Association between Striatal Brain Iron Deposition, Microbleeds and Cognition 1 Year After a Minor Ischaemic Stroke

Brain iron deposits (IDs) are inversely associated with cognitive function in community-dwelling older people, but their association with cognition after ischemic stroke, and whether that differs from microbleeds, is unknown. We quantified basal ganglia IDs (BGID) and microbleeds (BMBs) semi-automatically on brain magnetic resonance images from patients with minor stroke (NIHSS < 7), at presentation and 12 months after stroke. We administered the National Adult Reading Test (NART, estimates premorbid or peak adult cognition) and the Revised Addenbrooke’s Cognitive Examination (ACE-R; current cognition) at 1 and 12 months after stroke. We adjusted analyses for baseline cognition, age, gender, white matter hyperintensity (WMH) volume and vascular risk factors. In 200 patients, mean age 65 years, striatal IDs and BMBs volumes did not change over the 12 months. Baseline BGID volumes correlated positively with NART scores at both times (ρ = 0.19, p < 0.01). Baseline and follow-up BGID volumes correlated positively with age (ρ = 0.248, p < 0.001 and ρ = 0.271, p < 0.001 respectively), but only baseline (and not follow-up) BMB volume correlated with age (ρ = 0.129, p < 0.05). Both smoking and baseline WMH burden predicted verbal fluency and visuospatial abilities scores (B = −1.13, p < 0.02 and B = −0.22, p = 0.001 respectively) at 12 months after stroke. BGIDs and BMBs are associated differently with cognition post-stroke; studies of imaging and post-stroke cognition should adjust for premorbid cognition. The positive correlation of BGID with NART may reflect the lower premorbid cognition in patients with stroke at younger vs older ages.

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Development and Evaluation of a Cognitive Behavioural Intervention for Chronic Post-Stroke Insomnia

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465818000061 ◽

2018 ◽

Vol 46 (6) ◽

pp. 641-660 ◽

Cited By ~ 7

Author(s):

Katie Herron ◽

Lorna Farquharson ◽

Abigail Wroe ◽

Annette Sterr

Keyword(s):

Sleep Onset ◽

Community Dwelling ◽

Post Treatment ◽

Dysfunctional Attitudes ◽

Future Research ◽

Behavioural Intervention ◽

Sleep Onset Latency ◽

Post Stroke ◽

Cognitive Behavioural

Background:Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice.Aims:The present study developed a ‘CBTI+’ protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke.Method:A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up.Results:At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep.Conclusions:This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.

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Stent-assisted coiling of cerebral aneurysms with the Neuroform Atlas stent

Interventional Neuroradiology ◽

10.1177/1591019917753710 ◽

2018 ◽

Vol 24 (3) ◽

pp. 263-269 ◽

Cited By ~ 25

Author(s):

Ferdi Cay ◽

Ahmet Peker ◽

Anıl Arat

Keyword(s):

Cerebral Aneurysms ◽

Minor Stroke ◽

Parent Artery ◽

Technical Success ◽

Technical Success Rate ◽

Patient Demographics ◽

Clinical Events ◽

Angular Change ◽

A Minor

Objectives The Neuroform Atlas stent (AS) is the smallest intracranial stent with an open-cell design. This study reports the first clinical experience with AS. Methods All intracranial aneurysms treated by stent-assisted coiling using a single AS in a single institution were retrospectively evaluated. Patient demographics, aneurysm characteristics, angles between the parent artery and stented branch, technical success, and clinical and angiographic follow-up were analyzed. Results Fifty-five consecutive aneurysms treated with AS-assisted coiling were included. Of these, 69.1% were located distal to the circle of Willis. Technical success rate was 100%. The mean diameters of proximal and distal parent arteries were 2.62 mm (range 1.5–4.4) and 1.8 mm (range 0.8–3.5), respectively. Except for a minor stroke in a patient who completely discontinued antiplatelet therapy on postoperative day 4, there were no clinical events with permanent sequelae, and 94.1% of patients had Raymond-Roy score of 1 or 2 aneurysmal occlusion at a mean follow-up duration of 7.9 months. Although the angle between the parent artery and the stented branch increased significantly ( p < 0.001) with time, the angular change at follow-up was only 16.45 ± 11.03 degrees and was inversely correlated both with preoperative angle and the diameter of the distal parent artery ( r = −0.465 and r = −0.433, respectively, p = 0.004 for both). Conclusion AS-assisted coiling was associated with a favorable early clinical outcome and angiographic results in this series. This stent can be used for distally located aneurysms and results in minimal alteration of the arterial anatomy.

