Associations between stroke severity, aphasia severity, lesion location, and lesion size in acute stroke, and aphasia severity one year post stroke

Objective:Investigate the associations between general cognitive impairment and domain specific cognitive impairment with post-stroke depression and anxiety at six-months post-stroke.Methods:Participants were confirmed acute stroke patients from the OCS-CARE study who were recruited on stroke wards in a multi-site study and followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales, with scores greater than seven indicating possible mood disorders. General cognitive impairment at follow-up was assessed using the Montreal Cognitive Assessment, stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Linear regression was used to examine the associations between cognition and depression/anxiety symptoms at 6-months, controlling for acute-stroke severity and ADL-impairment, age, sex, education, and co-occurring post-stroke depression/anxiety.Results:437 participants mean age=69.28 years (S.D.=12.17), 226 male (51.72%), were included in analyses. Six-month post-stroke depression (n=115, 26%) was associated with six-month impairment on the MoCA (beta [b] =0.96, standard error [SE] =0.31, p=0.006), and all individual domains assessed by the OCS: spatial attention (b=0.67, SE=0.33, p =0.041), executive function (b=1.37, SE=0.47, p=0.004), language processing (b=0.87, SE=0.38, p=0.028), memory (b=0.76, SE=0.37, p=0.040), number processing (b=1.13, SE=0.40, p=0.005), praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety (n=133, 30%) was associated with impairment on the MoCA (b=1.47, SE=0.42, p=0.001), and spatial attention (b=1.25, SE=0.45, p=0.006), these associations did not remain significant after controlling for co-occurring post-stroke depression.Conclusion:Domain-general and domain-specific post-stroke cognitive impairment was found to be highly related to depressive symptomatology but not anxiety symptomatology.

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Abstract 2856: Lesion load of Corticospinal Tract and Initial Motor Impairment in the Acute Stroke Phase Predict Motor Impairment 3 Months Post-Stroke

Stroke ◽

10.1161/str.43.suppl_1.a2856 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Wuwei Feng ◽

Jing Wang ◽

Evgeny Sidorov ◽

Christine Holmstedt ◽

Christopher Doughty ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Corticospinal Tract ◽

Motor Impairment ◽

Lesion Size ◽

Sectional Area ◽

Lesion Load ◽

Cross Sectional ◽

Post Stroke ◽

Days Of Therapy

Background: We use lesion-mapping techniques in combination with diffusion tensor imaging to quantitatively test the hypothesis that motor impairment 3 months post- stroke is inversely related to the lesion load of the corticospinal tract (CST) in the acute stroke phase. Methods: We prospectively followed up a cohort of 32 patients who presented with their first-ever acute ischemic stroke with various degree of motor deficit , had a MRI during the hospitalization, and had follow-up motor assessments using the Fugl-Meyer Upper Extremity Scale (FM-UE) at 3 months (+/- 2 weeks) after stroke. We calculated a CST-lesion load for each patient by overlaying the patient’s lesion map from diffusion weighted image with a probabilistic DTI tract constructed from 12 age-matched healthy subjects . Both raw and weighted (which accounts for the narrowing of the CST as it descends from the motor cortex to the posterior limb of the internal capsule) were calculated; weighted lesion-loads were calculated by multiplying the lesion-tract overlap on each slice by the ratio of the maximum cross-sectional area of the tract to the cross-sectional area of the tract on that particular slice). A multiple regression is fit to assess the predicted value of CST lesion load (raw or weighted), along with other variables such age, gender, lesion size, initial impairment, days of therapy known to have an possible effect on motor outcome. Results: CST-lesion load and initial motor impairment are found to be significant predictors of upper extremity motor impairment at 3 months post-stroke. Age, gender, lesion size or days of therapy does not have predictive value in our cohort study. The adjusted R² is 0.63 with initial impairment and raw lesion load in the regression model, and is 0.66 with initial impairment and weighted lesion load. Conclusions: Our data shows the degree of motor impairment at 3 months after a first-ever ischemic stroke can be predicted by the overlap of the lesion with the canonical CST derived from age-matched healthy control subjects and the initial motor impairment measured in the acute phase.

