Abstract TP156: NIH Stroke Scale at Discharge as a Predictor for Return to Work Status After Mild Stroke

Background: A significant proportion of patients are unable to return to work (RTW) post stroke. While post-stroke depression and fatigue have been linked to patients’ RTW status, the role of discharge NIHSS has not been studied. Objective: To evaluate role of stroke severity, depression, fatigue, and cognitive impairment on patients’ ability to RTW. Methods: A retrospective study was conducted using a survey completed by a convenience sample of patients during follow-up in stroke clinic. The survey included PHQ-9, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). Demographic, work status, and clinical data (discharge NIHSS, mRS, medical history) were also collected. NIHSS was evaluated both continuously and dichotomized ( < 1, > 1). Patients who did and did not RTW were compared using chi square tests of proportions and Wilcox Ranked Sum tests; independence of factors was explored using logistic regression predicting RTW. Results: Out of 135 patients surveyed, 41% (N=56) reported employment at the time of their stroke. Of those, a significant percentage of patients were unable to RTW post stroke (57.1%); 39.3% (N=22) were unable to RTW due to physical limitations. Further analysis revealed patients who did not RTW were more likely to suffer from fatigue (p=0.026), have higher rates of cognitive impairment (p=0.027) and a higher NIHSS at discharge (p<0.001). Very low NIHSS was a very strong RTW predictor as patients with an NIHSS ≤ 1 at discharge were 15 times more likely to RTW than patients with a higher NIHSS (p=.001). Patients who worked in professional, managerial, or artistic occupations pre-stroke were more likely to return to work than those in public service, skilled or unskilled labor occupations (p=0.023). In multivariate analyses, fatigue, cognitive impairment and depression were no longer significant when NIHSS at discharge was a covariate. Type of occupation was independent of NIHSS. Conclusions: For patients with mild stroke, NIHSS at discharge indicating minimal to no disability is a strong independent predictor for RTW status. For patients with greater deficit, depression, fatigue and cognitive impairment could play a greater role; additional studies of patients with greater variety of stroke severity would be needed.

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The role of the inflammatory process in the development of post-stroke cognitive impairment

Zhurnal nevrologii i psikhiatrii im S S Korsakova ◽

10.17116/jnevro202112103216 ◽

2021 ◽

Vol 121 (3) ◽

pp. 16

Author(s):

M.A. Grigolashvili ◽

R.M. Mustafina

Keyword(s):

Cognitive Impairment ◽

Inflammatory Process ◽

Post Stroke

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Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke

Neurology ◽

10.1212/wnl.0000000000011748 ◽

2021 ◽

pp. 10.1212/WNL.0000000000011748

Author(s):

Owen A Williams ◽

Nele Demeyere

Keyword(s):

Cognitive Impairment ◽

Acute Stroke ◽

Spatial Attention ◽

Anxiety Symptoms ◽

Cognitive Domain ◽

Stroke Severity ◽

Depression And Anxiety ◽

Post Stroke ◽

Domain Specific ◽

Post Stroke Depression

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 TP161: Sexual Dysfunction in Mild Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp161 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Jennifer Blum ◽

Caroline Wisialowski ◽

Susan Taboada ◽

Sarah Clark ◽

Ilene Staff ◽

...

Keyword(s):

Sexual Dysfunction ◽

Safety Concern ◽

Clinical History ◽

Descriptive Statistics ◽

Self Report ◽

Convenience Sample ◽

True Incidence ◽

Post Stroke ◽

Physical Limitations ◽

Mild Stroke

Background: Stroke impacts several aspects of patients’ lives and sexual dysfunction post stroke has been reported in 40%-50% of patients. Current investigations have revealed links to depression, however this has not been examined specifically in mild stroke. Objective: To determine prevalence and factors associated with sexual dysfunction after mild stroke Design/methods: A retrospective study was conducted on a self-report questionnaire completed by a convenience sample of patients during a hospital follow-up appointment in the stroke clinic. Patients were asked about sexual dysfunction after stroke and if yes, to specify the cause: safety concern, physical limitation, consequence or change in libido. In addition, patients completed a PHQ-9 to measure depression, Fatigue Assessment Scale (FAS), and the Montreal Cognitive Assessment (MoCA). A thorough review of clinical history including NIHSS, mRS and demographics was completed by researchers. Descriptive statistics were used to identify and understand the patient population. Mild stroke was defined as NIHSS ≤ 5. Results: In our study of 135 patients, 21 (16%) did not respond to the sexual dysfunction question. Of the 114 who responded, only 11 (9.6%) reported sexual dysfunction and 9 (81%) attributed their sexual dysfunction to physical limitations. Descriptive statistics of the respondent subgroup indicate that the cohort was 59% male with a median (IQR) age of 64 (57,75) and that 52% were living with someone at the time. The mean NIHSS on discharge was 1 (IQR 0-3) and 77% were ischemic strokes. Few patients experienced post stroke depression (21.9%, N=25), and the cohort reported low levels of fatigue (median FAS=19). Low incidence and response rates precluded an analysis of specific predictors in this cohort. Conclusion: Physical limitations are reported to be the main cause of post stroke sexual dysfunction. Roughly 1 in 10 patients with mild stroke reported experiencing sexual dysfunction, however twice as many did not respond to the question. Therefore, the true incidence is unclear, prompting the need for further investigation on post stroke sexual dysfunction in mild stroke.

