scholarly journals Stroke survivors experience elevated levels of loneliness: a multi-year analysis of the National Survey for Wales

2020 ◽  
Author(s):  
Christopher Byrne ◽  
Christopher W. N. Saville ◽  
Rudi Coetzer ◽  
Richard Ramsey
Keyword(s):  
Social Isolation ◽  
Large Scale ◽  
Self Report ◽  
Objective Measures ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Annual Survey ◽  
Societal Relevance ◽  
Human Stroke ◽  
Nationally Representative

AbstractDespite clinical observation that stroke survivors frequently experience loneliness, there is no large-scale empirical evidence to support this observation. To address this issue, we completed two pre-registered analyses of a nationally representative annual survey that included a self-report measure of loneliness (N>21000). Across two separate cohorts, the results consistently showed that human stroke survivors report higher levels of loneliness compared to healthy individuals, and this relationship could not be accounted for by demographic factors (e.g., age, sex) or objective measures of social isolation (e.g., marital status, number of household members). These findings demonstrate that elevated levels of loneliness post-stroke are robust in that they replicate in large nationally representative samples and cannot be reduced to objective measures of social isolation. The work has clinical and societal relevance by suggesting that loneliness post-stroke is unlikely to be adequately “treated” if only the quantity and not the quality of social experiences are considered.

scholarly journals Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

2020 ◽  
pp. 026921552098172
Author(s):  
Niall M Broomfield ◽  
Robert West ◽  
Allan House ◽  
Theresa Munyombwe ◽  
Mark Barber ◽  
...  
Keyword(s):  
Item Response ◽  
Psychometric Evaluation ◽  
Self Report ◽  
Stroke Survivors ◽  
Reference Standard ◽  
Stroke Units ◽  
Post Stroke ◽  
Response Variance ◽  
Mild Stroke ◽  
Functional Outcome Measures

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

Abstract WP155: Is Erectile Dysfunction More Frequent Among Men with History of Stroke: Analysis of National Health and Nutrition Examination Surveys 2001 to 2004

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Sher Afgan ◽  
Muhammad A Saleem
Keyword(s):  
Erectile Dysfunction ◽  
National Health ◽  
The United States ◽  
Severe Disability ◽  
Self Report ◽  
Stroke Survivors ◽  
Health And Nutrition ◽  
History Of ◽  
Nationally Representative ◽  
Physician Diagnosis

Background: A common question among men who are stroke survivors is whether stroke occurrence will interfere with sexual performance. The question continues to have major significance in resumption of normal activities and reintegration into society for stroke survivors. Methods: Using a standard questionnaire, we examined trends and prevalence of erectile dysfunction in regards to moderate (sometimes) to severe (always) disability to get and keep an erection adequate for satisfactory intercourse in a nationally representative sample of the United States population. We analyzed data from 4929 men who participated in National Health and Nutrition Examination Survey (NHANES) 2001 to 2004. Stroke was defined based on self-report of physician diagnosis. Results: Moderate to severe disability to get and keep an erection adequate for satisfactory intercourse was reported by 13 (6.4%) men with history of stroke and 276 (5.8%) without stroke, respectively (p=0.65). After adjustment for differences in age, men with history of stroke did not have any increase in risk of moderate to severe disability to get and keep an erection adequate for satisfactory intercourse (odds ratio [OR] 0.8; 95% confidence interval [CI] 0.4 to1.7). Conclusions: Erectile dysfunction was relatively infrequent among men with history of stroke and no higher than in men without stroke.

scholarly journals Inter-hemispheric inhibition in stroke survivors is related to fatigue and cortical excitability

2019 ◽  
Author(s):  
Sasha Ondobaka ◽  
Nick Ward ◽  
Annapoorna Kuppuswamy
Keyword(s):  
Cortical Excitability ◽  
Effective Connectivity ◽  
Self Report ◽  
Stroke Survivors ◽  
Corticomotor Excitability ◽  
Post Stroke ◽  
Motor Cortex Excitability ◽  
Persistent Fatigue ◽  
Fatigue Severity ◽  
Exercise Induced

ABSTRACTObjectivePersistent post-stroke fatigue is a major debilitating condition that has been linked to low corticomotor excitability and aberrant attention, both phenomena that are associated with the inter-hemispheric inhibition balance in the brain. In this study, we examined the relationship between inter-hemispheric inhibitory effective connectivity, motor cortex excitability and chronic persistence of post-stroke fatigue.MethodsWe tested eighteen non-depressed stroke survivors with minimal motoric and cognitive impairments using spectral dynamic causal modelling (spDCM) of ‘resting state’ magnetic resonance imaging (rs-fMRI) and transcranial magnetic stimulation (TMS) measures of cortical excitability. We also assessed the levels of non-exercise induced, persistent fatigue using Fatigue Severity Scale (FSS) - a self-report questionnaire which has been widely applied and validated across different conditions. To understand neural effective connectivity mechanisms involved in fatigue and corticomotor excitability we examined the balance in inhibitory connectivity between homologue regions in M1, anterior insula, caudate and thalamus of the resting brain.ResultsInter-hemispheric inhibition balance between left and right M1 accounted for 67% of variability in the reported fatigue (R=.82, p<0.001). Inter-hemispheric inhibition balance in M1 also accounted for 54% of variability in the corticomotor excitability characterised by individual resting motor thresholds (R=.74, p<0.001), a measure that has been associated with subjective fatigue reports. Other examined inter-hemispheric connections did not show significant relationships with either fatigue or cortical excitability measures.ConclusionOur findings suggest that the balance in inter-hemispheric effective connectivity between primary motor regions is involved in regulation of corticomotor excitability and could explain subjective post-stroke fatigue.

