scholarly journals Physical Activity and Exercise Engagement in Patients Diagnosed with Transient Ischemic Attack and Mild/Non-disabling Stroke: A Commentary on Current Perspectives

2014 ◽  
Vol 3 ◽  
pp. RPO.S12338 ◽  
Author(s):  
James Faulkner ◽  
Lee Stoner ◽  
Danielle Lambrick
Keyword(s):  
Transient Ischemic Attack ◽  
Population Group ◽  
Care Program ◽  
Pharmacological Intervention ◽  
Future Research ◽  
Pharmacological Interventions ◽  
Exercise Interventions ◽  
Ischemic Attack ◽  
Research Initiatives ◽  
Cerebrovascular Stroke

Individuals diagnosed with a transient ischemic attack (TIA) or mild/non-disabling stroke are at high risk of cardiovascular or recurrent cerebrovascular (stroke, TIA) events. Pharmacological intervention (ie anti-platelet and anti-coagulant medication) is considered the cornerstone of secondary prevention care for this population group. However, recent research has explored the utility of non-pharmacological interventions (eg exercise, diet, education) in improving health outcomes and reducing the risk of secondary events in patients with TIA or mild/non-disabling stroke. This commentary discusses the efficacy of implementing exercise interventions as a part of the secondary care program for acute and non-acute TIA and stroke patients. Current perspectives and future research initiatives are also discussed.

scholarly journals A-07 Examining the Performance of Depressed Patients with Transient Ischemic Attack (TIA) on a Delayed Memory Task

2020 ◽  
Vol 35 (6) ◽  
pp. 797-797
Author(s):  
Lopez D ◽  
Lopez A ◽  
Quintana A ◽  
Gibson D ◽  
Arguelles-Borge S
Keyword(s):  
Depressive Symptoms ◽  
Transient Ischemic Attack ◽  
Verbal Memory ◽  
Depressive Symptomatology ◽  
Memory Task ◽  
Poor Performance ◽  
Future Research ◽  
Late Life Depression ◽  
Logical Memory ◽  
Ischemic Attack

Abstract Objective To determine whether depression plays a role in delayed memory in patients with a history of Transient Ischemic Attacks (TIA). Method The data from this study was derived from a large de-identified database from the National Alzheimer’s Coordinating Center containing neuropsychological information for transient ischemic attack (TIA) patients (1,585) who completed a Logical Memory-Delay. The sample was divided into two groups: those that related to depression (n = 473; mean age = 84.61; SD = 6.01) as determined by the etiologic diagnosis of the cognitive disorder-Depression and those that did not (n = 769; mean age = 87.47; SD = 6.37). Results An Independent-sample-t-test showed a performance difference in performance between those who endorsed depressive symptomatology [F(1,043) = 4.96,p < 0.001], than those who did not report depressive symptoms. Conclusions These findings suggest a link between Transient Ischemic Attack (TIA), depression and poor performance on delayed memory among older adults. Logical Memory-Delayed assesses long-term narrative memory. Based on research, depressive symptoms endorsed after a TIA can affect cognitive functioning. Specifically, studies have found that a decline in verbal memory can be in part, attributed to late-life depression. This cognitive decline may result from impaired executive functioning during the learning phase of the recall task, which then impacts their delayed recall. Given that cognitive weaknesses and psychological distress can impact considerably a patient after TIA, future studies should focus on understanding their relationship in terms of treatment outcomes. Additionally, since the effects of TIAs are typically short-lasting, future research should examine whether the observed cognitive effects are maintained over time when depression continues to be present.

scholarly journals Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis

2019 ◽  
Vol 8 (11) ◽  
pp. 1769 ◽  
Author(s):  
David Rice ◽  
Peter McNair ◽  
Eva Huysmans ◽  
Janelle Letzen ◽  
Patrick Finan
Keyword(s):  
Chronic Pain ◽  
State Of The Art ◽  
Behavioral Therapy ◽  
Self Management ◽  
Future Research ◽  
Psychological Function ◽  
Pharmacological Interventions ◽  
First Line ◽  
Exercise Interventions ◽  
Established Disease

Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.

scholarly journals Association Between Immigration Status and Acute Stroke Care

Stroke ◽  
2020 ◽  
Vol 51 (5) ◽  
pp. 1555-1562
Author(s):  
Manav V. Vyas ◽  
Andreas Laupacis ◽  
Peter C. Austin ◽  
Jiming Fang ◽  
Frank L. Silver ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Care Delivery ◽  
Stroke Care ◽  
Future Research ◽  
Immigration Status ◽  
Acute Stroke Care ◽  
Adjusted Risk ◽  
Ischemic Attack

