Pub Date : 2024-04-27DOI: 10.1177/17474930241253987
Francesco Arba, Chiara Rinaldi, Märit Jensen, Matthias Endres, Jochen Benedikt Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Claus Simonsen, Vincent Thijs, Christian Gerloff, Joanna Wardlaw, Götz Thomalla
Introduction:Lacunar stroke represents around a quarter of all ischemic strokes, however, their identification with Computed Tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging.Methods:We analysed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by NIHSS<7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score.Results:We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6), 325 (65%) males, median (IQR) NIHSS=6 (4-9); 108 (22%) lacunar infarcts were identified on MR, patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score correctly identified 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7,p<0.001), higher systolic (157 mmHg vs 151 mmHg,p=0.001) and diastolic (86 mmHg vs 83 mmHg,p=0.013) blood pressure and smaller infarct volume (2.4 ml vs 9.5 ml,p<0.001). Performance of lacunar score was: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts.Conclusions:Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials.
{"title":"Validation of a Simple Clinical Tool for Screening of Acute Lacunar Stroke – a substudy of the WAKE-UP trial","authors":"Francesco Arba, Chiara Rinaldi, Märit Jensen, Matthias Endres, Jochen Benedikt Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Claus Simonsen, Vincent Thijs, Christian Gerloff, Joanna Wardlaw, Götz Thomalla","doi":"10.1177/17474930241253987","DOIUrl":"https://doi.org/10.1177/17474930241253987","url":null,"abstract":"Introduction:Lacunar stroke represents around a quarter of all ischemic strokes, however, their identification with Computed Tomography in the hyperacute setting is challenging. We aimed to validate a clinical score to identify lacunar stroke in the acute setting, independently, with data from the WAKE-UP trial using magnetic resonance imaging.Methods:We analysed data from the WAKE-UP trial and extracted Oxfordshire Community Stroke Project (OCSP) classification. Lacunar score was defined by NIHSS<7 and OCSP lacunar syndrome. Assessment of lacunar infarct by two independent investigators was blinded to clinical data. We calculated sensitivity, specificity, negative and positive predictive value (NPV and PPV, respectively) of lacunar score.Results:We included 503 patients in the analysis, mean (±SD) age 65.2 (±11.6), 325 (65%) males, median (IQR) NIHSS=6 (4-9); 108 (22%) lacunar infarcts were identified on MR, patients fulfilling lacunar score criteria were 120 (24%), of which 47 (44%) had a lacunar infarct. Lacunar score correctly identified 322 (82%) of patients without lacunar infarct. Patients with lacunar score had lower NIHSS (4 vs 7,p<0.001), higher systolic (157 mmHg vs 151 mmHg,p=0.001) and diastolic (86 mmHg vs 83 mmHg,p=0.013) blood pressure and smaller infarct volume (2.4 ml vs 9.5 ml,p<0.001). Performance of lacunar score was: sensitivity 0.44; specificity 0.82; PPV 0.39; NPV 0.84; accuracy 0.73. Assuming a prevalence of lacunar stroke of 13%, PPV lowered to 0.30 but NPV was 0.90. Lacunar score performed better for supratentorial lacunar infarcts.Conclusions:Lacunar score had a very good specificity and NPV for screening of lacunar stroke. Implementation of this simple tool into clinical practice may help hyperacute management and guide patient selection in clinical trials.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140813059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-27DOI: 10.1177/17474930241253988
Anastasia Adamou, Fotios Barkas, Haralampos J Milionis, George Ntaios
Background:In stroke survivors, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite Glucagon-like receptor-1 agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in stroke survivors with diabetes mellitus or obesity.Methods:Following PRISMA guidelines, we systematically reviewed MEDLINE and Scopus until 15/11/2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.Results:Among 1,369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs. weekly). Additionally, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.Conclusion:In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.
