scholarly journals Sex differences in post-stroke aphasia rates are caused by age. A meta-analysis and database query

2018 ◽  
Author(s):  
Mikkel Wallentin
Keyword(s):  
Sex Differences ◽  
Age Differences ◽  
Meta Analysis ◽  
Stroke Severity ◽  
Sufficient Information ◽  
Language Function ◽  
Stroke Patients ◽  
Potential Confounding Variable ◽  
Health Database ◽  
And Gender

AbstractBackgroundStudies have suggested that aphasia rates are different in men and women following stroke. One hypothesis says that men have more lateralized language function than women. Given unilateral stroke, this would lead to a prediction of men having higher aphasia rates than women. Another line of observations suggest that women are more severely affected by stroke, which could lead to a higher aphasia rate among women. An additional potential confounding variable could be age, given that women are typically older at the time of stroke.Methods & ProceduresThis study consists of two parts. First, a meta-analysis of the available reports of aphasia rates in the two sexes was conducted. A comprehensive literature search yielded 25 studies with sufficient information about both aphasia and gender. These studies included a total of 48,362 stroke patients for which aphasia rates were calculated. Second, data were extracted from an American health database (with 1,967,038 stroke patients), in order to include age and stroke severity into a regression analysis of sex differences in aphasia rates.Outcomes & ResultsBoth analyses revealed significantly larger aphasia rates in women than in men (1.1-1.14 ratio). This speaks against the idea that men should be more lateralized in their language function. When age and stroke severity were included as covariates, sex failed to explain any aphasia rate sex difference above and beyond that which is explained by age differences at time of stroke.

scholarly journals Does testosterone affect lateralization of brain and behaviour? A meta-analysis in humans and other animal species

2008 ◽  
Vol 364 (1519) ◽  
pp. 929-942 ◽  
Author(s):  
Kristina A Pfannkuche ◽  
Anke Bouma ◽  
Ton G.G Groothuis
Keyword(s):  
Sex Differences ◽  
Animal Species ◽  
Meta Analysis ◽  
Mammalian Species ◽  
Experimental Studies ◽  
Fundamental Principle ◽  
Sufficient Information ◽  
Visuospatial Cognition ◽  
Organizational Effects ◽  
Meta Analyses

Lateralization of brain and behaviour has been the topic of research for many years in neuropsychology, but the factors guiding its development remain elusive. Based on sex differences in human lateralization, four hypotheses have been postulated that suggest a role for androgens, specifically testosterone. With the discovery that lateralization is a fundamental principle in the organization of brain and behaviour among vertebrates, it has now become possible to experimentally test such hypotheses in animal models. The use of different taxa, humans, other mammalian species and birds (with oestradiol and not testosterone involved in sexual differentiation in birds) facilitates to differentiate between the hypotheses. We used meta-analyses for analysing papers that provided sufficient information, and a semi-quantitative approach based on all relevant studies that we extracted from the literature. We tested the predictions of these hypotheses regarding strength and direction of lateralization for motor output, language and visuospatial cognition in these three taxa. We tested for sex differences and early organizational effects of testosterone (both correlative and experimental studies). We found sex differences in the direction of lateralization for non-human mammals (motor biases similar to humans) and in direction and strength in birds (visual cognitive tasks). However, the prediction that prenatal testosterone exposure affects the direction of lateralization was not supported for humans. In birds and non-human mammals, opposite trends were found, with the effect in non-human mammals being opposite to the expectation based on sex differences. None of the four hypotheses was sufficiently supported and more studies, testing a wider array of functions in different taxa while reporting the data more completely are needed.

scholarly journals WMH and long-term outcomes in ischemic stroke

Neurology ◽  
2019 ◽  
Vol 92 (12) ◽  
pp. e1298-e1308 ◽  
Author(s):  
Marios K. Georgakis ◽  
Marco Duering ◽  
Joanna M. Wardlaw ◽  
Martin Dichgans
Keyword(s):  
Ischemic Stroke ◽  
Functional Impairment ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Increased Risk

ObjectiveTo investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.MethodsFollowing the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle–Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.ResultsWe included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72–2.73), cognitive impairment (RR 2.29, 95% CI 1.48–3.54), functional impairment (RR 2.21, 95% CI 1.83–2.67), any recurrent stroke (RR 1.65, 95% CI 1.36–2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26–2.88), all-cause mortality (RR 1.72, 95% CI 1.47–2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44–2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.ConclusionsPresence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.

scholarly journals Factors contributing to sex differences in functional outcomes and participation after stroke

Neurology ◽  
2018 ◽  
Vol 90 (22) ◽  
pp. e1945-e1953 ◽  
Author(s):  
Hoang T. Phan ◽  
Christopher L. Blizzard ◽  
Mathew J. Reeves ◽  
Amanda G. Thrift ◽  
Dominique A. Cadilhac ◽  
...  
Keyword(s):  
Sex Differences ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Stroke Severity ◽  
Participation Restriction ◽  
Related Factors ◽  
Stroke Incidence ◽  
Incidence Studies ◽  
Individual Participant

ObjectiveTo examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.MethodsIndividual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993–2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0–100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis.ResultsIn unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18–1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16–1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97–1.20; 5 years: RRadjusted 1.05, 95% CI 0.94–1.18). Women also had greater participation restriction than men (pooled MDunadjusted −5.55, 95% CI −8.47 to −2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted −2.48, 95% CI −4.99 to 0.03).ConclusionsWorse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.