Background and Purpose— Immigrants to high-income countries have a lower incidence of stroke compared with long-term residents; however, little is known about the care and outcomes of stroke in immigrants. Methods— We used linked clinical and administrative data to conduct a retrospective cohort study of adults seen in the emergency department or hospitalized with ischemic stroke or transient ischemic attack between July 1, 2003, and April 1, 2013, and included in the provincial stroke registry. We ascertained immigration status using immigration records and compared processes of stroke care delivery between immigrants (defined as those immigrating after 1985) and long-term residents. In the subgroup with ischemic stroke, we calculated inverse probability treatment weight (IPTW)–adjusted risk ratios for disability on discharge (modified Rankin Scale score of 3 to 5), accounting for demographic characteristics and comorbid conditions to compare outcomes between immigrants and long-term residents. Results— We included 34 987 patients with ischemic stroke or transient ischemic attack, of whom 2649 (7.6%) were immigrants. Immigrants were younger than long-term residents at the time of stroke/transient ischemic attack (median age 67 years versus 76 years; P <0.001). In the subgroup with ischemic stroke, there were no differences in stroke care delivery, except that a higher proportion of immigrants received thrombolysis than long-term residents (21.2% versus 15.5%; P <0.001). Immigrants with ischemic stroke had a higher adjusted risk of being disabled on discharge (adjusted risk ratio, 1.18; 95% CI, 1.13–1.22) compared to long-term residents. Conclusions— Stroke care is similar in Canadian immigrants and long-term residents. Future research is needed to confirm the observed association between immigration status and disability after stroke and to identify factors underlying the association.

Abstract WP206: Risk of Recurrent Stroke in Patients Diagnosed with Comorbid Depression at the Time of Transient Ischemic Attack

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Michael P Lerario ◽  
Babak B Navi ◽  
Alexander E Merkler ◽  
Casara J Ferretti ◽  
Nicole C Allen ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Predictor Variable ◽  
Brain Magnetic Resonance Imaging ◽  
Misclassification Error ◽  
Future Research ◽  
Index Hospitalization ◽  
Comorbid Depression ◽  
Increased Risk ◽  
Cumulative Rate ◽  
Ischemic Attack

Introduction: Although rates of depression are increased in patients with transient ischemic attack (TIA), the effect of depression on recurrent cerebrovascular events is uncertain. Therefore, we aimed to calculate the risk of subsequent stroke in patients with comorbid depression at the time of TIA. Methods: We used all-payer claims data on all nonfederal acute care hospitalizations in New York, California, and Florida from 2005-2013. Our cohort comprised all patients hospitalized for TIA ( ICD-9-CM 435.x). The predictor variable was a diagnosis of depression ( ICD-9-CM 296.20-.25, 296.30-.35, 300.4, 311 in any diagnosis code position) during the index hospitalization for TIA. Kaplan-Meier survival statistics were used to calculate cumulative rates of our primary composite outcome of ischemic and hemorrhagic stroke ( ICD-9-CM 431, 433.x1, 434.x1, or 436 without concomitant trauma or rehabilitation codes). Cox proportional hazard analysis was used to examine the association between depression and stroke. Results: We identified a total of 1,817,842 TIA patients, among whom 223,311 (12.3%) were discharged from their index TIA visit with a comorbid depression diagnosis. Over a mean follow-up of 4.2 (+/- 2.1) years, 227,501 patients were diagnosed with subsequent stroke. The 1-year cumulative rate of stroke was 3.5% in both patients with depression (95% CI, 3.3-3.7%) and without depression (95% CI, 3.5-3.6%). The 5-year cumulative rate of stroke was 8.5% (95% CI, 8.2-8.9%) in those with depression compared to 8.9% (95% CI, 8.7-9.0%) in patients without depression at the time of their TIA diagnosis. After adjusting for demographics and vascular risk factors, depression was not associated with subsequent stroke (hazard ratio, 1.0; 95% CI, 1.0-1.1; p =0.7). To reduce any misclassification error, these results were unchanged in a sensitivity analysis which included only those patients who underwent brain magnetic resonance imaging during their index hospitalization for TIA. Conclusions: A comorbid diagnosis of depression at the time of TIA is not associated with an increased risk of subsequent stroke. Future research should evaluate whether incident depression diagnosed after hospital discharge for TIA is associated with heightened stroke risk.

scholarly journals Factors Associated with Cognitive Decline in Transient Ischemic Attack Patients

2014 ◽  
Vol 41 (3) ◽  
pp. 303-313 ◽  
Author(s):  
Leka Sivakumar ◽  
Richard Camicioli ◽  
Ken Butcher
Keyword(s):  
Cognitive Impairment ◽  
Transient Ischemic Attack ◽  
Patient Management ◽  
Research Priorities ◽  
Neurological Deficits ◽  
Future Research ◽  
Cognitive Changes ◽  
Factors Associated ◽  
Cognitive Sequelae ◽  
Ischemic Attack

Chronic cerebrovascular disease and large ischemic stroke are both associated with cognitive impairment. Much less is known about the acute cognitive sequelae of transient ischemic attack (TIA). Although often overlooked, there is increasing evidence that cognitive impairment does occur following TIA. In some patients, cognitive changes persist after resolution of focal neurological deficits, but the temporal profile of these symptoms is unknown. In addition, clinical and imaging correlates of cognitive impairment after TIA have not been systematically studied. This under-studied and recognized problem has significant implications for TIA patient management. In this review, we summarize the evidence currently available and identify future research priorities.

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