{"title":"Glucagon-Like Receptor-1 Agonists and Stroke: a Systematic Review and Meta-Analysis of Cardiovascular Outcome Trials","authors":"Anastasia Adamou, Fotios Barkas, Haralampos J Milionis, George Ntaios","doi":"10.1177/17474930241253988","DOIUrl":"https://doi.org/10.1177/17474930241253988","url":null,"abstract":"Background:In stroke survivors, approximately 15% and 60% exhibit concurrent diabetes mellitus and overweight/obesity, respectively, necessitating heightened secondary prevention efforts. Despite Glucagon-like receptor-1 agonists (GLP-1 RAs) demonstrating improved outcomes for those with diabetes mellitus or obesity, their underutilization persists among eligible individuals. This systematic review and meta-analysis investigated the impact of GLP-1 RAs on stroke risk. The findings aim to optimize the implementation of this therapeutic strategy in stroke survivors with diabetes mellitus or obesity.Methods:Following PRISMA guidelines, we systematically reviewed MEDLINE and Scopus until 15/11/2023. Eligible studies included randomized cardiovascular outcome trials (CVOTs) with individuals, with or without type 2 diabetes, randomized to either GLP-1 RA or placebo. The outcomes were total strokes, non-fatal strokes, and fatal strokes. Analyses were conducted using RevMan 5.4.1.Results:Among 1,369 screened studies, 11 were eligible, encompassing 82,140 participants (34.6% women) with a cumulative follow-up of 247,596 person-years. In the GLP-1 RAs group, the stroke rate was significantly lower compared to placebo (RR: 0.85, 95% CI: 0.77-0.93; NNT: 200), showing no heterogeneity or interaction with administration frequency (daily vs. weekly). Additionally, the GLP-1 RAs group exhibited a significantly lower rate of non-fatal strokes compared to placebo (RR: 0.87, 95% CI: 0.79-0.95; NNT: 250), with no heterogeneity or interaction based on administration frequency, route (oral vs subcutaneous), or diabetes presence.Conclusion:In this meta-analysis of 11 CVOTs with 82,140 participants, GLP-1 RAs demonstrated a 16% relative reduction in stroke risk compared to placebo. This finding may increase implementation of GLP-1 RAs by stroke specialists in individuals with stroke and comorbid diabetes mellitus or obesity.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140811282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-27DOI: 10.1177/17474930241253482
Jessica D’lima, Vincent Thijs, Han Lim, Thalys Sampaio Rodrigues, Ann-Marie Beaudoin
Background:Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship.Aims:To assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period.Summary of review:A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Amongst the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled OR showed a significant association (OR 4.11 [95% CI 1.03-16.40]). The 3 studies reporting on AF and stroke within a 90 day window did not find a significant temporal relationship (OR of 0.43 [95% CI 0.13-1.41]). Finally, the pooled result of those 7 studies did not show a significant association (OR 1.51 [95% CI 0.44 – 5.17]).Conclusions:This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment.
{"title":"Temporal Association Between Atrial Fibrillation and Ischemic Stroke: Systematic Review and Meta-Analysis","authors":"Jessica D’lima, Vincent Thijs, Han Lim, Thalys Sampaio Rodrigues, Ann-Marie Beaudoin","doi":"10.1177/17474930241253482","DOIUrl":"https://doi.org/10.1177/17474930241253482","url":null,"abstract":"Background:Paroxysmal atrial fibrillation (PAF) is strongly associated with ischemic stroke. Continuous cardiac implantable electronic devices (CIEDs) can assess PAF episodes over prolonged periods. Studies that attempted to find a temporal association between PAF and ischemic stroke were inconclusive. Thus, we performed a systematic review and meta-analysis to assess this relationship.Aims:To assess the temporal association between AF episodes and stroke within 30 days of the arrhythmic episode. The secondary outcome is a temporal association within a 90-day period.Summary of review:A total of 2804 studies that discussed the temporal relationship between PAF and ischemic stroke were screened, and 7 studies were included in the meta-analysis. Amongst the 4041 patients included in these studies, there were 138 patients with device detected PAF episodes and stroke. Four studies used a 30-day window for temporality and the pooled OR showed a significant association (OR 4.11 [95% CI 1.03-16.40]). The 3 studies reporting on AF and stroke within a 90 day window did not find a significant temporal relationship (OR of 0.43 [95% CI 0.13-1.41]). Finally, the pooled result of those 7 studies did not show a significant association (OR 1.51 [95% CI 0.44 – 5.17]).Conclusions:This meta-analysis supports a temporal relationship between PAF and ischemic stroke within a 30-day window. Establishing this relationship is important for individualized risk prediction and targeted anticoagulation treatment.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140811234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-27DOI: 10.1177/17474930241253702
Nishita Singh, Carol Kenney, Kenneth Butcher, Brian Buck, Philip A Barber, Thalia Shoshana Field, Philip Choi, Amy Ying Xin Yu, Tim Kleinig, Ramana Appireddy, Carlos A Molina, Keith W Muir, Michael D Hill, Shelagh B Coutts
Background:Almost half of acute ischemic stroke patients present with mild symptoms and there are large practice variations in their treatment globally. Individuals with an intracranial occlusion who present with minor stroke are at an increased risk of early neurological deterioration and poor outcomes. Individual patient data meta-analysis in the subgroup of patients with minor deficits showed benefit of alteplase in improving outcomes, however, this benefit has not been seen with intravenous alteplase in published randomized trials.Design:TEMPO-2 (A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) is a prospective, open label with blinded outcome assessment, randomized controlled trial, designed to test the superiority of intravenous tenecteplase (0.25mg/kg) over non thrombolytic standard of care, with an estimated sample size of 1274 patients. Adult patients presenting with acute ischemic stroke with NIHSS <5 and visible arterial occlusion or perfusion deficit within 12 hours of onset are randomized to receive either tenecteplase (0.25 mg/kg) or standard of care. The primary outcome is return to baseline neurological functioning, measured by the modified Rankin Scale (mRS) at 90 days. Safety outcomes include death and symptomatic hemorrhage (intra or extra-cranial). Other secondary outcomes include mRS 0-1, mRS 0-2, ordinal shift analysis of the mRS, partial and full recanalization on follow up CT Angiogram.Conclusion:Results of this trial will aid in determining whether there is benefit of using tenecteplase (0.25mg/kg) in treating patients presenting with minor stroke who are at high risk of developing poor outcomes due to presence of an intracranial occlusion.Trial Registry Name:A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion, Registration number: NCT02398656; URL: https://clinicaltrials.gov/study/NCT02398656 .
