Long-term trajectories of decline in cognition and daily functioning before and after stroke

ObjectiveAlthough knowledge on poststroke cognitive and functional decline is increasing, little is known about the possible decline of these functions before stroke. We determined the long-term trajectories of cognition and daily functioning before and after stroke.MethodsBetween 1990 and 2016, we repeatedly assessed cognition (Mini-Mental State Examination (MMSE), 15-Word Learning, Letter–Digit Substitution, Stroop, Verbal Fluency, Purdue Pegboard) and basic and instrumental activities of daily living (BADL and IADL) in 14 712 participants within the population-based Rotterdam Study. Incident stroke was assessed through continuous monitoring of medical records until 2018. We matched participants with incident stroke to stroke-free participants (1:3) based on sex and birth year. Trajectories of cognition and daily functioning of patients who had a stroke 10 years before and 10 years after stroke and the corresponding trajectories of stroke-free individuals were constructed using adjusted linear mixed effects models.ResultsDuring a mean follow-up of 12.5±6.8 years, a total of 1662 participants suffered a first-ever stroke. Patients who had a stroke deviated from stroke-free controls up to 10 years before stroke diagnosis in cognition and daily functioning. Significant deviations before stroke were seen in scores of MMSE (6.4 years), Stroop (5.7 years), Purdue Pegboard (3.8 years) and BADL and IADL (2.2 and 3.0 years, respectively).ConclusionPatients who had a stroke have steeper declines in cognition and daily functioning up to 10 years before their first-ever stroke compared with stroke-free individuals. Our findings suggest that accumulating intracerebral pathology already has a clinical impact before stroke.

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Abstract 2145: The Long-term Trajectory Of Functional Decline Before And After Stroke: The Northern Manhattan Study

Stroke ◽

10.1161/str.43.suppl_1.a2145 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Mandip Dhamoon ◽

Yeseon P Moon ◽

Myunghee C Paik ◽

Consuelo McLaughlin-Mora ◽

Ralph L Sacco ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Status ◽

Functional Decline ◽

Population Based ◽

Insurance Status ◽

Population Based Study ◽

Before And After ◽

Over Time

Background: Previous research in our population showed a steeper long-term decline in functional status after first ischemic stroke among those with Medicaid or no insurance compared to those with Medicare or private insurance. With only post-stroke data, it was unknown whether these findings were caused by the stroke. We sought to compare the long-term trajectory of functional status before and after ischemic stroke. Methods: The Northern Manhattan Study contains a prospective, population-based study of stroke-free individuals >40 years of age, followed for a median of 10 years. The Barthel index (BI) was assessed annually. Generalized estimating equations were used to assess functional decline over time before and after stroke. The 6 months after stroke were ignored, since the course of recovery during this period is well documented, and our interest was the long-term course of functional status. Follow-up was censored at the time of recurrent stroke. Sociodemographic and medical risk factors were included and results were stratified by insurance status. Linearity of the curves was evaluated by plotting residuals against time and with a lowess curve. Results: Among 3298 participants, 261 had an ischemic stroke during follow-up, of which 51 died within 6 months of stroke. Among the remaining 210 participants, mean age at stroke (standard deviation) was 77+9 years, 38% were male, 52% were Hispanic, 37% had diabetes, and 31% had coronary artery disease. There was no difference in functional decline over time before and after stroke (p= 0.51), with a decline of 0.96 BI points per year before stroke (p<.0001) and 1.24 after stroke (p=0.001). However, when stratified by insurance status, among those with Medicaid or no insurance, in a fully adjusted model, there was a difference in slope before and after stroke (p=0.04), with a decline of 0.58 BI points per year before stroke (p=0.02) and 1.94 after stroke (p=0.001). Other predictors of worse functional status were increasing age, female sex, diabetes, and being married. Conclusion: In this large, prospective, population-based study with long-term follow-up, there was a significantly steeper decline in functional status after ischemic stroke compared to before stroke among those with Medicaid or no insurance, after adjusting for confounders. The cause of this differential decline is not known but may be related to poor control of risk factors, silent strokes, or an effect of socioeconomic status.

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Cognitive and Functional Decline among Individuals 50 Years of Age or Older in Cambé, Paraná, Brazil: A Population-Based Study

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000444705 ◽

2016 ◽

Vol 6 (2) ◽

pp. 185-193

Author(s):

Marcos Aparecido Sarria Cabrera ◽

Maira Aira Sayuri Sakay Bortoletto ◽

Regina Kazue Tanno de Souza ◽

Douglas Manuel Carrapeiro Prina ◽

Maria Cristina Umpierrez Vieira ◽

...