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MR perfusion lesions after TIA or minor stroke are associated with new infarction at 7 days

Neurology ◽

10.1212/wnl.0000000000004039 ◽

2017 ◽

Vol 88 (24) ◽

pp. 2254-2259 ◽

Cited By ~ 11

Author(s):

Jun Lee ◽

Manabu Inoue ◽

Michael Mlynash ◽

Sharanpal K. Mann ◽

Carlo W. Cereda ◽

...

Keyword(s):

Brain Infarction ◽

Clinical Information ◽

Minor Stroke ◽

Ischemic Lesion ◽

Fluid Attenuated Inversion Recovery ◽

Abcd2 Score ◽

Revascularization Therapy ◽

A Minor ◽

The Relationship

Objective:To investigate the relationship between acute perfusion-weighted imaging (PWI) lesions occurring within the first hours after a TIA or a minor brain infarction (BI) and the incidence of new BI detected on a systematic MRI at 1 week.Methods:Consecutive patients who experienced a TIA or BI with a neurologic deficit that lasted <24 hours, did not receive any revascularization therapy (thrombolysis/thrombectomy), and underwent DWI/PWI at baseline and fluid-attenuated inversion recovery (FLAIR)/DWI 1 week after symptom onset were enrolled. Investigators blinded to clinical information independently assessed the presence of acute ischemic lesions on baseline DWI/PWI and follow-up DWI and FLAIR. Baseline and follow-up MRIs were then compared to determine the occurrence and location of new infarctions.Results:Sixty-four patients met the inclusion criteria. Median (IQR) ABCD2 score was 4 (3–5). Median delay from onset to baseline and follow-up MRI was 5 (2–10) hours and 6 (5–7) days, respectively. MRI revealed an acute ischemic lesion on DWI and/or PWI in 38 patients. Nine patients (14%) had a new infarction on follow-up MRI. Each had a PWI and 4 had a DWI lesion on baseline MRI. All new BIs except one were asymptomatic and in the same location as the acute PWI lesion.Conclusions:Our results showed that 30% of the acute focal PWI lesions detected after a TIA are associated with a new BI at 1 week. Those new BIs may result from the progression of the initial ischemic injury.

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Stability of Estimated Premorbid Cognitive Ability over Time after Minor Stroke and Its Relationship with Post-Stroke Cognitive Ability

Brain Sciences ◽

10.3390/brainsci9050117 ◽

2019 ◽

Vol 9 (5) ◽

pp. 117

Author(s):

Caroline A. McHutchison ◽

Francesca M. Chappell ◽

Stephen Makin ◽

Kirsten Shuler ◽

Joanna M. Wardlaw ◽

...

Keyword(s):

Cognitive Ability ◽

Cognitive Testing ◽

Minor Stroke ◽

Future Research ◽

Post Stroke ◽

Adult Reading ◽

The Stability ◽

National Adult Reading Test ◽

The Relationship ◽

Time Point

Considering premorbid or “peak” adult intelligence (IQ) is important when examining post-stroke cognition. The stability of estimated premorbid IQ and its relationship to current cognitive ability in stroke is unknown. We investigated changes in estimated premorbid IQ and current cognitive ability up to three years post-stroke. Minor stroke patients (NIHSS < 8) were assessed at one to three months, one and three years’ post-stroke. The National Adult Reading Test (NART) and Addenbrooke’s Cognitive Examination-Revised (ACE-R) were used to estimate premorbid IQ (NART IQ) and current cognitive ability respectively at each time-point. Baseline demographics, vascular and stroke characteristics were included. Of the 264 patients recruited (mean age 66), 158 (60%), 151 (57%), and 153 (58%) completed cognitive testing at each time-point respectively. NART IQ initially increased (mean difference (MD) = 1.32, 95% CI = 0.54 to 2.13, p < 0.001) before decreasing (MD = −4.269, 95% CI = −5.12 to −3.41, p < 0.001). ACE-R scores initially remained stable (MD = 0.29, 95% CI = −0.49 to 1.07, p > 0.05) before decreasing (MD = −1.05, 95% CI = −2.08 to −0.01, p < 0.05). Adjusting for baseline variables did not change the relationship between NART IQ and ACE-R with time. Increases in NART IQ were associated with more education. For ACE-R, older age was associated with declines, and higher NART IQ and more education was associated with increases. Across 3 years, we observed fluctuations in estimated premorbid IQ and minor changes in current cognitive ability. Future research should aim to identify variables associated with these changes. However, studies of post-stroke cognition should account for premorbid IQ.

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Neutrophil counts, neutrophil ratio, and new stroke in minor ischemic stroke or TIA

Neurology ◽

10.1212/wnl.0000000000005554 ◽

2018 ◽

Vol 90 (21) ◽

pp. e1870-e1878 ◽

Cited By ~ 11

Author(s):

Bihong Zhu ◽

Yuesong Pan ◽

Jing Jing ◽

Xia Meng ◽

Xingquan Zhao ◽

...