Abstract P532: Hypertension and Gender Differences in Acute Ischemic Stroke Patients Treated With Rtpa

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Thomas I Nathaniel ◽  
Jordan Gainey ◽  
Leah Wormack ◽  
Chibueze Ubah ◽  
Leanne Brechtel ◽  
...  
Keyword(s):  
Gender Differences ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Hypertensive Patients ◽  
Ischemic Cerebrovascular Disease ◽  
And Gender ◽  
Similar Incidence

Background: Women and men have a similar incidence for ischemic cerebrovascular disease but women are more frequently hit by stroke later in life than men. It has been shown that women presented with severe stroke symptoms during admission, a poorer prognosis, are likely to have an overall poorer outcome after ischemic stroke when compared with men. However, some studies indicate similarities in outcome for men and women after stroke. Moreover, there is evidence that women treated with tPA benefit at least as much as men. Since a higher diastolic blood pressure increases the risk for a worse prospective functional status in men, but less significance in women, it is not clear whether hypertensive patients with acute ischemic stroke treated will reveal similarity or difference in functional outcome. We investigated this issue in the current study. Method: We performed a retrospective analysis of 4500 acute ischemic stroke patients who presented to a health care system between January 2010 and June 2016 and received rt-PA. We develop a new tool to determine the possibility of erasing any gender difference, and identify the most important factor for the poorer outcomes in women or men and whether thrombolysis may counteract this effect. Results: Our results reveal that poorer outcomes after stroke and the observed gender differences is due to age, at stroke onset, and that thrombolysis may neutralize this effect. Conclusion: The important factor for the poorer outcome and gender differences in hypertensive patients with acute ischemic stroke is mainly due to stroke severity and thrombolysis may play a major role in neutralizing this effect.

scholarly journals Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials

2021 ◽  
pp. 239698732110564
Author(s):  
Willeke F Westendorp ◽  
Jan-Dirk Vermeij ◽  
Craig J Smith ◽  
Amit K Kishore ◽  
John Hodsoll ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Functional Outcome ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Antibiotic Group

Introduction Infection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis. Patients and methods We searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality. Results 4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450). Discussion and conclusion Preventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.

scholarly journals MetaFun: Unveiling sex differences in multiple omics studies through comprehensive functional meta-analysis

2021 ◽  
Author(s):  
Pablo Malmierca-Merlo ◽  
Ruben Sanchez-Garcia ◽  
Ruben Grillo-Risco ◽  
Irene Perez-Diez ◽  
José Francisco Català-Senent ◽  
...  
Keyword(s):  
Gender Differences ◽  
Sex Differences ◽  
Statistical Power ◽  
Meta Analysis ◽  
Sex And Gender ◽  
And Gender ◽  
Sex And Gender Differences

Sex and gender differences in different health scenarios has been thoroughly acknowledged in the literature, and yet, very scarcely analyzed. To fill the gap, here we present MetaFun, which allows to meta-analyze multiple omics datasets with a sex-based perspective, and to combine different datasets to gain major statistical power and to assist the researcher in understanding these sex differences in the diseases under study. Metafun is freely available at bioinfo.cipf.es/metafun

Abstract TMP40: Pharyngeal Electrical Stimulation for Early Decannulation in Tracheotomised Stroke Patients With Dysphagia: A Meta-analysis of Individual Patient Data From Randomised Controlled Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Philip M Bath ◽  
Lisa J Woodhouse ◽  
Sonja Suntrup-Krueger ◽  
Shaheen Hamdy ◽  
Rainer Dziewas
Keyword(s):  
Electrical Stimulation ◽  
Randomised Controlled Trials ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Randomised Controlled

Background: Dysphagia is common after stroke and associated with a poor outcome. Pharyngeal electrical stimulation (PES) increased decannulation rates in tracheotomised stroke patients with dysphagia following ventilation in two trials. We report the results of an individual patient data meta-analysis assessing PES in severely dysphagic tracheotomised stroke patients. Methods: We searched for randomised controlled trials of PES in dysphagic tracheotomised stroke patients and obtained individual patient data for demographic and clinical (stroke severity, NIHSS; functional oral intake scale, FOIS; decannulation) variables from trialists. Data are number (%), median [interquartile range], mean (standard deviation) and mean difference (MD) or odds ratio (OR) with 95% confidence intervals (CI). Results: Two completed trials were identified (n=30, PHAST-TRAC n=69 [funded by Phagenesis Ltd]), with data for 99 participants (PES 55, 56%; sham 44, 44%). Mean age 64 (13) years, female 40 (40%), NIHSS 18 [14-21], time from onset to randomisation 27 days [20-38], and FOIS=1 (nil by mouth). As compared with sham, PES was associated with an increased proportion of patients who were ready for early decannulation, 59% versus 11% (OR 11.4, 95% CI 3.86-33.33; p<0.001) and improved FOIS score at discharge (MD 1.13, 95% CI 0.25-2.00; p=0.011). Treated participants who were ready for decannulation tended to have a shorter hospital length of stay: 23 vs 41 days (p=0.070) than those who were not ready. No device-related serious adverse events were reported. Conclusions: PES was associated with an increased proportion of stroke patients who were ready for decannulation and less dysphagia, in two randomised trials.

Age, Gender-Role Orientation, and Attitudes toward Menstruation

1988 ◽  
Vol 63 (3) ◽  
pp. 827-834 ◽  
Author(s):  
Joan C. Chrisler
Keyword(s):  
Community College ◽  
Sex Differences ◽  
New Jersey ◽  
Gender Role ◽  
Age Differences ◽  
Sex Role ◽  
Role Orientation ◽  
Gender Role Orientation ◽  
Attitude Questionnaire ◽  
And Gender

Students aged 18 to 23 yr. at a community college in suburban New Jersey and adults aged 30 to 39 yr. from suburban New Jersey completed the 1974 Bern Sex-role Inventory and Brooks-Gunn and Ruble's 1980 Menstrual Attitude Questionnaire. Significant age differences, sex differences and gender role differences in attitudes toward menstruation were found. Their implications are discussed.

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