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Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽

10.1371/journal.pone.0259806 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259806

Author(s):

Brent Strong ◽

Michele C. Fritz ◽

Liming Dong ◽

Lynda D. Lisabeth ◽

Mathew J. Reeves

Keyword(s):

Depressive Symptoms ◽

Acute Stroke ◽

Recovery Period ◽

Stroke Severity ◽

Stroke Survivors ◽

Stroke Patients ◽

Early Recovery ◽

Post Stroke ◽

Early Recovery Period ◽

Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

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Associations between lesion size, lesion location and aphasia in acute stroke

Aphasiology ◽

10.1080/02687038.2020.1727838 ◽

2020 ◽

pp. 1-19

Author(s):

Hedda Døli ◽

Wenche Andersen Helland ◽

Turid Helland ◽

Karsten Specht

Keyword(s):

Acute Stroke ◽

Lesion Size ◽

Lesion Location

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Focal or generalized vascular brain damage and vulnerability to depression after stroke: a 1-year prospective follow-up study

International Psychogeriatrics ◽

10.1017/s104161020500270x ◽

2006 ◽

Vol 18 (1) ◽

pp. 19-35 ◽

Cited By ~ 36

Author(s):

I. Aben ◽

J. Lodder ◽

A. Honig ◽

R. Lousberg ◽

A. Boreas ◽

...

Keyword(s):

Risk Factors ◽

Brain Damage ◽

Rating Scales ◽

Screening Tools ◽

Vascular Depression ◽

Lesion Location ◽

Post Stroke ◽

Negative Results ◽

Post Stroke Depression ◽

One Year

Background: Both the lesion location hypothesis and the vascular depression hypothesis have been proposed to explain the high incidence of depression in stroke patients. However, research studying both hypotheses in a single cohort is, at present, scarce.Objective: To test the independent effects of lesion location (left hemisphere, anterior region) and of co-occurring generalized vascular damage on the development of depression in the first year after ischemic stroke, while other risk factors for depression are controlled for.Methods: One hundred and ninety consecutive patients with a first-ever, supratentorial infarct were followed up for one year. CT was performed in the acute phase of stroke, while in 75 patients an additional MRI scan was also available. Depression was assessed at 1, 3, 6, 9, and 12 months after stroke using self-rating scales as screening tools and the SCID-I to diagnose depression according to DSM-IV criteria.Results: Separate analyses of the lesion location hypothesis and the vascular depression hypothesis failed to reveal significant support for either of these biological models of post-stroke depression. Similar negative results appeared from one overall, multivariate analysis including variables of both focal and generalized vascular brain damage, as well as other non-cerebral risk factors. In addition, level of handicap and neuroticism were independent predictors of depression in this cohort, as has been reported previously.Conclusion: This study supports neither the lesion location nor the vascular depression hypothesis of post-stroke depression. A biopsychosocial model including both premorbid (prior to stroke) vulnerability factors, such as neuroticism and (family) history of depression, as well as post-stroke stressors, such as level of handicap, may be more appropriate and deserves further study.

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Fatigue Impact Scale Demonstrates Greater Fatigue in Younger Stroke Survivors

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100015353 ◽

2012 ◽

Vol 39 (5) ◽

pp. 619-625 ◽

Cited By ~ 23

Author(s):

Natalie E. Parks ◽

Gail A. Eskes ◽

Gordon J. Gubitz ◽

Yvette Reidy ◽

Christine Christian ◽

...

Keyword(s):

Quality Of Life ◽

Ischemic Stroke ◽

Stroke Severity ◽

Stroke Patients ◽

Younger Patients ◽

Post Stroke ◽

Impact Scale ◽

Fatigue Impact Scale ◽

One Year

Background:Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue.Methods:The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS).Results:We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS.Conclusions:Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.