scholarly journals Post-stroke fatigue is linked to resting state posterior hypoactivity and prefrontal hyperactivity

2021 ◽  
Author(s):  
Georgia Mary Cotter ◽  
Mohamed Salah Khlif ◽  
Laura Bird ◽  
Mark E Howard ◽  
Amy Brodtmann ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Resting State ◽  
Large Scale ◽  
Brain Activity ◽  
Low Frequency ◽  
Resting State Fmri ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Whole Brain ◽  
Post Stroke

Background and Purpose. Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown. Methods. This observational study included 63 stroke survivors (22 women; age 30-89 years; mean 67.5 years) from the Cognition And Neocortical Volume After Stroke (CANVAS) study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischaemic stroke. Participants underwent brain imaging 3 months post-stroke, including a 7-minute resting state fMRI echoplanar sequence. We calculated the fractional amplitude of low-frequency fluctuations, a measure of resting state brain activity at the whole-brain level. Results. Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. A generalised linear regression model analysis with age, sex, and stroke severity covariates was conducted to compare resting state brain activity in the 0.01-0.08 Hz range, as well as its subcomponents - slow-5 (0.01-0.027 Hz), and slow-4 (0.027-0.073 Hz) frequency bands between fatigued and non-fatigued participants. We found no significant associations between post-stroke fatigue and ischaemic stroke lesion location or stroke volume. However, in the overall 0.01-0.08 Hz band, participants with post-stroke fatigue demonstrated significantly lower resting-state activity in the calcarine cortex (p<0.001, cluster-corrected pFDR=0.009, k=63) and lingual gyrus (p<0.001, cluster-corrected pFDR=0.025, k=42) and significantly higher activity in the medial prefrontal cortex (p<0.001, cluster-corrected pFDR=0.03, k=45), attributed to slow-4 and slow-5 oscillations, respectively. Conclusions. Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity, reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This first whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.

Post-stroke fatigue is associated with resting state posterior hypoactivity and prefrontal hyperactivity

2021 ◽  
pp. 174749302110483
Author(s):  
Georgia Cotter ◽  
Mohamed Salah Khlif ◽  
Laura Bird ◽  
Mark E Howard ◽  
Amy Brodtmann ◽  
...  
Keyword(s):  
Resting State ◽  
Large Scale ◽  
Brain Activity ◽  
Low Frequency ◽  
Stroke Survivors ◽  
Whole Brain ◽  
Post Stroke ◽  
State Study ◽  
Stroke Study ◽  
Patient Health

Background Fatigue is associated with poor functional outcomes and increased mortality following stroke. Survivors identify fatigue as one of their key unmet needs. Despite the growing body of research into post-stroke fatigue, the specific neural mechanisms remain largely unknown. Aim This observational study aimed to identify resting state brain activity markers of post-stroke fatigue. Method Sixty-three stroke survivors (22 women; age 30–89 years; mean 67.5 ± 13.4 years) from the Cognition And Neocortical Volume After Stroke study, a cohort study examining cognition, mood, and brain volume in stroke survivors following ischemic stroke, underwent brain imaging three months post-stroke, including a 7-minute resting state functional magnetic resonance imaging. We calculated the fractional amplitude of low-frequency fluctuations, which is measured at the whole-brain level and can detect altered spontaneous neural activity of specific regions. Results Forty-five participants reported experiencing post-stroke fatigue as measured by an item on the Patient Health Questionnaire-9. Fatigued compared to non-fatigued participants demonstrated significantly lower resting-state activity in the calcarine cortex ( p < 0.001, cluster-corrected pFDR = 0.009, k = 63) and lingual gyrus ( p < 0.001, cluster-corrected pFDR = 0.025, k = 42) and significantly higher activity in the medial prefrontal cortex ( p < 0.001, cluster-corrected pFDR = 0.03, k = 45). Conclusions Post-stroke fatigue is associated with posterior hypoactivity and prefrontal hyperactivity reflecting dysfunction within large-scale brain systems such as fronto-striatal-thalamic and frontal-occipital networks. These systems in turn might reflect a relationship between post-stroke fatigue and abnormalities in executive and visual functioning. This whole-brain resting-state study provides new targets for further investigation of post-stroke fatigue beyond the lesion approach.

STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

2017 ◽  
Vol 15 (2) ◽  
pp. 0-0 ◽  
Author(s):  
Chloe Witty ◽  
Thomas Heffernan ◽  
Leigh Riby
Keyword(s):  
Verbal Memory ◽  
Digit Span ◽  
Qualitative Interviews ◽  
Stroke Survivor ◽  
Self Report ◽  
Stroke Recovery ◽  
Step Test ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

scholarly journals A longitudinal analysis of loneliness, social isolation and falls amongst older people in England

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Feifei Bu ◽  
Jessica Abell ◽  
Paola Zaninotto ◽  
Daisy Fancourt
Keyword(s):  
Social Isolation ◽  
Life Style ◽  
Large Scale ◽  
Hospital Admissions ◽  
Social Contact ◽  
Total Sample ◽  
Point Increase ◽  
Longitudinal Association ◽  
Nationally Representative ◽  
Socio Demographic Factors

AbstractLoneliness and social isolation have been identified as important predictors of various health outcomes, but little research has investigated their influence on falls. This study aimed to investigate the longitudinal association between loneliness, social isolation and falls amongst older adults in England, looking at both self-reported falls and falls that require hospital admissions. This study drew on large scale, nationally representative data from the English Longitudinal Study of Ageing linked with Hospital Episode Statistics. Data were analysed using survival analysis, with self-reported falls (total sample = 4013) and falls require hospital admission being modelled separately (total sample = 9285). There was a 5% increase in the hazard of self-reported falls relative to one point increase in loneliness independent of socio-demographic factors (HR: 1.05, 95% CI: 1.02–1.08), but the association was explained away by individual differences in health and life-style measures (HR: 1.03, 95% CI: 1.00–1.07). Both living alone (HR: 1.18, 95% CI: 1.07–1.32) and low social contact (HR: 1.04, 95% CI: 1.01–1.07) were associated with a greater hazard of self-reported falls even after controlling for socio-demographic, health and life-style differences. Similar results were also found for hospital admissions following a fall. Our findings were robust to a variety of model specifications.

Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Alyssa J Herzig ◽  
Nancy Mayo ◽  
Syd Miller
Keyword(s):  
Length Of Hospital Stay ◽  
Critical Factor ◽  
Self Report ◽  
Screening Tools ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
C Statistic ◽  
Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

scholarly journals Expanding the Scope of Administrative Health Records Through Advanced Statistical Methods

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 275-275
Author(s):  
Igor Akushevich ◽  
Carl V Hill ◽  
Konstantin Arbeev
Keyword(s):  
Large Scale ◽  
Self Report ◽  
Administrative Claims ◽  
Barriers To Entry ◽  
Health Records ◽  
Individual Level ◽  
Health Related ◽  
Electronic Health ◽  
Nationally Representative ◽  
Longitudinal Extension

Abstract The objective of the Symposium is to expand familiarity of the application of advanced methods of modern statistical modeling and data management, to administrative health data by combining methodological innovations with practical hands-on demonstrations. Topics will cover a range of methodological and substantive topics including: i) decomposition and partitioning approaches in analysis of disparities and time trends in AD/ADRD; ii) new artificial intelligence technologies that allow us to enrich electronic health record datasets with self-report scores in geriatrics; iii) using administrative data to model adherence to disease management and health-related behavior; iv) the use of longitudinal extension of the average attributable fraction to study health disparities and multimorbidity; and v) the geographic and racial disparities in total and remaining life expectancies after diagnoses of AD/ADRD and other chronic conditions. The increasing availability of large-scale datasets based on electronic health records and administrative claims records provide an unprecedented opportunity for obtaining nationally representative results based on individual-level measures that reflect the real care-related and epidemiological processes. This makes the reduction of barriers to entry to the use of such data of vital importance to the community of geriatrics and health researchers.

Therapy of post-stroke depression – a systematic review

2013 ◽  
Vol 10 (02) ◽  
pp. 108-129 ◽  
Author(s):  
W. Gaebel ◽  
W. Wannagat ◽  
J. Zielasek
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Placebo Control ◽  
Post Stroke ◽  
Pharmacological Studies ◽  
Post Stroke Depression ◽  
Control Procedures ◽  
Antidepressant Pharmacotherapy

SummaryWe performed a systematic review of randomized placebo-controlled pharmacological and non-pharmacological trials for the therapy and prevention of post-stroke depression that have been published between 1980 and 2011. We initially identified 2 260 records of which 28 studies were finally included into this review. A meta-analytic approach was hampered by considerable differences regarding the kinds of therapeutic regimens and the study durations. Modest effects favoring treatment of post-stroke depression could be found for pharmacological treatment as well as repetitive transcranial magnetic stimulation. For the prevention of post-stroke depression, antidepressant pharmacotherapy showed promising results. However, large-scale studies with better standardized study populations, optimized placebo control procedures in non-pharmacological studies, and replication in larger follow-up studies are still necessary to find the optimal therapeutic regimens to prevent and treat post-stroke depression.

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