Prevalence and factors associated with memory disturbance and dementia after acute ischemic stroke

Prevalence and risk factors associated with memory disturbance and dementia were determined in acute ischemic stroke (AIS) patients in hospitals before discharge, three and six months after stroke. A prospective cohort study was conducted during January-December 2017 with 401 AIS patients admitted to Srinagarind Hospital, Khon Kaen Hospital and Chum Phae Hospital, Khon Kaen, Thailand. The demographics and clinical characteristics, previous illness and past medical history, and laboratory test results of the patients were collected from the medical records, while depression screening, NIH stroke scale (NIHSS) scoring and mini mental state examination (MMSE) were performed using particular medical record forms. The prevalence of memory disturbance and dementia was 56.6, 41.6 and 38.2% before discharge, three and six months after stroke, respectively. Based on logistic regression analysis, age, education and stroke severity were the risk factors associated with the studied disorders before discharge and three months after stroke. Meanwhile, age and education were the risk factors for six months after stroke. Our findings suggested that the prevalence of memory disturbance and dementia remained high at all study periods.

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Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020618 ◽

2020 ◽

Vol 17 (2) ◽

pp. 618 ◽

Cited By ~ 2

Author(s):

Yi-Ju Tseng ◽

Ru-Fang Hu ◽

Shin-Tyng Lee ◽

Yu-Li Lin ◽

Chien-Lung Hsu ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Treatment Outcomes ◽

Plasminogen Activator ◽

Tissue Type ◽

Hospital Death ◽

Factors Associated ◽

Laboratory Test Results ◽

Poor Outcomes

Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.

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Another Look at Obesity Paradox in Acute Ischemic Stroke: Association Rule Mining

Journal of Personalized Medicine ◽

10.3390/jpm12010016 ◽

2021 ◽

Vol 12 (1) ◽

pp. 16

Author(s):

Pum-Jun Kim ◽

Chulho Kim ◽

Sang-Hwa Lee ◽

Jong-Hee Shon ◽

Youngsuk Kwon ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Beneficial Effect ◽

Acute Ischemic Stroke ◽

Association Rule ◽

Association Rule Mining ◽

Obesity Paradox ◽

Stroke Severity ◽

Obese Patients ◽

Rule Mining

Though obesity is generally associated with the development of cardiovascular disease (CVD) risk factors, previous reports have also reported that obesity has a beneficial effect on CVD outcomes. We aimed to verify the existing obesity paradox through binary logistic regression (BLR) and clarify the paradox via association rule mining (ARM). Patients with acute ischemic stroke (AIS) were assessed for their 3-month functional outcome using the modified Rankin Scale (mRS) score. Predictors for poor outcome (mRS 3–6) were analyzed through BLR, and ARM was performed to find out which combination of risk factors was concurrently associated with good outcomes using maximal support, confidence, and lift values. Among 2580 patients with AIS, being obese (OR [odds ratio], 0.78; 95% CI, 0.62–0.99) had beneficial effects on the outcome at 3 months in BLR analysis. In addition, the ARM algorithm showed obese patients with good outcomes were also associated with an age less than 55 years and mild stroke severity. While BLR analysis showed a beneficial effect of obesity on stroke outcome, in ARM analysis, obese patients had a relatively good combination of risk factor profiles compared to normal BMI patients. These results may partially explain the obesity paradox phenomenon in AIS patients.

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Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patients Smokers Treated with Thrombolytic Therapy

The American Journal of the Medical Sciences ◽

10.1016/j.amjms.2021.01.028 ◽

2021 ◽

Author(s):

Adeola Awujoola ◽

Patrick Sodeke ◽

Odebunmi Olufeyisayo ◽

Moboni Mokikan ◽

Emanuel Adeyemi ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Ischemic Stroke ◽

Clinical Risk Factors ◽

Stroke Patients ◽

Factors Associated ◽

Clinical Risk

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Risk factors associated with extracranial atherosclerosis in old patients with acute ischemic stroke

Scientific Reports ◽

10.1038/s41598-018-31026-z ◽

2018 ◽

Vol 8 (1) ◽

Author(s):

Lili Wang ◽

Maolin He ◽

Yun Zhang

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Old Patients ◽

Factors Associated

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Angioedema Secondary to tPA Use in Acute Ischemic Stroke Patient with Hypertension: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.1.49582 ◽

2021 ◽

Vol 2 (5) ◽

pp. 159-162

Author(s):

