Abstract 10: Neuroendocrine Dysfunction and Functional Disability Following Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lisa A Kreber ◽  
Charan K Singh
Keyword(s):  
Growth Hormone ◽  
Ischemic Stroke ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Independent Living ◽  
Functional Disability ◽  
Rating Scale ◽  
Hormone Deficiency ◽  
Stroke Patients ◽  
Disability Rating Scale

Comprehensive studies of the incidence of neuroendocrine dysfunction following stroke are lacking. The objectives of this study were to determine the incidence of neuroendocrine dysfunction in patients with stroke and to determine if growth hormone deficiency (GHD) contributes to disability following stroke. Hormones were assessed in 130 patients with stroke (ischemic: n=65; hemorrhagic: n=65; M time since stroke=155 days; men=81; M age = 52). TSH, T3, T4, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, cortisol, and insulin-like growth factor-1 were assessed. All patients underwent glucagon stimulation testing (GST) to assess growth hormone (GH). Patients were then classified as having severe GHD, moderate GHD or normal GH based on the results of the GST. Functional disability was assessed with the Disability Rating Scale, Independent Living Scale (ILS), and the Mayo-Portland Adaptability Inventory-IV. The majority of stroke patients had GHD (30% severe; 29% moderate). Patients with ischemic stroke had a higher prevalence of GHD (34% severe; 33% moderate) compared to patients with hemorrhagic stroke (26% severe; 23% moderate). The severe GHD group had significantly lower levels of FSH than the moderate GHD and normal GH groups (p<0.01). The moderate GHD group had significantly lower levels of LH than the severe GHD and normal GH groups (p<0.05) and significantly lower levels of T3 than the severe GHD and normal GH groups (p<0.05). The severe GHD group performed worse on the Activities of Daily Living and Behavior subscales of the ILS than the moderate GHD and normal GH groups (p<0.05). GHD was more prevalent in patients with ischemic stroke, indicating that type of stroke may influence neuroendocrine functioning. Additionally, FSH, LH and T3 were lower in patients with GHD than in patients with normal levels of GH. The implications of these findings suggest that routine, comprehensive neuroendocrine testing may be warranted in individuals who have sustained a stroke. Patients with GHD were more functionally disabled in their ability to perform activities of daily living and to engage in socially appropriate behavior. These findings suggest that hormone deficiencies can influence disability post-stroke.

Abstract WP67: Ultra-early Institution of Statin Treatment is Associated With Improved Outcomes Among Acute Ischemic Stroke Patients Receiving Thrombolytic Treatment

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Ischemic Stroke ◽  
Activities Of Daily Living ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Daily Living ◽  
Recombinant Tissue Plasminogen Activator ◽  
Statin Treatment ◽  
Functional Independence ◽  
Stroke Patients ◽  
Statin Use

Background: There is preliminary evidence that early statin use may improve the outcomes of acute ischemic stroke patients following endovascular treatment. Methods: We analyzed data from subjects treated with intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment the Interventional Management of Stroke III trial. We compared the rates of functional independence (defined by modified Rankin scale of 0-2) and minimal impairment of activities of daily living (Barthel index at 90 days 95-100)at 3 and 12 months among subjects with ultra-early institution of statin treatment (on Day 0) with those in whom statin treatment was not initiated and in those in whom statins were initiated between Day 1-discharge (delayed institution)after adjusting for age and baseline National Institutes of Health Stroke Scale score strata, history of hyperlipidemia; and statin use at baseline Results: Of the 656 subjects who were recruited in the trial, ultra-early institution of statin treatment and delayed institution occurred in 51 and 387 subjects, respectively. At 3 months post randomization, the adjusted rates of independent functional outcome (odds ratio [OR] 2.3; 95 % confidence interval [CI] 1.2-4.5; P = 0.015) and minimal impairment of activities of daily living (OR 2.2; 95 % CI 1.1-4.3; P = 0.022) were higher among subjects with ultra-early institution of statin treatment compared with those without any statin treatment. The adjusted rates of functional independence (OR 2.7; 95 % CI 1.4-5.2; P = 0.004) continued to higher among subjects with ultra-early institution of statin treatment at 12 months post randomization. The adjusted rates of functional independence and minimal impairment of activities of daily living were higher among subjects with ultra-early institution of statin treatment compared with those without any statin treatment in subjects randomized to endovascular treatment. Conclusions: Ultra-early institution of statin treatment in acute ischemic stroke patients treated with IV rt-PA with or without endovascular treatment was associated with improved outcome at both 3 and 12 months

scholarly journals Clinical and radiological correlates of activities of daily living in cerebellar atrophy caused by PMM2 mutations (PMM2-CDG)

