Percutaneous Mastoid Electrical Stimulator improves poststroke depression and cognitive function in patients with ischemic stroke

Abstract Backgrond Poststroke depression could lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of percutaneous mastoid electrical stimulator (PMES) plus antidepressant on poststroke depression and cognitive function.Methods 258 clinically depressed ischemic stroke patients within 14 d of index stroke were randomly assigned to PMES plus antidepressant (PMES group) and sham plus antidepressant (sham group). All patients underwent Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months after the stroke. The clinical outcome was defined as treatment response (≥50% reduction in HRSD) and depression remission (HRSD≤9) at 6 months.Results Compared with the sham group, PEMS group significantly improved MoCA and HRSD scoreat the end of the 6-month treatment period (P<0.001). The mean value of MoCA score change (3.50±2.55 vs 2.72±2.52; P=0.005), and HRSD score change (-11.93 ±5.32 vs -10.48 ± 6.10, P = 0.041) was significantly greater in the PMES group compared to sham group at 6 months. In fully adjusted models, PMES plus antidepressant was associated with increased treatment response rate [adjusted odds ratio (OR), 2.04; 95% confidence interval (CI), 1.15-3.63; P=0.015], and depression remission rate [adjusted OR, 1.83; 95% CI, 1.05-3.18; P=0.032]. In fully adjust models, PMES plus antidepressant was associated with decreased risk of 6-month MoCA score <26 (adjusted OR, 0.25; 95%CI, 0.09–0.70; P=0.008).Conclusion These findings demonstrate that PMES adjunctive to antidepressant therapy is highly effective in reducing depression, achieving remission in the short term, and improving cognition.

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Percutaneous Mastoid Electrical Stimulator Improves Poststroke Depression and Cognitive F unction in Patients with Ischaemic Stroke: A Prospective, Randomized, Double-blind, and Sham-controlled Study

10.21203/rs.2.17451/v4 ◽

2020 ◽

Author(s):

Taoli Lu ◽

Lanying He ◽

Bei Zhang ◽

Jian Wang ◽

Lili Zhang ◽

...

Keyword(s):

Ischaemic Stroke ◽

Sham Group ◽

Mean Value ◽

Controlled Study ◽

Poststroke Depression ◽

Score Change ◽

Double Blind ◽

The Mean ◽

Electrical Stimulator ◽

Moca Score

Abstract Background : Poststroke depression can lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of a percutaneous mastoid electrical stimulator (PMES) plus antidepressants on poststroke depression and cognitive function. Methods: This study was a prospective, randomized, double-blind, and sham-controlled study . A total of 258 clinically depressed ischaemic stroke patients within 14 days of index stroke were randomly assigned to the PMES plus antidepressant (PMES group, N=125) and sham plus antidepressant (sham group, N=133) groups. All patients underwent the Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months(M6) after ischaemic stroke. Primary outcomes were the percentage of patients showing a treatment response (≥50% reduction in HRSD score) and depression remission (HRSD score≤9) at 6 months. The secondary outcome was the percentage of patients with a MoCA score <26 . Results: The percentages of patients showing a treatment response and depression remission were significantly higher in the PMES group than in the sham group (57.60% vs 41.35%, P=0.009; 44.00% vs 29.32%, P=0.014 respectively). The mean value of the HRSD score change [M(month)6-baseline] was significantly higher in the PMES group than in the sham group at 6 months (-11.93 ±5.32 vs -10.48 ± 6.10, P = 0.036, respectively). The percentage of patients with MoCA scores <26 was lower in the PEMS group than in the sham group(12.0% vs 24.06%, P=0.012,respectively), and the mean value of the MoCA score change (M6-baseline) was higher in the PMES group than in the sham group (3.50±2.55 vs 2.72±2.52, P=0.005,respectively). Conclusion: These findings demonstrate that PMES adjunctive to antidepressant therapy is effective in reducing depression, achieving remission in the short term, and improving cognition. Trial registration: This trial was retrospectively registered (registration number: ChiCTR1800016463) on 03 June 2018

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Percutaneous Mastoid Electrical Stimulator improves poststroke depression and cognitive function in patients with ischemic stroke:A Prospective, Randomized, Double-blind, and Sham-controlled Study

10.21203/rs.2.17451/v3 ◽

2020 ◽

Author(s):

Taoli Lu ◽

lanying he ◽

Bei Zhang ◽

Jian Wang ◽

Lili Zhang ◽

...