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Post-stroke dysphagia: frequency, risk factors, and topographic representation: hospital-based study

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00281-9 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Eman M. Khedr ◽

Mohamed A. Abbass ◽

Radwa K. Soliman ◽

Ahmed F. Zaki ◽

Ayman Gamea

Keyword(s):

Risk Factors ◽

Hemorrhagic Stroke ◽

Lesion Size ◽

National Institutes Of Health ◽

Stroke Severity ◽

Swallowing Function ◽

Post Stroke ◽

Ischemic Group ◽

Outcome Severity ◽

The Mean

Abstract Background The frequency of dysphagia varies considerably across literature. Post-stroke dysphagia is a common cause of increased morbidity and length of hospitalization. This study aimed to estimate the frequency, risk factors of dysphagia following first-ever ischemic or hemorrhagic stroke and its neuroradiological correlation. Methods Two hundred fifty patients (180 ischemic and 70 hemorrhagic strokes) with first-ever stroke were recruited within 72 h of onset. Detailed history, neurological examination, and computed tomography and/or magnetic resonance were done for each patient. Severity of stroke was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Swallowing function was assessed by water swallowing test (WST) and dysphagia outcome severity scale (DOSS). Results Ninety-eight (39.2%) of all stroke patients had dysphagia, 57 (31.7%) of ischemic group, 41 (58.6%) of hemorrhagic group. The mean age of ischemic group with dysphagia was older than ages of non-dysphagic and older than hemorrhagic stroke with dysphagia group. The mean total NIHSS was higher in dysphagic group than non-dysphagic group in both ischemic and hemorrhagic stroke. Dysphagia in ischemic group was highly associated with diabetes mellitus (DM), hypertension (HTN), and atrial fibrillation (AF). Dysphagia was commonly associated with middle cerebral artery (MCA), brainstem, and capsular infarctions as well as with intracerebral hemorrhage (ICH) with ventricular extension. Stroke severity and lesion size were the main determinant of dysphagia severity. Conclusions The frequency of post-stroke dysphagia is consistent with other studies. Advanced age, DM, HTN, and AF were the main risk factors. MCA, brain stem, capsular infarctions, and ICH with ventricular extension were frequently associated with dysphagia. Stroke severity and lesion size were independent predictors of dysphagia severity.

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Abstract T P115: Racial/Ethnic Differences in Post-Stroke Rehabilitation Utilization and Functional Outcomes in the South Carolina Stroke Belt

Stroke ◽

10.1161/str.45.suppl_1.tp115 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Charles Ellis ◽

Andrea D Boan ◽

Tanya N Turan ◽

Shelly Ozark ◽

David Bachman ◽

...

Keyword(s):

South Carolina ◽

Ethnic Differences ◽

Functional Outcomes ◽

Daily Living ◽

Stroke Rehabilitation ◽

Stroke Severity ◽

Post Stroke ◽

One Year ◽

Racial Ethnic

Background: Significant racial and ethnic disparities in stroke incidence, severity, morbidity and mortality have been consistently reported, but there are limited reports on racial/ethnic differences in post-stroke rehabilitation utilization and long term functional outcomes. Objective: To examine racial and ethnic differences in post-stroke rehabilitation utilization and functional outcomes. Methods: We examined one year follow-up data collected as part of the STEP-South Carolina Project that was designed to measure clinical, treatment, and functional outcomes in post-stroke patients. We used univariate and multivariate regression analyses adjusted for stroke severity to examine racial-ethnic differences in rehabilitation utilization (occupational therapy, physical therapy, speech therapy) and functional outcomes using a 20 question measure of activities of daily living (ADL) & instrumental activities of daily living (IADL) performance, life participation and driving. Results: Data from 162 stroke survivors (106 White, 56 Black) were collected at one year follow-up. As shown in the table, no significant differences were found between Blacks and Whites for rehabilitation utilization. In multivariate comparisons controlling for NIHSS, Blacks were less likely to report independence in overall functional performance outcomes as well as specific measures of toileting, walking, transportation, laundry and shopping. In addition, fewer Blacks reported driving at one year post-discharge. Conclusions: Fewer Blacks exhibited ADL and IADL independence at one year post-stroke after controlling for stroke severity, despite the fact that there were no racial-ethnic differences in rehabilitation utilization. Future studies are needed to further understand the reason for this disparity in recovery

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The strange role of brain lesion size in cognitive neuropsychology

10.1101/2021.03.27.437336 ◽

2021 ◽

Author(s):

