Current Perspectives in Post-stroke Cognitive Impairment

2013 ◽  
Vol 8 (2) ◽  
pp. 136 ◽  
Author(s):  
Antonio Federico ◽  
Alla Guekht ◽  
Michael Brainin ◽  
◽  
◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Stroke Rehabilitation ◽  
Capillary Flow ◽  
Significant Proportion ◽  
Conclusive Evidence ◽  
Mixed Dementia ◽  
Long Term Outcomes ◽  
Post Stroke ◽  
Medical Need

Post-stroke cognitive impairment (PSCI) is a particularly serious consequence of cerebral ischaemia and often inhibits or retards patient rehabilitation. Current treatments do not improve long-term outcomes for a significant proportion of patients and remain a substantially unmet medical need. Initiatives to address the challenge of post-stroke rehabilitation have included therapies that modify multiple pathogenetic mechanisms and provide protection to neural networks and facilitate their regeneration. Promising biological agents have been tested, but few have so far yielded clinically conclusive evidence further emphasising the shortage of therapies available to treat this disease. The multimolecular agent Actovegin® has been shown to stimulate capillary flow and neurometabolism after stroke and to provide promising results in the treatment of mixed dementia. Clinical trials are now in progress to fully evaluate this pleiotropic neurometabolic therapy.

Abstract WP141: Identifying Modifiable Predictors of Long-term Functional Outcome After Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Arunima Kapoor ◽  
Richard Swartz ◽  
Krista Lanctot ◽  
Mark Bayley ◽  
Alex Kiss
Keyword(s):  
Cognitive Impairment ◽  
Sleep Apnea ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Post Stroke ◽  
Baseline Visit ◽  
Modifiable Factors

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.

Cerebrovascular and Neurodegenerative Pathologies in Long-Term Stable Mild Cognitive Impairment

2021 ◽  
pp. 1-15
Author(s):  
Manu J. Sharma ◽  
Brandy L. Callahan
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cerebral Amyloid Angiopathy ◽  
Neurofibrillary Tangles ◽  
Small Vessel Disease ◽  
Significant Proportion ◽  
Amyloid Angiopathy ◽  
Prodromal Phase ◽  
Cerebral Amyloid

Background: Mild cognitive impairment (MCI) is considered by some to be a prodromal phase of a progressive disease (i.e., neurodegeneration) resulting in dementia; however, a substantial portion of individuals (ranging from 5–30%) remain cognitively stable over the long term (sMCI). The etiology of sMCI is unclear but may be linked to cerebrovascular disease (CVD), as evidence from longitudinal studies suggest a significant proportion of individuals with vasculopathy remain stable over time. Objective: To quantify the presence of neurodegenerative and vascular pathologies in individuals with long-term (>5-year) sMCI, in a preliminary test of the hypothesis that CVD may be a contributor to non-degenerative cognitive impairment. We expect frequent vasculopathy at autopsy in sMCI relative to neurodegenerative disease, and relative to individuals who convert to dementia. Methods: In this retrospective study, using data from the National Alzheimer’s Coordinating Center, individuals with sMCI (n = 28) were compared to those with MCI who declined over a 5 to 9-year period (dMCI; n = 139) on measures of neurodegenerative pathology (i.e., Aβ plaques, neurofibrillary tangles, TDP-43, and cerebral amyloid angiopathy) and CVD (infarcts, lacunes, microinfarcts, hemorrhages, and microbleeds). Results: Alzheimer’s disease pathology (Aβ plaques, neurofibrillary tangles, and cerebral amyloid angiopathy) was significantly higher in the dMCI group than the sMCI group. Microinfarcts were the only vasculopathy associated with group membership; these were more frequent in sMCI. Conclusion: The most frequent neuropathology in this sample of long-term sMCI was microinfarcts, tentatively suggesting that silent small vessel disease may characterize non-worsening cognitive impairment.

