anti-convulsant and 10 children had active epilepsy. Median PSOM score at one-year for the overall cohort was 0.5 (IQR 0-1.5). Median PSOM score among children with active epilepsy was 3.3 (IQR 0.5-6). Figure demonstrates distribution of categorized PSOM scores stratified by the presence of active epilepsy. On univariable regression analyses, older age (OR 1.1, 95% CI 1.0-1.1, P=0.02), maintenance anti-convulsant at one-year (OR 2.7, 95% CI 1.0-7.0, P=0.04) and active epilepsy (OR 6.3, 95% CI 1.7-25, P=0.007) were associated with higher total PSOM scores. After multivariable adjustment for age and maintenance anti-convulsant, active epilepsy remained associated with higher total PSOM score (OR 7.8, 95% CI 1.3-46, P=0.02). Conclusions: Active epilepsy one-year after pediatric arterial ischemic stroke is associated with poorer neurologic outcome.


2016 ◽  
Vol 12 ◽  
pp. P1074-P1074
Author(s):  
Laili Soleimani ◽  
Ramit Ravona-Springer ◽  
Anthony Heymann ◽  
James Schmeidler ◽  
Mary Sano ◽  
...  

Author(s):  
Anna Maria Lopatkiewicz ◽  
Joanna Pera ◽  
Agnieszka Slowik ◽  
Tomasz Dziedzic

Abstract Background Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Methods Of 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome. Results Group 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1. Conclusions Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.


PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3286 ◽  
Author(s):  
Chun Xie ◽  
Xiaochun Wang ◽  
Chenglin Zhou ◽  
Chang Xu ◽  
Yu-Kai Chang

Objective The present study was to determine the effect of a combined exercise and dietary program on cognitive function as well as the relationship between the program-induced weight change and cognitive function alterations. Design The study applies a quasi-experimental design. Methods Fifty-eight adolescents with obese status (body mass index, BMI >28 kg/m2) were assigned to either an experiment (n = 30) or control group (n = 28). Participants in the experiment group received a scheduled program with a specific exercise protocol (two sessions per day, six days per week) and diet plan for four consecutive weeks; the control group was instructed to maintain their normal school activities. The primary outcome measures were anthropometric data and flanker task performance. Results The combined program led to reduced BMI with maintenance of the incongruent accuracy in the experiment group, but the incongruent accuracy decreased in the control group after the four-week period. Additionally, the change in weight status between post- and pre-test measurements was inversely correlated with the change in incongruent accuracy. Conclusion The combined exercise and dietary program resulted in decreased weight and enhanced executive function in the obese adolescents, and the weight alteration may be considered the mediator between the intervention and executive function.


Author(s):  
Betsi Sumanti ◽  
Hexanto Hexanto ◽  
Widiastuti Widiastuti

   ASSOCIATION BETWEEN ALTERED HS-CRP LEVELS AND  COGNITIVE FUNCTION OF ISCHEMIC STROKE PATIENTSABSTRACTIntroduction: The incidence of cognitive impairment in acute ischemic stroke patients is increasing. The mechanism of the inflammatory effect, such as  elevated hs-CRP level, a  non-specific inflammatory marker  sensitive to chronic inflammation due to hypoperfusion as well other vascular risk, is thought to have an effect on cognitive function.Aims: To determine the relationship of cognitive function changes in acute phase of ischemic stroke with hs-CRP level changes on day 3 and day 7 after onset.Methods: This was a cross sectional study of 31 first-timer ischemic stroke patients who met inclusion and exclusion criteria. The level of hs-CRP was checked on the 3rd day and 7th day after onset, while MoCA-Ina was assessed on the 7th day after onset. Cognitive disturbance was considered if MoCA <26. Analyses was done using SPSS 2.0Results: The average onset of day 3 Hs-CRP concentration was 0.66 (0.12-16.67)mg/dl and the onset of day 7 was 5.455 (0.14-17.34)mg/dl. The mean change of hs-CRP level between 3 day and 7 day after onset was -0,16 (-3.32-4.95). There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Discussion: There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Keyword: Acute ischemic stroke, hs-CRP, MoCA-Ina scoresABSTRAKPendahuluan: Insidens penurunan fungsi kognitif pada pasien stroke iskemik akut semakin meningkat. Hal ini diduga dipengaruhi oleh mekanisme efek inflamasi, meliputi peningkatan kadar high sensitive-C reactive protein (hs-CRP), salah satu penanda inflamasi non-spesifik yang sangat sensitif pada inflamasi kronis, akibat hipoperfusi maupun karena risiko vaskuler lainnya.Tujuan: Mengetahui hubungan perubahan fungsi kognitif pasien stroke iskemik fase akut dengan perubahan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan.Metode: Studi potong lintang terhadap penderita stroke iskemik pertama kali yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pemeriksaan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan dan MoCA-Ina pada hari ke-7 setelah awitan. Fungsi kognitif dinyatakan terganggu jika MoCA-Ina <26. Analisis data menggunakan program SPSS 22.0.Hasil: Didapatkan rerata kadar Hs-CRP hari ke-3 setelah awitan adalah 0,66 (0,12-16,67)mg/dl dan hari ke-7 setelah awitan adalah 5,455 (0,14-17,34)mg/dl. Dengan rerata perubahan kadar hs-CRP awitan hari ke-3 dan awitan hari ke-7 adalah -0,16 (-3,32-4,95). Didapatkan hubungan yang bermakna antara perubahan kadar hs-CRP hari ke-3 setelah awitan dan hari ke-7 setelah awitan dengan fungsi kognitif pasien stroke iskemik akut.Kesimpulan: Didapatkan hubungan yang bermakna antara peningkatan kadar hs-CRP pada hari ke-7 dan kadar hari ke-3 dengan fungsi kognitif pasien stroke iskemik akut.Kata kunci: hs-CRP, MoCA-Ina, stroke iskemik akut 


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