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Abstract T P42: Patients With a Clinical Diagnosis of Non-disabling Stroke, and a Normal MRI are Clinically Indistinguishable From Patients With a MRI Lesion at 1 Year Post Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp42 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Stephen Makin ◽

Martin Dennis ◽

Joanna M Wardlaw

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Expert Panel ◽

Recurrent Stroke ◽

Final Diagnosis ◽

Cognitively Impaired ◽

Post Stroke ◽

Mild Stroke ◽

One Year

Background: Up to one third of patients with a clinically apparent mild stroke and no other apparent cause of their symptoms have a normal MRI. We examined disability, recurrent stroke, and cognitive impairment at one year compared to patient with an MRI-DWI lesion. Methods: We recruited consecutive patients with a non-disabling ischaemic stroke, and performed clinical assessment and MRI (with DWI) . An expert panel reviewed all cases, we included patients with a final diagnosis of stroke and excluded patients with another diagnosis. At one year post stroke we recorded modified Rankin scale (mRs), stroke and TIA recurrence, Addenbrookes Cognitive Assessment Revised (ACE-R) and the Beck Depression index (BDI) and performed another MRI. Non-attenders were assessed by telephone or post. We defined cognitive impairment as ACE-R of <88, and depression as a BDI of >9. Results: Almost one third (75/264) (median NIHSS=2) of patients had a no relevant lesion on MRI DWI. There was no difference in age, sex, symptoms, or risk factors in patients with and without a lesion, 197 had MRI at 1 year (all had clinical follow-up). Of 75 with no lesion, 41% were mRs ≥2, 13% had recurrent stroke or TIA, 36% were cognitively impaired and 46% had depression. This was not significantly different from the patients with a lesion. Of the 197 who had a follow-up MRI 50 patients with no initial lesion had follow-up MRI and one had a new lesion, (versus 20/147 patients with a lesion) (p=0.016). Conclusions: Patients with a clinical stroke and no other obvious cause for their symptoms are clinically indistinguishable from patients with the same NIHSS who have a lesion on DWI-MRI, in terms of recurrence, disability, or cognitive impairment. Suggesting that these patients have had a stroke that does not appear on MRI. The presence of an initial lesion increases the liklihood of a lesion on 1 year MRI, however without a difference in clinical stroke this is of doubtful significance.

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The Role of Arginase 1 in Post-Stroke Immunosuppression and Ischemic Stroke Severity

Translational Stroke Research ◽

10.1007/s12975-015-0431-9 ◽

2015 ◽

Vol 7 (2) ◽

pp. 103-110 ◽

Cited By ~ 23

Author(s):

Ashley B. Petrone ◽

Grant C. O’Connell ◽

Michael D. Regier ◽

Paul D. Chantler ◽

James W. Simpkins ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Severity ◽

Post Stroke ◽

Arginase 1

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Return to Work Among Stroke Survivors

Workplace Health & Safety ◽

10.1177/2165079918812483 ◽

2019 ◽

Vol 67 (2) ◽

pp. 87-94 ◽

Cited By ~ 6

Author(s):

Kristin D. Ashley ◽

Loretta T. Lee ◽

Karen Heaton

Keyword(s):

Occupational Health ◽

Return To Work ◽

Quantitative Research ◽

Stroke Severity ◽

Stroke Survivors ◽

Factors Affecting ◽

Work And Employment ◽

Subsequent Failure

Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. A literature search was conducted using the keywords: “stroke,” “cerebrovascular disease,” “return to work,” and “employment.” After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

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Cognitive impairment is differentially associated with depression and anxiety at six-months post-stroke

10.1101/2020.09.24.20200972 ◽

2020 ◽

Author(s):

Owen A Williams ◽

Nele Demeyere

Keyword(s):