P1920Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation: A single-center large-scale study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
U Canpolat ◽  
D Kocyigit ◽  
M U Yalcin ◽  
C Coteli ◽  
Y Z Sener ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Large Scale ◽  
Second Generation ◽  
Significant Proportion ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Free Survival

Abstract Background Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exists about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective: We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic AF population at our tertiary referral center. Methods In this non-randomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa) free survival was defined as absence of AF, atrial flutter or atrial tachycardia recurrence >30 s following 3-months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9±9.2 and 12.1±2.6, respectively. At median 39 (IQR: 26–56) months follow-up, ATa free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs 102/141 [72.3%] for persistent AF, p=0.019) and 84.4% after a mean 1.48±0.42 ablations.Cox regression analysis showed that left atrium diameter, duration of AF history and early ATa recurrence were found as the independent predictors of late recurrence. PNP was observed in 17 (3.5%) patients. Figure 1 Conclusions Second-generation CB based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and early persistent AF patients with an acceptable complication rates at long-term follow-up.

scholarly journals Treatment Capacity and Clinical Outcomes for Patients With Schizophrenia Who Were Treated With Electroconvulsive Therapy: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Joanne E Plahouras ◽  
Gerasimos Konstantinou ◽  
Tyler S Kaster ◽  
Daniel Z Buchman ◽  
George Foussias ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Treatment Response ◽  
Clinical Outcomes ◽  
Electroconvulsive Therapy ◽  
Psychiatric Treatment ◽  
Long Term Outcomes ◽  
Readmission Rates ◽  
Consent To Treatment ◽  
Maintenance Ect

Abstract Background Patients with schizophrenia are often found incapable to consent to psychiatric treatment. We evaluated clinical outcomes for incapable and capable patients with schizophrenia treated with electroconvulsive therapy (ECT). Methods We conducted a chart review of all inpatients treated with an acute course of ECT between 2010 and 2018 at the Centre for Addiction and Mental Health, Toronto, Canada. Short-term outcomes included treatment response and cognitive impairment. We assessed whether incapable patients regained the capacity to consent to treatment. Long-term outcomes included readmissions and subsequent courses of acute or maintenance ECT. Results A total of 159 (67%) incapable and 79 (33%) capable patients were included. Patients experienced treatment response (incapable, n = 108, 67.9%; capable, n = 52, 65.8%; P = .771) and few experienced cognitive impairment (incapable, n = 21, 13.2%; capable, n = 19, 24.1%; P = .043). A minority of patients were treated with a subsequent course of acute ECT (incapable, n = 46, 28.9%; capable, n = 16, 20.3%; P = .162). Incapable patients were more likely to be treated with maintenance ECT for at least 6 months (incapable, n = 46, 28.9%; capable, n = 13, 16.5%; P = .039). Both groups had similar readmission rates (incapable, n = 70, 44.0%; capable, n = 35, 44.3%; P = 1.000). Eight (5.0%) incapable patients regained capacity and 7 consented to further treatment. Conclusions Irrespective of treatment capacity, the majority of patients demonstrated clinical improvement. Incapable patients experienced less cognitive side effects when compared with capable patients, though they had fewer treatments overall. This study informs clinicians, patients, and substitute decision-makers about the outcomes and challenges of ECT in patients with schizophrenia.

scholarly journals Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke

2020 ◽  
Vol 3 ◽  
pp. 28 ◽  
Author(s):  
Jefrey Shumba ◽  
Affraic McLoughlin ◽  
Lamorna Browne ◽  
Alenka Schmid ◽  
Maev-Ann Wren ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Functional Impairment ◽  
Odds Ratio ◽  
Long Term Care ◽  
Meta Analysis ◽  
Standard Form ◽  
Term Care ◽  
Post Stroke

Introduction: Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC. Patients and methods: PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic. Results: 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%]. Discussion and conclusion: Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.

scholarly journals A Systematic Review of the Clinical Use of Gabapentin and Pregabalin in Bipolar Disorder

2021 ◽  
Vol 14 (9) ◽  
pp. 834
Author(s):  
Qin Xiang Ng ◽  
Ming Xuan Han ◽  
Seth En Teoh ◽  
Clyve Yu Leon Yaow ◽  
Yu Liang Lim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bipolar Disorder ◽  
Significant Proportion ◽  
Evidence Base ◽  
Small Sample ◽  
Long Term Outcomes ◽  
Open Label ◽  
Related Drug ◽  
Small Sample Sizes