Keyword(s):

Daily Living ◽

Mini Mental State Examination ◽

Functional Decline ◽

Population Based ◽

Older Individuals ◽

Population Based Study ◽

Low Socioeconomic ◽

Lower Socioeconomic ◽

Socioeconomic Profile ◽

State Examination

Aims: To identify the frequency of cognitive and functional decline (CFD) among adults 50 years of age and older by a population-based study. Methods: Cognitive function was analyzed by the Mini-Mental State Examination, and the functional conditions were based on instrumental activities of daily living (IADL). Cases of CFD included individuals with cognitive decline and 2 or more compromised IADL. Results: A total of 693 individuals were studied. The frequency of CFD was 16.3%. A low socioeconomic profile was associated with greater CFD independent of gender, age, education, and presence of depression (OR = 2.46; 95% CI: 1.53-3.97). Conclusions: These data show a high frequency of CFD among adults 50 years and older. Individuals with less education and a lower socioeconomic level exhibited poorer cognitive and functional conditions.

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How specialist ECT consultants inform patients about memory loss

Psychiatric Bulletin ◽

10.1192/pb.bp.108.023739 ◽

2009 ◽

Vol 33 (11) ◽

pp. 412-415

Author(s):

Dalia Hanna ◽

Kerry Kershaw ◽

Robert Chaplin

Keyword(s):

Mini Mental State Examination ◽

Response Rate ◽

Memory Loss ◽

Accreditation Process ◽

Clinical Implications ◽

Permanent Memory ◽

Long Term Follow Up ◽

State Examination

Aims and MethodA questionnaire was distributed to consultants with a special interest in electroconvulsive therapy (ECT) at clinics participating in an ECT accreditation process. This aimed to ascertain a consensus of clinical practice regarding informing patients about the treatment and assessment of memory during ECT.ResultsThe response rate was 64%. There is consensus on informing patients about the possibility of permanent memory loss. Memory is assessed before and during an ECT course by clinical interview and Mini-Mental State Examination, but rarely at long-term follow-up.Clinical ImplicationsPatients need to be informed about the possibility of permanent memory loss before consenting to ECT. Clinical teams need to make greater efforts to assess memory, particularly after this treatment.

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Trajectories of cognitive decline over 10 years in a Brazilian elderly population: the Bambuí cohort study of aging

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011001500004 ◽

2011 ◽

Vol 27 (suppl 3) ◽

pp. s345-s350 ◽

Cited By ~ 19

Author(s):

Erico Castro-Costa ◽

Michael E. Dewey ◽

Elizabeth Uchôa ◽

Josélia O. A. Firmo ◽

Maria Fernanda Lima-Costa ◽

...

Keyword(s):

Cohort Study ◽

Cognitive Decline ◽

Elderly Population ◽

Mini Mental State Examination ◽

Population Based ◽

Gender And Education ◽

Cognitive Trajectory ◽

Using Data ◽

State Examination

Few population-based studies have examined long term cognitive trajectory, and these studies were conducted in high income countries. We investigated the association of age, gender and education with 10-year cognitive trajectory in a well-defined population of elderly using data from the Bambuí Cohort Study of Aging, in Brazil. Cognition was measured using the Mini- Mental State Examination (MMSE). Cohort members underwent annual follow-ups. This analysis was based on 12,206 MMSE measurements from 1,461 (91%) baseline participants. We used mixed effects models to study MMSE as outcome. The key findings from this analysis are that women and people with a higher schooling level at baseline had high scores of MMSE, while older participants started off lower. Regarding cognitive decline, women, older people and those with a higher schooling level declined faster.

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Abstract 235: Predictors of functional decline over time in an urban population: The Northern Manhattan Study

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a235 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Mandip Dhamoon ◽

Yeseon P Moon ◽

Myunghee C Paik ◽

Palma Gervasi-Franklin ◽

Ralph L Sacco ◽

...