Cognitive Impairment ◽

Spatial Attention ◽

Depressive Symptomatology ◽

Depression Scale ◽

Anxiety Symptoms ◽

Cognitive Domain ◽

Stroke Severity ◽

Depression And Anxiety ◽

Post Stroke ◽

Post Stroke Depression

Objective: This study investigated 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 a subset of 437 stroke patients from the OCS-CARE study who were followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales. General cognitive impairment was assessed using the Montreal Cognitive Assessment and stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Multivariable linear regression was used to examine the associations between cognition and depression/anxiety symptoms, controlling for acute stroke severity and ADL impairment, age, sex, education, and co-occurring post-stroke depression/anxiety. Results: Six-month post-stroke depression 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 including 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), and praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety 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), but these associations did not remain significant after controlling for co-occurring post-stroke depression. Conclusion: The different profiles of associations between cognitive impairment and post-stroke depression and anxiety suggest that cognitive impairment is highly related to depressive symptomatology, but associations observed between cognitive impairment and anxiety may actually be the result of co-morbid post stroke depression.

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Abstract WP233: Unraveling the Profile and Risk Factors of Post-Stroke Cognitive Impairment Among West African Stroke Survivors: Data From the SIREN Study

Stroke ◽

10.1161/str.51.suppl_1.wp233 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Rufus Akinyemi ◽

Bruce Ovbiagele ◽

Onoja Akpa ◽

Fred Sarfo ◽

Joshua Akinyemi ◽

...

Keyword(s):

Risk Factors ◽

Cognitive Impairment ◽

Conditional Logistic Regression ◽

Leafy Vegetables ◽

Stroke Severity ◽

Stroke Survivors ◽

Community Screening ◽

Post Stroke ◽

Green Leafy Vegetables ◽

Education Network

Background: There is paucity of data on the epidemiology of post-stroke cognitive impairment among African stroke survivors. The aim of this study is to report the profile and risk factors of post- stroke cognitive impairment among stroke survivors participating in the Stroke Investigative Research and Education Network (SIREN) Study. Methods: 1566 were evaluated with the Montreal Cognitive Assessment (MoCA) tool, the Community Screening Instrument for Dementia (CSID) and the Stick Design Test three months after the index stroke. Domain scores were derived for executive function, language memory and visuo-constructive/visuospatial domains. Cut off scores were derived from normative cognitive data obtained from comparable healthy stroke-free control subjects. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: Of 1566 stroke survivors [mean age 57.7 (13.4) years] who were assessed 3 months after stroke, 37% were impaired in global cognition and 18-43% were impaired in different domains of cognition (executive, memory, language and visuo-constructive). Stroke severity measured by modified NIHSS score had a strong significant negative association with cognitive function in all domains OR 1.96(1.32-2.91). Older age 1.04 (1.02-2.05), male gender 0.69 (0.50 -0.96), low intake of green leafy vegetables 2.83 (2.03 -3.95) and cardiac disease 1.86 (1.31 -2.75) were associated with poorer cognitive performance in different cognitive domains. Conclusion: The frequency of post-stroke cognitive impairment was high among African stroke survivors three months after the ictus. Diet low in green leafy vegetables is a potentially modifiable risk factor for post-stroke cognitive impairment among West Africans.

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Why acute ischemic stroke patients in the United States use or do not use emergency medical services transport? Findings of an inpatient survey

BMC Health Services Research ◽

10.1186/s12913-019-4741-6 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Sudha Xirasagar ◽

Meng-han Tsai ◽

Khosrow Heidari ◽

James W. Hardin ◽

Yuqi Wu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Emergency Medical Services ◽

The United States ◽

Medical Services ◽

Stroke Severity ◽

Convenience Sample ◽

Post Stroke ◽

Emergency Medical ◽

Stroke Disability

Abstract Background Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS. Methods During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, knowledge of stroke and EMS importance, subjective reactions, role of bystanders and financial factors. Descriptive and multiple regression analyses were performed. Results Of 108 inpatients surveyed (out of 1179 AIS admissions), 49% were male, 44% African American, mean age 63.5 years, 59% mild strokes, 75 (69%) arrived by EMS, 33% were unaware of any stroke symptom prior to stroke, and 75% were unaware of the importance of EMS use for good outcome. Significant factors that influenced EMS use decisions (identified by regression analysis adjusting for stroke severity) were: prior familiarity with stroke (self or family/friend with stroke) adjusted odds ratio, 5.0 (95% confidence interval, 1.6, 15.1), perceiving symptoms as relevant for self and indicating possible stroke, 26.3 (7.6, 91.1), and bystander discouragement to call 911, 0.1 (0.01,0.7). Further, all 27 patients who knew the importance of EMS had used EMS. All patients whose physician office advised actions other than calling EMS at symptom onset, did not use EMS. Conclusion Systematic stroke education of patients with stroke-relevant comorbidities and life-style risk factors, and public health educational programs may increase EMS use and mitigate post-stroke disability.

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