Effect of Diabetes on Post-stroke Recovery: A Systematic Narrative Review

Background: Patients with stroke often have comorbid diabetes. Considering its detrimental effects on brain function, diabetes may increase the risk of poor recovery.Methods: The aim of this review was to investigate the effect of diabetes on post-stroke recovery by a systematic review. Several specific aspects of post-stroke recovery, including activities of daily living (ADL), motor, cognitive, and quality of life (QOL) recovery, were examined. We searched the PubMed, SCOPUS, Embase, and Cochrane Library databases for relevant studies on the effect of diabetes on post-stroke recovery, published until May 26, 2021. A total of 52,051 potentially relevant articles were identified. After reading the titles and abstracts and assessing their eligibility based on full-text articles, 34 publications were included in this review.Results: Of 29 studies that assessed ADL recovery after stroke, 22 studies suggested that diabetes had a negative effect on recovery of ADL after stroke. Regarding motor recovery, only one out of four studies showed that diabetes had some effect on motor recovery after stroke. Of the two studies on cognitive recovery, one reported that diabetes was an independent predictor of poor cognitive recovery after stroke. Three studies on QOL reported that a poor QOL after stroke was associated with the presence of diabetes.Conclusions: The current review suggests that the post-stroke recovery of ADL seems to be poorer in patients with diabetes than patients without diabetes. Further, there are insufficient data to conclude the effect of diabetes on motor and cognitive recovery, but it may have some influence on the quality of life after stroke.Systematic Review Registration: doi: 10.37766/inplasy2021.11.0032, identifier: INPLASY2021110032.

Modifiable Lifestyle Factors Associated with Cognitive Recovery from MCI: A 12-Year Longitudinal Study

Introduction Many studies have investigated the risk factors associated with progression from mild cognitive impairment (MCI) to cognitive impairment, while it is unclear which lifestyle factors are associated with cognitive recovery among those who have mild cognitive impairment. Methods The study includes 7,422 participants above 65 years old with MCI from The Chinese Longitudinal Healthy Longevity Survey (CLHLS). Cox regression analysis was adopted to investigate the association between cognitive recovery and selected lifestyle factors. LASSO was applied to select the variables. Results Daily consumption of fresh fruits is associated with higher possibility of cognitive recovery (HR: 1.28, 95% CI: 1.15-1.42) while daily consumption of meat show opposite influence (HR: 0.90, 95% CI: 0.80-0.99). Smoking (HR: 0.99, 95% CI: 0.98-1.00) and alcohol consumption (HR: 1.00, 95% CI: 0.99-1.00) are both negatively associated with cognitive recovery. Daily engagement in reading (HR: 1.24, 95% CI: 1.00-1.54), housework (HR: 1.21, 95% CI: 1.08-1.35) as well as mahjong and other card games (HR: 1.23, 95% CI: 1.08-1.39) are associated with higher possibility of cognitive recovery. Conclusion This study has identified important modifiable lifestyle factors associated with natural cognitive recovery from MCI. The findings have considerable implications for dementia prevention.

Can Cranioplasty Be Considered a Tool to Improve Cognitive Recovery Following Traumatic Brain Injury? A 5-Years Retrospective Study

Cranioplasty (CP) is a neurosurgical intervention of skull repairing following a decompressive craniectomy. Unfortunately, the impact of cranioplasty on cognitive and motor function is still controversial. Fifteen TBI subjects aged 26–54 years with CP after decompressive craniectomy were selected in this observational retrospective study. As per routine clinical practice, a neuropsychological evaluation carried out immediately before the cranioplasty (Pre CP) and one month after the cranioplasty (T0) was used to measure changes due to CP surgery. This assessment was performed each year for 5 years after discharge in order to investigate long-term cognitive changes (T1-T5). Before cranioplasty, about 53.3% of subjects presented a mild to severe cognitive impairment and about 40.0% a normal cognition. After CP, we found a significant improvement in all neuropsychological test scores. The more significant differences in cognitive recovery were detected after four years from CP. Notably, we found significant differences between T4 and T0-T1, as well as between T5 and T0-T1-T2 in all battery tests. This retrospective study further suggests the importance of CP in the complex management of patients with TBI showing how these patients might improve their cognitive function over a long period after the surgical procedure.