2021 ◽  
Author(s):  
Fabio Pettinato ◽  
Giovanni Mostile ◽  
Roberta Battini ◽  
Diego Martinelli ◽  
Annalisa Madeo ◽  
...  
Keyword(s):  
Peripheral Neuropathy ◽  
Activities Of Daily Living ◽  
Functional Outcome ◽  
Daily Living ◽  
Functional Disability ◽  
Rating Scale ◽  
Cerebellar Atrophy ◽  
Multivariate Regression Analysis ◽  
Disability Score ◽  
Severe Intellectual Disability

AbstractWe aimed to identify clinical, molecular and radiological correlates of activities of daily living (ADL) in patients with cerebellar atrophy caused by PMM2 mutations (PMM2-CDG), the most frequent congenital disorder of glycosylation. Twenty-six PMM2-CDG patients (12 males; mean age 13 ± 11.1 years) underwent a standardized assessment to measure ADL, ataxia (brief ataxia rating scale, BARS) and phenotype severity (Nijmegen CDG rating scale, NCRS). MRI biometry of the cerebellum and the brainstem were performed in 23 patients (11 males; aged 5 months–18 years) and 19 control subjects with equal gender and age distributions. The average total ADL score was 15.3 ± 8.5 (range 3–32 out of 36 indicating severe functional disability), representing variable functional outcome in PMM2-CDG patients. Total ADL scores were significantly correlated with NCRS (r2 = 0.55, p < 0.001) and BARS scores (r2 = 0.764; p < 0.001). Severe intellectual disability, peripheral neuropathy, and severe PMM2 variants were all significantly associated with worse functional outcome. Higher ADL scores were significantly associated with decreased diameters of cerebellar vermis (r2 = 0.347; p = 0.004), hemispheres (r2 = 0.436; p = 0.005), and brainstem, particularly the mid-pons (r2 = 0.64; p < 0.001) representing the major radiological predictor of functional disability score in multivariate regression analysis. We show that cerebellar syndrome severity, cognitive level, peripheral neuropathy, and genotype correlate with ADL used to quantify disease-related deficits in PMM2-CDG. Brainstem involvement should be regarded among functional outcome predictors in patients with cerebellar atrophy caused by PMM2-CDG.

Neuropsychological correlates of instrumental activities of daily living in neurocognitive disorders: a possible role for executive dysfunction and mood changes

2018 ◽  
Vol 30 (12) ◽  
pp. 1871-1881 ◽  
Author(s):  
Martina Amanzio ◽  
Sara Palermo ◽  
Milena Zucca ◽  
Rosalba Rosato ◽  
Elisa Rubino ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Independent Living ◽  
Rating Scale ◽  
Behavioral Assessment ◽  
Executive Dysfunction ◽  
Self Monitoring ◽  
Mood Changes ◽  
Instrumental Activities ◽  
Living Skills

ABSTRACTSince baseline executive dysfunction predicts worsening Instrumental Activities of Daily Living (i-ADL) over time and progression to Alzheimer's Disease (AD), we aimed to analyze the role of neuropsychological variables to outline which factors can contribute to functional impairment. Specific attention to executive functions (EFs) has been given.A total of 144 subjects complaining of different cognitive deficits – ranging from “MCI likely due to AD” to “mild AD patients” – underwent an overall neuropsychological assessment. The Behavioral Assessment of the Dysexecutive Syndrome was used to analyze EFs. We conducted multiple linear regression analyses to study whether the level of independent living skills – assessed with the Lawton-scale – could be associated with cognitive and behavioral measurements.We found a significant association between i-ADL and specific EFs measured by Rule Shift Cards (p = 0.04) and Modified Six Elements (p = 0.02). Moreover, considering i-ADL scores, we observed an involvement of mood changes and a reduced awareness of deficits in terms of Hamilton Depression Rating Scale (p = 0.02) and Awareness of Deficit Questionnaire – Dementia scale (p < 0.0001), respectively.Our results suggest the importance of considering the association between a reduction in i-ADL and executive dysfunction in patients who have AD etiopathology, for which the ability to inhibit a response, self-monitoring, set-shifting and mood deflection play a key role. Besides, no straightforward associations between i-ADL scores and global cognition, memory, language comprehension, attention, and perspective taking abilities were found.

Increased intramuscular adipose tissue of the quadriceps is related to the decrease of activities of daily living in stroke patients

Nutrition ◽  
2021 ◽  
pp. 111277
Author(s):  
Naoki Akazawa ◽  
Masaki Kishi ◽  
Toshikazu Hino ◽  
Ryota Tsuji ◽  
Kimiyuki Tamura ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Stroke Patients ◽  
Intramuscular Adipose Tissue
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