Keyword(s):

Cognitive Function ◽

Sham Group ◽

Mean Value ◽

Controlled Study ◽

Poststroke Depression ◽

Score Change ◽

Double Blind ◽

The Mean ◽

Electrical Stimulator ◽

Moca Score

Abstract Backgrond : Poststroke depression could lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of percutaneous mastoid electrical stimulator (PMES) plus antidepressant on poststroke depression and cognitive function. Methods: This study was a prospective, randomized, double-blind, and sham-controlled study . 258 clinically depressed ischemic stroke patients within 14 d of index stroke were randomly assigned to PMES plus antidepressant (PMES group, N=125) and sham plus antidepressant (sham group, N=133). All patients underwent Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months after the stroke. Primary outcomes were the percentage of treatment response (≥50% reduction in HRSD score) and depression remission (HRSD score≤9) at 6 months. Secondary outcome was the percentage of MoCA score <26. Results: The percentage of treatment response and depression remission in PMES group were significantly higher than that in the sham group (57.60% vs 41.35%, P=0.009), (44.00% vs 29.32%, P=0.014), respectively. The mean value of HRSD score change(M6-baseline) was significantly greater in the PMES group compared to sham group at 6 months (-11.93 ±5.32 vs -10.48 ± 6.10, P = 0.036). The percentage MoCA score <26 in PEMS group was lower than that in sham group(12.0% vs 24.06%, P=0.012), the mean value of MoCA score change (M6-baseline) was higher in PMES group compared to sham group (3.50±2.55 vs 2.72±2.52; P=0.005). Conclusion: These findings demonstrate that PMES adjunctive to antidepressant therapy is effective in reducing depression, achieving remission in the short term, and improving cognition. Trial registration: This trial was retrospectively registered (registration number: ChiCTR1800016463) on 03 June 2018

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Percutaneous Mastoid Electrical Stimulator improves poststroke depression and cognitive function in patients with ischemic stroke:A Prospective, Randomized, Double-blind, and Sham-controlled Study

10.21203/rs.2.17451/v2 ◽

2020 ◽

Author(s):

Taoli Lu ◽

Lanying He ◽

Bei Zhang ◽

Jian Wang ◽

Lili Zhang ◽

...

Keyword(s):

Cognitive Function ◽

Sham Group ◽

Mean Value ◽

Controlled Study ◽

Poststroke Depression ◽

Score Change ◽

Double Blind ◽

The Mean ◽

Electrical Stimulator ◽

Moca Score

Abstract Backgrond: Poststroke depression could lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of percutaneous mastoid electrical stimulator (PMES) plus antidepressant on poststroke depression and cognitive function. Methods: This study was a prospective, randomized, double-blind, and sham-controlled study. 258 clinically depressed ischemic stroke patients within 14 d of index stroke were randomly assigned to PMES plus antidepressant (PMES group, N=125) and sham plus antidepressant (sham group, N=133). All patients underwent Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months after the stroke. Primary outcomes were the percentage of treatment response (≥50% reduction in HRSD score) and depression remission (HRSD score≤9) at 6 months. Secondary outcome was the percentage of MoCA score <26. Results: The percentage of treatment response and depression remission in PMES group were significantly higher than that in the sham group (57.60% vs 41.35%, P=0.009), (44.00% vs 29.32%, P=0.014), respectively. The mean value of HRSD score change(M6-baseline) was significantly greater in the PMES group compared to sham group at 6 months (-11.93 ±5.32 vs -10.48 ± 6.10, P = 0.036). The percentage MoCA score <26 in PEMS group was lower than that in sham group(12.0% vs 24.06%, P=0.012), the mean value of MoCA score change (M6-baseline) was higher in PMES group compared to sham group (3.50±2.55 vs 2.72±2.52; P=0.005). Conclusion: These findings demonstrate that PMES adjunctive to antidepressant therapy is effective in reducing depression, achieving remission in the short term, and improving cognition. Trial registration: This trial was retrospectively registered (registration number: ChiCTR1800016463) on 03 June 2018

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A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy

Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie ◽

10.1024/1422-4917/a000211 ◽

2013 ◽

Vol 41 (1) ◽

pp. 69-74 ◽

Cited By ~ 10

Author(s):

Frank Häßler ◽

Olaf Reis ◽

Steffen Weirich ◽

Jacqueline Höppner ◽

Birgit Pohl ◽

...

Keyword(s):

Case Report ◽

Treatment Response ◽

Electroconvulsive Therapy ◽

Rating Scale ◽

Combined Treatment ◽

Adolescent Patient

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

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Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

Current Neurovascular Research ◽

10.2174/1567202617666200521083132 ◽

2020 ◽

Vol 17 (4) ◽

pp. 361-375

Author(s):

Victor C. Schulz ◽

Pedro S.C. de Magalhaes ◽

Camila C. Carneiro ◽

Julia I.T. da Silva ◽

Vivian N. Silva ◽

...

Keyword(s):

Ischemic Stroke ◽

Real World ◽

Time Window ◽

Functional Dependence ◽

Developed Countries ◽

First Year ◽

Middle Income ◽

Probability Of Survival ◽

Stroke Center ◽

Cerebral Reperfusion

Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.

