Relationship between Comorbid Cognitive Impairment and Functional Outcomes in Stroke Patients with Spatial Neglect

Introduction: Disability is often an assumed and accepted consequence of stroke. Post-stroke disability is frequently attributed to demographic risk factors such as age and stroke severity. These factors cannot explain all the variability in stroke outcomes. Other factors, such as post-stroke depression, sleep apnea and cognitive impairment can impact function, and yet their relationships to long-term outcomes are rarely assessed. The primary purpose of our research is to understand the role of these potentially modifiable factors in predicting long-term post-stroke functional outcomes. Hypothesis: Stroke patients who screen positive for depression, sleep apnea or cognitive impairment at baseline will have significantly worse long-term functional outcome. Methods: A follow up outcome assessment of stroke patients is being conducted by telephone 2-3 years after an initial baseline visit where their risk of depression, sleep apnea and cognitive impairment was assessed. Baseline predictors such as age and stroke severity are also abstracted from their baseline visit. Assessment measures were selected to evaluate numerous levels of human functioning and include the following: modified Rankin Scale, MoCA, Barthel Index, Frenchay Activites Index and Reintegration to Normal Living Index. The primary outcome is mRS Score, with a score ≥ 2 indicating poor outcome. Results: Seventy six patients have been enrolled in our study and projected enrolled of another 100 patients should be complete by December 2015. Based on preliminary data, our prognostic logistic regression model including only stroke severity and age is statistically significant, χ2(2)= 29.06, p < 0.001. This model explains 42.7% (Nagelkerke R2) of the variance in long-term outcomes and correctly classifies outcome in 78.9% of patients. Future analyses with the full sample size and addition of potentially modifiable factors will verify whether these factors increase the predictive value of our prognostic model. Conclusion: By identifying modifiable factors related to poor functional outcomes, this study may allow the development of novel interventions to alter the trajectory of this vulnerable population to help optimize long-term function after stroke.

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Association Between Early Cognitive Impairment and Midterm Functional Outcomes Among Chinese Acute Ischemic Stroke Patients: A Longitudinal Study

Frontiers in Neurology ◽

10.3389/fneur.2020.00020 ◽

2020 ◽

Vol 11 ◽

Cited By ~ 2

Author(s):

Juan Li ◽

Jing Wang ◽

Bei Wu ◽

Hanzhang Xu ◽

Xiongfeng Wu ◽

...

Keyword(s):

Ischemic Stroke ◽

Cognitive Impairment ◽

Longitudinal Study ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Stroke Patients

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Translation Research for the Rehabilitation of Left Spatial Neglect and Associated Disorders of Attention in Stroke Patients

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld18.2.55 ◽

2008 ◽

Vol 18 (2) ◽

pp. 55-65 ◽

Cited By ~ 2

Author(s):

Nkiruka Arene ◽

Argye E. Hillis

Keyword(s):

Theoretical Basis ◽

Attention Bias ◽

Spatial Neglect ◽

Clinical Use ◽

Stroke Patients ◽

Translation Research ◽

Unilateral Neglect ◽

Assessment And Treatment ◽

Sound Theoretical Basis ◽

Review Current

Abstract The syndrome of unilateral neglect, typified by a lateralized attention bias and neglect of contralateral space, is an important cause of morbidity and disability after a stroke. In this review, we discuss the challenges that face researchers attempting to elucidate the mechanisms and effectiveness of rehabilitation treatments. The neglect syndrome is a heterogeneous disorder, and it is not clear which of its symptoms cause ongoing disability. We review current methods of neglect assessment and propose logical approaches to selecting treatments, while acknowledging that further study is still needed before some of these approaches can be translated into routine clinical use. We conclude with systems-level suggestions for hypothesis development that would hopefully form a sound theoretical basis for future approaches to the assessment and treatment of neglect.

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Transcranial Direct Current Stimulation (tDCS) Improves Functional Outcomes in Acute Stroke Patients

Case Medical Research ◽

10.31525/ct1-nct03888209 ◽

2019 ◽

Author(s):

Keyword(s):

Acute Stroke ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Functional Outcomes ◽

Stroke Patients ◽

Direct Current Stimulation

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Dietary interventions in mild cognitive impairment and dementia

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2019.21.1/niscarmeas ◽

2019 ◽

Vol 21 (1) ◽

pp. 69-82 ◽

Cited By ~ 3

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Functional Outcomes ◽

Clinical Utility ◽

Randomized Clinical Trials ◽

Dietary Intervention ◽

Nutritional Supplements ◽

Dietary Interventions ◽

Dietary Counseling ◽

Nutritional Elements

Dietary intervention is an enticing approach in the fight against cognitive impairment. Nutritional supplements and dietetic counseling are relatively easy and benign interventions, but research has not yet yielded irrefutable evidence as to their clinical utility. Heterogeneity in the results of available clinical studies, as well as methodological and practical issues, does not allow replication and generalization of findings. The paper at hand reviews only randomized clinical trials of single nutrients, multi-nutrient formulations and dietary counseling in mild cognitive impairment and dementia of the Alzheimer's type focusing on both cognitive and functional outcomes. Thus far, folate, vitamin E, Ω-3 fatty acids, and certain multi-nutrient formulations have shown some preliminary promising results; larger, well-designed trials are needed to confirm these findings before nutritional elements can be incorporated in recommended clinical guidelines.

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Faculty Opinions recommendation of Prism adaptation therapy enhances rehabilitation of stroke patients with unilateral spatial neglect: a randomized, controlled trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14267418.15779647 ◽

2012 ◽

Author(s):

Philippe Azouvi

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Prism Adaptation ◽

Spatial Neglect ◽

Stroke Patients ◽

Unilateral Spatial Neglect ◽

Randomized Controlled

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Prestroke statin use enhances collateralization in acute ischemic stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201012 ◽

2020 ◽

Vol 38 (4) ◽

pp. 311-321

Author(s):

Jiaying Zhu ◽

Mengmeng Ma ◽

Jinghuan Fang ◽

Jiajia Bao ◽

Shuju Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Statin Therapy ◽

Cerebral Artery ◽

Functional Outcomes ◽

Collateral Circulation ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Reviews in Clinical Gerontology ◽

10.1017/s0959259814000100 ◽

2014 ◽

Vol 24 (3) ◽

pp. 219-227 ◽

Cited By ~ 2

Author(s):

Francisco J Tarazona-Santabalbina ◽

Juan R Doménech-Pascual ◽

Ángel Belenguer-Varea A ◽

Eduardo Rovira Daudi

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Functional Recovery ◽

Functional Outcomes ◽

Older Patients ◽

Future Research ◽

Research Perspectives ◽

Increased Risk ◽

Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

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The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study

Neurorehabilitation ◽

10.3233/nre-210034 ◽

2021 ◽

pp. 1-9

Author(s):

Kyeong Joo Song ◽

Min Ho Chun ◽

Junekyung Lee ◽

Changmin Lee

Keyword(s):

Gait Speed ◽

Functional Outcomes ◽

Near Infrared ◽

Gait Training ◽

Berg Balance Scale ◽

Cortical Activation ◽

Control Group ◽

Stroke Patients ◽

Robot Assisted ◽

Functional Near Infrared Spectroscopy

OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI–Lower (P = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.

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