Despite its prevalence and disease burden, several chasms still exist with regard to the pharmacotherapy of bipolar disorder (BD). Polypharmacy is commonly encountered as a significant proportion of patients remain symptomatic, and the management of the depressive phase of the illness is a particular challenge. Gabapentin and pregabalin have often been prescribed off-label in spite of a paucity of evidence and clinical practice guidelines to support its use. This systematic review aimed to synthesize the available human clinical trials and inform evidence-based pharmacological approaches to BD management. A total of six randomized, controlled trials (RCTs) and 13 open-label trials involving the use of gabapentin and pregabalin in BD patients were reviewed. Overall, the studies show that gabapentin and its related drug pregabalin do not have significant clinical efficacy as either monotherapy or adjunctive therapy for BD. Gabapentin and pregabalin are probably ineffective for acute mania based on the findings of RCT, with only small open-label trials to support its potential adjunctive role. However, its effects on the long-term outcomes of BD remain to be elucidated. The evidence base was significantly limited by the generally small sample sizes and the trials also had heterogeneous designs and generally high risk of bias.

scholarly journals Cerebellar culmen-substantia nigra tract assisted rehabilitation post stroke: a case report

2022 ◽  
Vol 2 (1) ◽  
pp. 24-28
Author(s):  
哲朗 石田 ◽  
Murayama Tomonori
Keyword(s):  
Computed Tomography ◽  
Cognitive Impairment ◽  
Case Report ◽  
Substantia Nigra ◽  
Temporal Lobe ◽  
Stroke Rehabilitation ◽  
Rare Case ◽  
Low Density ◽  
Post Stroke

An 88-year-old right-handed man was admitted to our hospital for cognitive impairment and right-sided paralysis. His head non-contrast computed tomography (CT) showed large low-density areas (LDA) and fibrous structures in the left occipital and temporal lobe regions. Despite the fact that it had been more than 10 years since his stroke, rehabilitation was effective. This is a rare case in which cerebellar culmen -substantia nigra tract assisted rehabilitation after stroke.

scholarly journals Neurotropic effects of respiratory viral infections: mental and neuropsychological aspects

2021 ◽  
Vol 17 (6) ◽  
pp. 496-502
Author(s):  
A.A. Shuprovich
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Performance ◽  
Viral Infections ◽  
Psychiatric Symptoms ◽  
Significant Proportion ◽  
The Body ◽  
Significant Heterogeneity ◽  
Attention Performance ◽  
Respiratory Viral Infections

The review is devoted to the problem of neurological complications that result from respiratory viral infections due to viral invasion to the central and peripheral nervous systems. Psychoneurological consequences after the disease of COVID-19 are considered separately. Viral pathogens can enter the central nervous system (CNS) in various ways, including through hematogenous infection of the endothelium (the “Trojan horse” mechanism) as well as through peripheral nerves or olfactory sensory neurons. The latter route is mostly used by respiratory viruses, such as coronaviruses (CoV), which enter the body intranasally because the olfactory nerve connects the nasal epithelium with the olfactory bulb — the way to the CNS. CoV in the human brain can cause long-term effects associated with the development or exacerbation of chronic neurological diseases, such as multiple sclerosis. Coronavirus COVID-19, which causes coronavirus disease, can provoke long-term outcomes after recovery, such as psychiatric symptoms and cognitive impairment, which are detected by cognitive screening. In the post-COVID period, patients demonstrated poor cognitive performance in the areas of attention, performance, and memory as well as increased levels of depression, anxiety, post-traumatic stress, fatigue, and sleep disturbances. These effects should be considered as possible post-viral disorders that require special diagnosis and appropriate treatment. Significant heterogeneity of applied approaches and methods hinders the comprehensive characterization of cognitive functions in specific areas since the studies often excluded people with previous cognitive impairment. Nevertheless, most studies indicate some degree of cognitive impairment in patients with COVID-19. Although the rates vary, a significant proportion of survivors show poor cognitive performance in the areas of attention, performance, and memory. These results have several important implications for further research, clinical management, and treatment of those who have experienced COVID-19.

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