Incentivization and cognitive performance in those who sustain mild traumatic brain injury: A series of case studies of aviation-rated army personnel

BACKGROUND: There is much research examining trajectories of cognitive recovery in those who sustain mild traumatic brain injury (mTBI). OBJECTIVE: Although the majority of research indicates a full recovery within months of a single, uncomplicated mTBI there remain few who report cognitive symptoms long after injury. Ample evidence indicates incentives to underperform on cognitive testing can negatively affect cognitive recovery, but there is little to no research on how incentives to perform well may affect recovery. This gap in research should be considered to obtain a full picture of cognitive recovery following mTBI. METHOD: Aeromedical Evaluations present a unique opportunity to study cognitive and functional recovery after mTBI. Three case studies are presented from the Aviation Community of recovery from mTBI. Each case presented is one who was monetarily incentivized to perform well on testing. RESULTS: All three cases passed established guidelines for performance validity testing. Each case recovered to estimated baseline performance, though one case needed additional time. There was some evidence of lowered processing speed on two of the three cases. CONCLUSIONS: Consistent with current literature on mTBI, recovery from injury is considered the rule as opposed to the exception. Though there are many studies examining how incentives to underperform hinder recovery, there is little research on how incentives to perform well may affect cognitive performance after mTBI. Such may be considered a gap in research and should be a focus of future work.

BOLD Coupling between Lesioned and Healthy Brain Is Associated with Glioma Patients’ Recovery

Predicting functional outcomes after surgery and early adjuvant treatment is difficult due to the complex, extended, interlocking brain networks that underpin cognition. The aim of this study was to test glioma functional interactions with the rest of the brain, thereby identifying the risk factors of cognitive recovery or deterioration. Seventeen patients with diffuse non-enhancing glioma (aged 22–56 years) were longitudinally MRI scanned and cognitively assessed before and after surgery and during a 12-month recovery period (55 MRI scans in total after exclusions). We initially found, and then replicated in an independent dataset, that the spatial correlation pattern between regional and global BOLD signals (also known as global signal topography) was associated with tumour occurrence. We then estimated the coupling between the BOLD signal from within the tumour and the signal extracted from different brain tissues. We observed that the normative global signal topography is reorganised in glioma patients during the recovery period. Moreover, we found that the BOLD signal within the tumour and lesioned brain was coupled with the global signal and that this coupling was associated with cognitive recovery. Nevertheless, patients did not show any apparent disruption of functional connectivity within canonical functional networks. Understanding how tumour infiltration and coupling are related to patients’ recovery represents a major step forward in prognostic development.

Effect of a Virtual Reality-Based Restorative Environment on the Emotional and Cognitive Recovery of Individuals with Mild-to-Moderate Anxiety and Depression

In this study, restorative environment theory and virtual reality (VR) technology were combined to build different 3D dynamic VR interactive scenes. We discuss the effects of a VR restorative environment on the emotional and cognitive recovery of individuals with mild-to-moderate anxiety and depression. First, we built a VR restorative garden scene, divided into four areas: forest, lawn, horticultural planting, and water features. The scene was verified to have a good recovery effect in 26 participants. Then, 195 participants with mild-to-moderate anxiety and depression were selected as experimental subjects. Through psychological testing and EMG (Electromyography) and EEG (Electroencephalography) data feedback, we further explored the differences in the sense of presence in VR restorative scenes and their effect on individual emotional and cognitive recovery. The results showed that (1) both the restorative environment images and the VR scenes had a healing effect (the reduction in negative emotions and the recovery of positive emotions and cognition), with no difference in the subjective feeling of recovery among the different scenes, but the recovery score of the VR urban environment was higher than that of the natural environment (differing from the results in real environments); (2) a high sense of presence can be experienced in different VR scenes, and interactive activities in VR scenes can provide a great presence experience; (3) the recovery effects of VR restorative environment on emotion and self-efficacy are realized through the presence of VR scenes; (4) a VR restorative environment is helpful for the emotional improvement and cognitive recovery of individuals with mild-to-moderate anxiety and depression. VR urban scenes also have good recovery effects. In terms of cognitive recovery, self-efficacy improved significantly. In addition, from the perspective of EEG indicators, the VR restorative scene experience activated the prefrontal lobe, which is conducive to cognitive recovery in individuals with mild-to-moderate anxiety and depression. In terms of emotional improvement, negative emotions were significantly reduced in the different VR scene groups. In conclusion, we further explored ways to help individuals with mild-to-moderate anxiety and depression, in order to promote the development and application of mental health.