Christoph Sperber

Keyword(s):

Cognitive Deficits ◽

Outcome Prediction ◽

Causal Relation ◽

Size Control ◽

Lesion Size ◽

List Type ◽

Cognitive Neuropsychology ◽

Lesion Location ◽

Post Stroke

Abstract The size of brain lesions is a variable that is frequently considered in cognitive neuropsychology. In particular, lesion-deficit inference studies often control for lesion size, and the association of lesion size with post-stroke cognitive deficits and its predictive value are studied. In the present article, the role of lesion size in cognitive deficits and its computational or design-wise consideration is discussed and questioned. First, I argue that the commonly discussed role or effect of lesion size in cognitive deficits eludes us. A generally valid understanding of the causal relation of lesion size, lesion location, and cognitive deficits is unachievable. Second, founded on the theory of covariate control, I argue that lesion size control is no valid covariate control. Instead, it is identified as a procedure with only situational benefits, which is supported by empirical data. This theoretical background is used to suggest possible research practices in lesion-deficit inference, post-stroke outcome prediction, and behavioural studies. Last, control for lesion size is put into a bigger methodological and also historical context – it is identified to relate to a long-known association problem in neuropsychology, which was previously discussed from the perspectives of a mislocalisation in lesion-deficit mapping and the symptom complex approach. Highlights - Lesion size is a factor that is often considered or controlled in neuropsychology - No general causal relation between lesion size, lesion location and deficit exists - Lesion size in brain mapping, outcome prediction and behavioural study is discussed - Lesion size control is no valid covariate control - Practical suggestions and guidelines how to consider lesion size are provided

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Abstract P660: Statin Therapy is Associated With Lower Mortality One Year After Ischemic Stroke: A National Data Linkage Study

Stroke ◽

10.1161/str.52.suppl_1.p660 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Kadie-Ann Sterling ◽

Melanie Turner ◽

Peter Langhorne ◽

Mark Barber ◽

Mary J Macleod

Keyword(s):

Ischaemic Stroke ◽

Statin Therapy ◽

Mortality Data ◽

Stroke Severity ◽

Separate Analysis ◽

Current Guideline ◽

Post Stroke ◽

Risk Of Death ◽

Study Population ◽

One Year

Introduction: Statins significantly reduce the risk of fatal and non-fatal cardiovascular events in patients with atherosclerotic cardiovascular disease and other high-risk conditions. Current guidelines strongly recommend the use of statins in all eligible patients after an ischaemic stroke, but some patient groups (e.g. elderly, female) still miss out, suggesting more evidence of benefit is still needed. Aim: To investigate the effect of statins on one-year mortality outcomes in ischaemic stroke survivors. Methods: This retrospective study linked routinely collected health data from the Scottish Stroke Care Audit (SSCA), the Prescribing Information System (PIS) and the Scottish Morbidity Record (SMR) 01 and mortality data from the National Records of Scotland (NRS). The study population included patients from January 2010 to December 2015 who survived an ischaemic stroke. Statin therapy was defined as at least one statin prescription within six months of the stroke event (yes/no) and data modelled to analyse the effect on mortality outcomes up to one year. Data were analysed using Cox proportional hazards in SPSS version 25. Results: The study population included 24 499 patients discharged from hospital to their usual place of residence within thirty days after an incident ischaemic stroke and who survived to six months. Statins were prescribed to 21 356 (87.2%) within the first six months in the community setting. Patients on a statin were more likely to be younger [median age 71.2 (IQR 61.1 to 79.5) versus 73.2 (IQR 55.5 to 83.2) years] and male (53.7% versus 46.3%) but had similar Charlson Comorbidity Index scores compared with patients not prescribed a statin. Post stroke statin therapy significantly reduced the risk of death [HR 0.49 (95% confidence interval 0.41 to 0.59)] when adjusted for age, sex, prior statin therapy and baseline stroke severity. Separate analysis also revealed similar benefits regardless of age and sex. Conclusion: Post-stroke statin therapy was associated with a reduced risk of death within one year even accounting for age, sex or comorbidities. This reinforces the benefit of current guideline implementation.

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