Keyword(s):

Ischemic Stroke ◽

Minor Stroke ◽

Minor Ischemic Stroke ◽

Cerebrovascular Events ◽

Increased Risk ◽

Risk Patients ◽

Composite Events ◽

A Minor ◽

Derived Data

ObjectiveEvidence about whether neutrophil counts or neutrophil ratio is associated with new stroke is scant. The aim of this study is to assess the association of neutrophil counts or neutrophil ratio with a new stroke in patients with minor stroke or TIA.MethodsWe derived data from the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events trial. Patients with a minor stroke or TIA were categorized into 4 groups according to the quartile of neutrophil counts or neutrophil ratio. The primary outcome was a new stroke (ischemic or hemorrhagic), and secondary outcomes included a new composite vascular event (stroke, myocardial infarction, or death resulting from cardiovascular causes) and ischemic stroke during the 90-day follow-up. We assessed the association between neutrophil counts, neutrophil ratio, and risk of new stroke.ResultsA total of 4,854 participants were enrolled, among whom 495 had new strokes at 90 days. Compared with the first quartile, the second, third, and fourth quartiles of neutrophil counts were associated with increased risk of new stroke (adjusted hazard ratio 1.40 [95% confidence interval (CI) 1.05–1.87], 1.55 [95% CI 1.17–2.05], and 1.69 [95% CI 1.28–2.23], respectively, p for trend <0.001). Similar results were observed for the endpoint of composite events and ischemic stroke. Parallel results were found for neutrophil ratio.ConclusionHigh levels of both neutrophil counts and neutrophil ratio were associated with an increased risk of new stroke, composite events, and ischemic stroke in patients with a minor ischemic stroke or TIA.

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Carotid Stenting for Severe Radiation-Induced Extracranial Carotid Artery Occlusive Disease

Journal of Endovascular Therapy ◽

10.1177/152660280000700106 ◽

2000 ◽

Vol 7 (1) ◽

pp. 36-40 ◽

Cited By ~ 40

Author(s):

Nadim Al-Mubarak ◽

Gary S. Roubin ◽

Sriram S. Iyer ◽

Camilo R. Gomez ◽

Ming W. Liu ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Stenting ◽

Occlusive Disease ◽

Minor Stroke ◽

Effective Treatment Option ◽

Extracranial Carotid Artery ◽

Radiation Induced ◽

The Mean ◽

A Minor

Purpose: To present our experience with carotid artery stenting as an alternative treatment to endarterectomy in patients with radiation-induced carotid artery occlusive disease. Methods and Results: Fourteen patients (10 males; mean age 61 years, range 52 to 79) underwent percutaneous stenting of 15 carotid arteries for severe radiation-induced extracranial stenoses. Technical success was achieved in all patients, with reduction of the mean stenosis from 77% ± 6% to 8% ± 2%. In 2 patients, ipsilateral vertebral artery lesions were stented concomitantly. One patient had a minor stroke after the procedure but recovered fully in 2 days. No other complications were encountered. Nine (64%) patients had 6-month follow-up imaging (angiography or duplex scanning) that showed no evidence of restenoses (obstruction ≥50%). At 18 ± 2 months, 3 (21%) patients had died from unrelated causes. No neurological events occurred, and no repeat carotid artery interventions were required in the remaining patients. Conclusions: Carotid stenting is an effective treatment option for severe radiation-induced carotid artery occlusive disease.

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Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors

Scientific Reports ◽

10.1038/s41598-019-52721-5 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Anna Carnes-Vendrell ◽

Joan Deus ◽

Jessica Molina-Seguin ◽

Josep Pifarré ◽

Francisco Purroy

Keyword(s):

Transient Ischemic Attack ◽

Rating Scale ◽

Previous History ◽

Minor Stroke ◽

Post Stroke ◽

Stroke Prevalence ◽

Post Stroke Depression ◽

History Of ◽

Ischemic Attack

Abstract Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.

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Corpus callosum size may predict late-life depression in women: A 10-year follow-up study

European Psychiatry ◽

10.1016/j.eurpsy.2014.09.332 ◽

2014 ◽

Vol 29 (S3) ◽

pp. 546-547

Author(s):

F. Cyprien ◽

P. Courtet ◽

P. Poulain ◽

J. Maller ◽

C. Meslin ◽

...