Keyword(s):

Risk Factors ◽

Functional Status ◽

Functional Decline ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Vascular Events ◽

Over Time

Background: There is limited data on predictors of long-term functional status in population samples, and even less about the effect of vascular risk factors on function. We hypothesized that functional status would decline over time, and that vascular risk factors would affect function and mediate functional decline. Methods: The Northern Manhattan Study contains a prospective, population-based study of 3298 stroke-free individuals > 40 years of age, followed for a median of 11 years for vascular events. The Barthel index (BI) was assessed annually and analyzed as a continuous variable on a 100-point scale. Generalized estimating equations models were adjusted for demographic, medical, and social risk factors assessed at baseline. Models were censored and uncensored for stroke and myocardial infarction (MI) occurring during follow-up. Secondarily, motor and non-motor domains of the BI were analyzed separately, and models were stratified by age. Results: Mean age (standard deviation) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% had diabetes, and 74% hypertension. Among 3298 participants, there were 33556 BI assessments. There was an annual decline of 1.02 BI points (p<0.0001). Predictors of change in BI over time included: age (−0.08 BI points per year; p<0.0001), Hispanic ethnicity (−0.22 per year, compared to white; p=0.016), female sex (−0.30 per year, compared to male; p<0.0001), diabetes (−0.38 per year, compared to non-diabetics; p=0.0002), and depression (−0.26 per year, compared to no depression; p=0.046). Results did not change when stroke and MI were censored. Magnitude and significance of predictors of BI were similar for motor and non-motor domains. The following had a different effect on change in BI in those above the median age (68 years), compared to those less than or equal to the median: age (−0.15 per year vs. −0.03; p for difference <0.0001), female compared to male sex (−0.43 per year vs. −0.15; p=0.049), and depression compared to no depression (−0.64 per year vs. −0.008, p=0.023). Conclusion: In this large, population-based, multi-ethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when the effect of vascular events was excluded by censoring. Vascular risk factors predicted functional decline even in the absence of clinical events. The impact of gender sex and depression was stronger amongst the elderly.

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No relation between biomarkers at age 47–49 and aortic diameter after 14–19 years of follow-up – a population-based study

VASA ◽

10.1024/0301-1526/a000632 ◽

2017 ◽

Vol 46 (4) ◽

pp. 291-295 ◽

Cited By ~ 2

Author(s):

Soumia Taimour ◽

Moncef Zarrouk ◽

Jan Holst ◽

Olle Melander ◽

Gunar Engström ◽

...

Keyword(s):

Population Based ◽

Aortic Diameter ◽

Aortic Dilatation ◽

Population Based Study ◽

Reactive Protein ◽

Abdominal Aortic ◽

Long Term Follow Up ◽

Old Men

Abstract. Background: Biomarkers reflecting diverse pathophysiological pathways may play an important role in the pathogenesis of abdominal aortic aneurysm (aortic diameter ≥30 mm, AAA), levels of many biomarkers are elevated and correlated to aortic diameter among 65-year-old men undergoing ultrasound (US) screening for AAA. Probands and methods: To evaluate potential relationships between biomarkers and aortic dilatation after long-term follow-up, levels of C-reactive protein (CRP), proneurotensin (PNT), copeptin (CPT), lipoprotein-associated phospholipase 2 (Lp-PLA2), cystatin C (Cyst C), midregional proatrial natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) were measured in 117 subjects (114 [97 %] men) aged 47–49 in a prospective population-based cohort study, and related to aortic diameter at US examination of the aorta after 14–19 years of follow-up. Results: Biomarker levels at baseline did not correlate with aortic diameter after 14–19 years of follow up (CRP [r = 0.153], PNT [r = 0.070], CPT [r = –.156], Lp-PLA2 [r = .024], Cyst C [r = –.015], MR-proANP [r = 0.014], MR-proADM [r = –.117]). Adjusting for age and smoking at baseline in a linear regression model did not reveal any significant correlations. Conclusions: Tested biomarker levels at age 47–49 were not associated with aortic diameter at ultrasound examination after 14–19 years of follow-up. If there are relationships between these biomarkers and aortic dilatation, they are not relevant until closer to AAA diagnosis.

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Endoscopically controlled surgery with open hemilaminectomy for the treatment of intradural extramedullary tumors: an operative technique and short-term outcomes of 20 consecutive cases

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00222-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Xiaorong Yan ◽

Huiqing Wang ◽

Cai Li ◽

Yuanxiang Lin ◽

Lin Lin ◽

...