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Depression treatment response to ketamine: sex-specific role of interleukin-8, but not other inflammatory markers

Translational Psychiatry ◽

10.1038/s41398-021-01268-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jennifer L. Kruse ◽

Megha M. Vasavada ◽

Richard Olmstead ◽

Gerhard Hellemann ◽

Benjamin Wade ◽

...

Keyword(s):

Treatment Response ◽

Inflammatory Markers ◽

Rating Scale ◽

Antidepressant Medication ◽

Post Treatment ◽

Therapeutic Modality ◽

Depression Treatment ◽

Open Label ◽

Time Interaction ◽

Baseline Levels

AbstractInflammation plays a role in depression pathophysiology and treatment response, with effects varying by sex and therapeutic modality. Lower levels of interleukin(IL)-8 predict depression response to antidepressant medication and to electroconvulsive therapy (ECT), although ECT effects are specific to females. Whether IL-8 predicts depression response to ketamine and in a sex-specific manner is not known. Here, depressed patients (n = 46; female, n = 17) received open label infusion of ketamine (0.5 mg/kg over 40 min; NCT02165449). Plasma levels of IL-8 were evaluated at baseline and post-treatment. Baseline levels of IL-8 had a trending association with response to ketamine, depending upon sex (responder status × sex interaction: p = 0.096), in which lower baseline levels of IL-8 in females (p = 0.095) but not males (p = 0.96) trended with treatment response. Change in levels of IL-8 from baseline to post-treatment differed significantly by responder status (defined as ≥50% reduction in Hamilton Depression Rating Scale [HAM-D] Score), depending upon sex (responder status × sex × time interaction: F(1,42)=6.68, p = 0.01). In addition, change in IL-8 interacted with sex to predict change in HAM-D score (β = -0.63, p = 0.003); increasing IL-8 was associated with decreasing HAM-D score in females (p = 0.08) whereas the inverse was found in males (p = 0.02). Other inflammatory markers (IL-6, IL-10, tumor necrosis factor-α, C-reactive protein) were explored with no significant relationships identified. Given these preliminary findings, further evaluation of sex differences in the relationship between IL-8 and treatment response is warranted to elucidate mechanisms of response and aid in the development of personalized approaches to depression treatment.

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EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

International Journal of Stroke ◽

10.1177/17474930211026519 ◽

2021 ◽

pp. 174749302110265

Author(s):

Moamina Ismail ◽

Vincent CT Mok ◽

Adrian Wong ◽

Lisa Au ◽

Brian Yiu ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Ischemic Stroke ◽

Recurrent Stroke ◽

Early Onset Dementia ◽

Delayed Onset ◽

Lower Baseline ◽

History Of ◽

Ischemic Attack ◽

Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEÎµ4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of â¥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEÎµ4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of â¥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

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Abstract TMP46: Is There an Effect of Statins on Ischemic Stroke Functional Outcomes in the Oldest Old?

Stroke ◽

10.1161/str.48.suppl_1.tmp46 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Matthew Alcusky ◽

Anne L Hume ◽

Kate L Lapane

Keyword(s):

Ischemic Stroke ◽

Functional Status ◽

Functional Outcomes ◽

Acute Treatment ◽

Functional Dependence ◽

Oldest Old ◽

Health Benefit ◽

Neuroprotective Effects ◽

Data Set ◽

Statin Use

Background: The net health benefit of statin use in the oldest patients remains controversial. Preclinical models and previous clinical studies have suggested statins may exhibit neuroprotective effects in stroke, however evidence in the very old remains limited. Our objective was to compare changes in functional status before and after acute ischemic stroke (AIS) between statin users and non-users in a national cohort. Methods: A patient’s first hospitalization for AIS from 04/01/11 to 12/31/2012 was selected from Medicare Part A claims. Patients with a pre-hospitalization nursing home Minimum Data Set assessment and a post-hospitalization assessment in a skilled nursing facility were included. Pre-stroke statin exposure was defined using Part D claims. Functional status was measured continuously and categorically (dependent:<20, partially dependent(PD):20-59, assisted independent(AI):60-100) using Shah’s modified Barthel Index (mBI). Multivariable logistic regression examined the association of statins with a minimum clinically important mBI decrease of 10 points among non-dependent patients. Results: Among 10,203 patients with an assessment before hospitalization, 7.2% died, and 48.7% were included (mean age: 83.6±9.6; 74.5% women). Statin use was common (36.5%), while acute treatment was infrequent (thrombolysis: 4.9%; thrombectomy: 0.1%). The distribution of functional dependence, PD, and AI shifted from 17.3%, 56.1%, and 26.7% at baseline to 49.7%, 44.4%, and 5.9% post-stroke, respectively. A consistent association with 10-point mBI decline was observed for statin exposure among all non-dependent (OR: 0.8; 95%CI: 0.7-1.0) and within strata of PD (OR:0.8; 95%CI: 0.7-1.0) and AI patients (OR: 0.8; 95%CI: 0.5-1.3). In contrast, acute treatment was more strongly associated with function in AI (OR: 0.5; 95%CI: 0.2-1.0) versus PD patients (OR: 1.0; 95%CI: 0.7-1.5). Conclusion: In this high-burden population, our results are suggestive of a possible protective association for pre-stroke statin exposure. Further research is needed to examine temporal and dose-response relationships between statin exposure and functional outcomes across diverse patient populations.