Keyword(s):

White Matter ◽

Corpus Callosum ◽

Elderly Women ◽

Late Life ◽

Magnetic Resonance Images ◽

Community Dwelling ◽

Cerebral White Matter ◽

Intracranial Volume ◽

Late Life Depression

BackgroundRecent research on late-life depression (LLD) pathophysiology suggests the implication of abnormalities in cerebral white matter [1] and particularly in interhemispheric transfer [2]. Corpus callosum (CC) is the main brain interhemispheric commissure [3]. Hence, we investigated the association between baseline CC measures and risk of LDD.MethodsWe studied 467 non-demented individuals without LLD at baseline from a cohort of community-dwelling people aged 80 years or younger (the ESPRIT study). LLD was assessed at year 2, 4, 7 and 10 of the study follow-up. At baseline, T1-weighted magnetic resonance images were manually traced to measure the mid-sagittal areas of the anterior, mid and posterior CC. Multivariate Cox proportional hazards models stratified by sex were used to predict LLD incidence over 10 years.ResultsA significant interaction between gender and CC size was found (P = 0.02). LLD incidence in elderly women, but not in men, was significantly associated with smaller anterior (HR 1.37 [1.05–1.79] P = 0.017), mid (HR 1.43 [1.09–1.86] P = 0.008), posterior (HR1.39 [1.12–1.74] P = 0.002) and total (HR 1.53 [1.16–2.00] P = 0.002) CC areas at baseline in Cox models adjusted for age, education, global cognitive impairment, ischemic pathologies, left-handedness, white matter lesion, intracranial volume and past depression.LimitationsThe main limitation was the retrospective assessment of major depression.ConclusionsSmaller CC size is a predictive factor of incident LLD over 10 years in elderly women. Our finding suggests a possible role of CC and reduced interhemispheric connectivity in LLD pathophysiology. Extensive explorations are needed to clarify the mechanisms leading to CC morphometric changes in mood disorders.

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Early Post-stroke Cognition: In-hospital Predictors and the Association With Functional Outcome

Frontiers in Neurology ◽

10.3389/fneur.2020.613607 ◽

2020 ◽

Vol 11 ◽

Author(s):

Richa Sharma ◽

Dania Mallick ◽

Rafael H. Llinas ◽

Elisabeth B. Marsh

Keyword(s):

Logistic Regression ◽

Cognitive Impairment ◽

Functional Status ◽

Critical Time ◽

Minor Stroke ◽

Post Stroke ◽

C Statistic ◽

The Relationship ◽

Moca Score

Purpose: To characterize and predict early post-stroke cognitive impairment by describing cognitive changes in stroke patients 4–8 weeks post-infarct, determining the relationship between cognitive ability and functional status at this early time point, and identifying the in-hospital risk factors associated with early dysfunction.Materials and Methods: Data were collected for 214 patients with ischemic stroke and 39 non-stroke controls. Montreal Cognitive Assessment (MoCA) exams were administered at post-hospitalization clinic visits approximately 4–8 weeks after infarct. MoCA scores were compared for patients with: no stroke, minor stroke [NIH Stroke Scale (NIHSS) < 5], and major stroke. Ordinal logistic regression was performed to assess the relationship between MoCA score and functional status [modified Rankin Scale score (mRS)] at follow-up. Predictors of MoCA < 26 and < 19 (cutoffs for mild and severe cognitive impairment, respectively) at follow-up were identified by multivariable logistic regression using variables available during hospitalization.Results: Post stroke cognitive impairment was common, with 66.8% of patients scoring < 26 on the MoCA and 22.9% < 19. The average total MoCA score at follow-up was 18.7 (SD 7.0) among major strokes, 23.6 (SD 4.8) among minor strokes, and 27.2 (SD 13.0) among non-strokes (p = <0.0001). The follow-up MoCA score was associated with the follow-up mRS in adjusted analysis (OR 0.69; 95% C.I. 0.59–0.82). Among patients with no prior cognitive impairment (N = 201), a lack of pre-stroke employment, admission NIHSS > 6, and left-sided infarct predicted a follow-up MoCA < 26 (c-statistic 0.75); while admission NIHSS > 6 and infarct volume > 17 cc predicted a MoCA < 19 (c-statistic 0.75) at follow-up.Conclusion: Many patients experience early post-stroke cognitive dysfunction that significantly impacts function during a critical time period for decision-making regarding return to work and future independence. Dysfunction measured at 4–8 weeks can be predicted during the inpatient hospitalization. These high-risk individuals should be identified for targeted rehabilitation and counseling to improve longer-term post-stroke outcomes.

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Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland

Journal of Rehabilitation Medicine ◽

10.2340/jrm.v53.1118 ◽

2021 ◽

Author(s):

Jeremia P. O. Held ◽

Anne Schwarz ◽

Johannes Pohl ◽

Eva Thürlimann ◽

Silvan Porrtmann ◽

...

Keyword(s):

Physical Activity ◽

Community Dwelling ◽

Outpatient Rehabilitation ◽

Stroke Survivors ◽

Post Stroke ◽

Neurological Functioning ◽

Observational Cohort ◽

The Impact

Introduction: Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods: A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results: Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion: The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.

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