Chris Kim ◽

Andrea Hladik

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Case Report ◽

Acute Ischemic Stroke ◽

Ace Inhibitor ◽

Sudden Onset ◽

Acute Ischemic Stroke Patient ◽

Factors Associated ◽

Tissue Plasminogen ◽

Life Threatening

Introduction: A well-documented complication of administering tissue plasminogen activator (tPA) in stroke patients is acute intracranial bleeding. A lesser known but still significant complication is angioedema secondary to tPA administration, which can develop in certain individuals with risk factors such as angiotensin converting enzyme (ACE) inhibitor use and location of the stroke. Knowing the potential for this life-threatening complication and being prepared for its proper management is vital for emergency physicians. Case Report: We report a 53-year-old Black female who presented to the emergency department with sudden onset of slurred speech and a facial droop. She was found to have an acute ischemic stroke and tPA was administered. She subsequently developed angioedema. Retrospectively, the patient was found to have risk factors that are thought to predispose patients to tPA-induced angioedema. Conclusion: Risk factors associated with angioedema secondary to tPA administration have been documented in patients taking ACE inhibitors, as well as patients who develop strokes in the frontal lobe. While many cases may be mild, some patients may develop life-threatening angioedema. Although this complication does not necessarily contraindicate tPA use, it is prudent for the emergency physician to be vigilant for its development, prepared for its treatment, and to be diligent in assessing the need for control of the patient’s airway.

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Abstract 1122‐000166: Stroke Severity Factors in patients with Acute Ischemic Stroke and Heart Failure Stratifying by Age

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000166 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Camron K Edrissi ◽

Carolyn Sanders ◽

Chase Rathfoot ◽

Krista Knisely ◽

Thomas Nathaniel ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Heart Valve ◽

Prosthetic Heart Valve ◽

Stroke Severity ◽

Factors Associated ◽

Elevated Systolic Blood Pressure

Introduction : The goal of this study is to investigate the clinical risk factors associated with acute ischemic stroke (AIS) severity in heart failure (HF) patients above and below 70 years old using the National Institutes of Health Stroke Scale (NIHSS) as a measure for stroke severity. Methods : This study uses retrospective analysis of AIS patients who were previously diagnosed with HF. Data was collected from a regional stroke center from January 2010 to June 2016. Multivariate logistic regression identified the factors associated with stroke severity, with a NIHSS score <7 indicating low severity and a score ≥7 indicating high severity. These results were stratified by patient ages of < and ≥70 years old. Results : A total of 590 patients presented with AIS and a previous diagnosis of HF. The AIS‐HF population contained 223 patients that were <70 years old and 367 that were ≥70 years old. In the AIS‐HF population, patients who were ≥70 years old who presented with coronary artery stenosis (CAS) (OR = 8.592, 95% CI, 2.123‐34.772, P <0.003), prosthetic heart valve (OR = 22.028, 95% CI, 1.454‐333.746, P <0.026), elevated systolic blood pressure (OR = 1.014, 95% CI, 1.002‐1.026, P < 0.024), and tissue plasminogen activator (tPA) administration (OR = 4.002, 95% CI, 1.912‐8.377, P < 0.001) were associated with a higher NIHSS. Alternatively, those that presented with gender differences (OR = 0.466, 95% CI, 0.235‐0.925, P < 0.029), family history of stroke (OR = 0.084, 95% CI, 0.010‐0.726, P < 0.024), obesity (OR = 0.493, 95% CI, 0.261‐0.930, P < 0.029), smoking (OR = 0.253, 95% CI, 0.063‐1.022, P < 0.054), serum creatinine (OR = 0.629, 95% CI, 0.399‐0.992, P < 0.046), INR level (OR = 0.457, 95% CI, 0.191‐1.094, P < 0.079) were associated with a lower NIHSS. Conclusions : The data revealed a variety of components that may affect Stroke Severity in AIS patients with HF. The associated factors exhibited significant differences between distinct age groups. AIS‐HF patients ≥70 years old who presented with CAS, prosthetic heart valve, elevated systolic blood pressure, and received tPA administration were associated with higher stroke severity (≥7 NIHSS) compared to <70 years old group. Identifying more concrete clinical and demographic associations may aid in the identification and evidence‐based management of patients who suffer from AIS.

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Risk factors of acute ischemic stroke in patients presented to Beni-Suef University Hospital: prevalence and relation to stroke severity at presentation

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-018-0012-4 ◽

2018 ◽

Vol 54 (1) ◽

Cited By ~ 4

Author(s):

Rasha H. Soliman ◽

Mohammed I. Oraby ◽

Mohammed Fathy ◽

Alaa M. Essam

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

University Hospital ◽

Stroke Severity

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Cholesterol reducer and Thrombolytic therapy in acute ischemic stroke

10.21203/rs.2.20629/v1 ◽

2020 ◽

Author(s):

Nicolas Poupore ◽

Dan Strat ◽

Tristan Mackey ◽

Katherine Brown ◽

Ashley Snell ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Demographic Data ◽

Recombinant Tissue Plasminogen Activator ◽

Clinical Risk Factors ◽

Medication History ◽

Factors Associated ◽

Clinical Risk

Abstract Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy.Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions.Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions.Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.

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