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Dance Rhythms Improve Motor Symptoms in Individuals with Parkinson’s Disease: A Randomized Clinical Trial

Journal of Dance Medicine & Science ◽

10.12678/1089-313x.031522a ◽

2021 ◽

Author(s):

Jéssica A. Moratelli ◽

Kettlyn H. Alexandre ◽

Leonessa Boing ◽

Alessandra Swarowsky ◽

Clynton L. Corrêa ◽

...

Keyword(s):

Parkinson’S Disease ◽

Clinical Trial ◽

Parkinson's Disease ◽

Randomized Clinical Trial ◽

Rating Scale ◽

Freezing Of Gait ◽

Motor Symptoms ◽

Score Change ◽

Significant Difference ◽

Binary Group

Background: Evidence-based practices involving dance modalities found in binary (two-beat rhythm) or quaternary (four-beat rhythm) show that dance positively influences the motor aspects of disease.Aim: This randomized clinical trial aimed to analyze the effect of two dance rhythm (binary and quaternary) on the balance, gait, and mobility in individuals with Parkinson’s disease (PD). Methods: Thirty-one individuals with PD were randomized into the binary group (n = 18) and the quaternary group (n = 13). Both groups participated in different dance rhythms lasting 12 weeks, twice a week, for 45 minutes. Results: The binary group showed a significant difference in balance (p = 0.003), freezing of gait (p = 0.007), as well as in the motor aspects of MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), with emphasis on the total values with a score change of 3.23. In the quaternary group, significant differences were found in balance (p = 0.021) with a score change of -2.54 and in the motor aspects of the MDS-UPDRS Part III where the total values stood out with a change of 3.54. Discussion: When comparing the possible effects of binary and quaternary rhythms on the motor symptoms of individuals with PD, it was demonstrated that binary rhythm improved balance, freezing gait, and UPDRSIII. As for the quaternary rhythm, the benefits were in balance and the UPDRSIII. Conclusion: The binary and the quaternary rhythm dance protocols positively influenced the motor symptoms of individuals with PD after 12 weeks of intervention.

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Assessment of mature serum brain-derived neurotrophic factor (BDNF) is not superior to total serum BDNF in prediction of antidepressant treatment outcome

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1480 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S410-S410 ◽

Cited By ~ 1

Author(s):

A. Eckert ◽

T. Mikoteit ◽

J. Beck ◽

U.M. Hemmeter ◽

S. Brand ◽

...

Keyword(s):

Treatment Outcome ◽

Treatment Response ◽

Rating Scale ◽

Antidepressant Treatment ◽

Serum Levels ◽

Total Serum ◽

Enzyme Linked Immunosorbent Assay ◽

Functional Link ◽

Neurotrophic Activity ◽

Serum Bdnf

BackgroundSerum BDNF levels are decreased in major depressive disorder (MDD) and tend to normalize under antidepressant treatment, serving as a treatment outcome predictor. BDNF is initially synthetized as precursor protein proBDNF and is cleaved to mature BDNF (mBDNF) while only the latter exerts neurotrophic activity.AimThe aim was to explore if a specific enzyme-linked immunosorbent assay (ELISA) kit for mBDNF in serum would be superior to the unspecific assessment of total serum BDNF in predicting treatment response in MDD.MethodsTwenty-five patients with MDD underwent standardized treatment with duloxetine. Severity of depression was measured by Hamilton Depression Rating Scale (HDRS) at baseline (BL), after one (W1), two (W2) and six weeks (W6) of treatment. Treatment response was defined as a HDRS ≥ 50% reduction of BL score at W6. mBDNF and total BDNF serum levels were determined at BL, W1 and W2.ResultsA high and stable correlation was found between mBDNF and total BDNF serum levels over all measurements. The predictive value of mBDNF BL levels and mBDNFΔW1 to response was similar to that of total BDNF BL and total BDNFΔW1. The assessment of serum mBDNF was not superior to total BDNF in prediction of treatment outcome.ConclusionsNot only baseline total BDNF but also mBDNF is predictive to treatment outcome. The later might represent the main player in this respect, which supports the idea of a functional link between neuroplasticity and MDD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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