Keyword(s):

Surgical Technique ◽

Spinal Deformity ◽

Tumor Recurrence ◽

Clinical Symptoms ◽

Short Term ◽

Before And After ◽

Intradural Extramedullary ◽

Controlled Surgery

Abstract Background To present a surgical technique for the treatment of intradural extramedullary (IDEM) tumors by using endoscopically controlled surgery with open hemilaminectomy technique. Methods In this study, 20 patients with 22 IDEM tumors were enrolled. An endoscopically controlled surgery with open hemilaminectomy was employed to remove the tumors. Data related to clinical symptoms and medical images before and after surgery were collected for perioperative evaluation and follow-up analysis. Results All the tumors in 20 patients were well removed. The clinical symptoms were significantly reduced in all the patients as well. The short-term follow-up data showed that there was no tumor recurrence or spinal deformity. Conclusion The endoscopically controlled surgery with open hemilaminectomy technique provided favorable exposure and satisfactory resection to the IDEM tumors. It may be an effective surgical method for treating IDEM tumors. Larger samples and longer follow-up data are needed to verify its long-term effectiveness.

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Psychotropic and pain medication use in individuals with traumatic brain injury—a Swedish total population cohort study of 240 000 persons

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2020-324353 ◽

2021 ◽

Vol 92 (5) ◽

pp. 519-527

Author(s):

Yasmina Molero ◽

David James Sharp ◽

Brian Matthew D'Onofrio ◽

Henrik Larsson ◽

Seena Fazel

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Total Population ◽

Medication Use ◽

Population Based ◽

Pain Medication ◽

Short Term ◽

Pain Medications ◽

Before And After

ObjectiveTo examine psychotropic and pain medication use in a population-based cohort of individuals with traumatic brain injury (TBI), and compare them with controls from similar backgrounds.MethodsWe assessed Swedish nationwide registers to include all individuals diagnosed with incident TBI between 2006 and 2012 in hospitals or specialist outpatient care. Full siblings never diagnosed with TBI acted as controls. We examined dispensed prescriptions for psychotropic and pain medications for the 12 months before and after the TBI.ResultsWe identified 239 425 individuals with incident TBI, and 199 658 unaffected sibling controls. In the TBI cohort, 36.6% had collected at least one prescription for a psychotropic or pain medication in the 12 months before the TBI. In the 12 months after, medication use increased to 45.0%, an absolute rate increase of 8.4% (p<0.001). The largest post-TBI increases were found for opioids (from 16.3% to 21.6%, p<0.001), and non-opioid pain medications (from 20.3% to 26.6%, p<0.001). The majority of prescriptions were short-term; 20.6% of those prescribed opioids and 37.3% of those with benzodiazepines collected prescriptions for more than 6 months. Increased odds of any psychotropic or pain medication were associated with individuals before (OR: 1.62, 95% CI: 1.59 to 1.65), and after the TBI (OR: 2.30, 95% CI: 2.26 to 2.34) as compared with sibling controls, and ORs were consistently increased for all medication classes.ConclusionHigh rates of psychotropic and pain medications after a TBI suggest that medical follow-up should be routine and review medication use.

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Long-term mortality and active TB disease among patients who were lost to follow-up during second line tuberculosis treatment in 2011-2014: population-based study in the country of Georgia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab127 ◽

2021 ◽

Author(s):

Giorgi Kuchukhidze ◽

Davit Baliashvili ◽

Natalia Adamashvili ◽

Ana Kasradze ◽

Russell R Kempker ◽

...

Keyword(s):

Multivariable Analysis ◽

Positive Culture ◽

Population Based ◽

Drug Resistant ◽

Second Line ◽

Adjusted Risk ◽

Tb Treatment ◽

Country Of Georgia

Abstract BACKGROUND High rates of loss to follow-up (LFU) exist among patients with multi-drug and extensively drug-resistant tuberculosis (M/XDR TB); We aimed to identify long-term clinical outcomes of patients who were LFU during second-line TB treatment. METHODS We conducted a follow-up study among adults who received second-line TB treatment in the country of Georgia during 2011-2014 with a final outcome of LFU. We attempted to interview all LFU patients, administered a structured questionnaire and obtained sputum samples. Active TB at follow-up was defined by positive sputum Xpert-TB/RIF or culture. RESULTS Follow-up information was obtained for 461 patients, among these patients, 107 (23%) died and 177 (38%) were contacted, of those contacted 123 (69%) consented to participate and 92 provided sputum samples. Thirteen (14%) had active TB with an estimated infectious time-period for transmitting drug-resistant TB in the community of 480 days (IQR=803). In multivariable analysis, positive culture at the time of LFU was associated with active TB at the time of our study (adjusted risk ratio=13.3, 95% CI: 4.2, 42.2) CONCLUSIONS Nearly one-quarter of patients on second-line TB treatment who were LFU died. Among those LFU evaluated in our study, one in seven remained in the community with positive sputum cultures. To reduce death and transmission of disease, additional strategies are needed to encourage patients to complete treatment.

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