{"title":"A Randomized Controlled Trial of Tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion (TEMPO-2): Rational and design of a multicenter, randomized open-label clinical trial.","authors":"Nishita Singh, Carol Kenney, Kenneth Butcher, Brian Buck, Philip A Barber, Thalia Shoshana Field, Philip Choi, Amy Ying Xin Yu, Tim Kleinig, Ramana Appireddy, Carlos A Molina, Keith W Muir, Michael D Hill, Shelagh B Coutts","doi":"10.1177/17474930241253702","DOIUrl":"https://doi.org/10.1177/17474930241253702","url":null,"abstract":"Background:Almost half of acute ischemic stroke patients present with mild symptoms and there are large practice variations in their treatment globally. Individuals with an intracranial occlusion who present with minor stroke are at an increased risk of early neurological deterioration and poor outcomes. Individual patient data meta-analysis in the subgroup of patients with minor deficits showed benefit of alteplase in improving outcomes, however, this benefit has not been seen with intravenous alteplase in published randomized trials.Design:TEMPO-2 (A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion) is a prospective, open label with blinded outcome assessment, randomized controlled trial, designed to test the superiority of intravenous tenecteplase (0.25mg/kg) over non thrombolytic standard of care, with an estimated sample size of 1274 patients. Adult patients presenting with acute ischemic stroke with NIHSS <5 and visible arterial occlusion or perfusion deficit within 12 hours of onset are randomized to receive either tenecteplase (0.25 mg/kg) or standard of care. The primary outcome is return to baseline neurological functioning, measured by the modified Rankin Scale (mRS) at 90 days. Safety outcomes include death and symptomatic hemorrhage (intra or extra-cranial). Other secondary outcomes include mRS 0-1, mRS 0-2, ordinal shift analysis of the mRS, partial and full recanalization on follow up CT Angiogram.Conclusion:Results of this trial will aid in determining whether there is benefit of using tenecteplase (0.25mg/kg) in treating patients presenting with minor stroke who are at high risk of developing poor outcomes due to presence of an intracranial occlusion.Trial Registry Name:A Randomized Controlled Trial of tenecteplase Versus Standard of Care for Minor Ischemic Stroke With Proven Occlusion, Registration number: NCT02398656; URL: https://clinicaltrials.gov/study/NCT02398656 .","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140811188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1177/17474930241249588
Gabriel Broocks, Helge Kniep, Rosalie McDonough, Matthias Bechstein, Christian Heitkamp, Laurens Winkelmeier, Susan Klapproth, Tobias Djamsched Faizy, Maximilian Schell, Gerhard Schön, Uta Hanning, Susanne Gellißen, André Kemmling, Panagiotis Papanagiotou, Jens Fiehler, Lukas Meyer
Purpose:The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS.Aim:We hypothesized twofold: 1) the treatment effect of vessel recanalization in patients with core volume >50ml but ASPECTS≥6 is not different compared to high ASPECTS patients with core volume <50ml, and 2) recanalization is associated with core overestimation.Methods:We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal-CT. Functional endpoint was the rate of functional independence at day-90 defined as modified Rankin Scale (mRS) 0-2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the eTICI (extended Thrombolysis in Cerebral Infarction) scale. Multivariable logistic regression analysis and prospensity score matching (PSM) were used to assess the association of recanalization (eTICI≥2b) with functional outcome and core overestimation.Results:Of 630 patients with ASPECTS≥6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS≥6 (+25.8%,95%CI: 16.3-35.4,p<0.001) compared to patients with ASPECTS≥6 and core volume <50 ml (+14.9%,95%CI: 5.7-24.1,p=0.002). Recanalization (aOR: 3.87, 95%CI: 1.66-9.00, p=0.002) and higher core volume (aOR: 1.04,95%CI: 1.02-1.05,p<0.001) were significantly associated with core overestimation.Conclusions:In patients with ASPECTS≥6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT.
{"title":"Thrombectomy in ischemic stroke patients with large core but minor ischemic changes on non-enhanced computed tomography","authors":"Gabriel Broocks, Helge Kniep, Rosalie McDonough, Matthias Bechstein, Christian Heitkamp, Laurens Winkelmeier, Susan Klapproth, Tobias Djamsched Faizy, Maximilian Schell, Gerhard Schön, Uta Hanning, Susanne Gellißen, André Kemmling, Panagiotis Papanagiotou, Jens Fiehler, Lukas Meyer","doi":"10.1177/17474930241249588","DOIUrl":"https://doi.org/10.1177/17474930241249588","url":null,"abstract":"Purpose:The Alberta Stroke Program Early CT Score (ASPECTS) is regularly used to guide patient selection for mechanical thrombectomy (MT). Similarly, penumbral imaging based on computed tomography perfusion (CTP) may serve as neuroimaging tool to guide treatment. Yet, patients with a large ischemic core on CTP may show only minor ischemic changes resulting in a high ASPECTS.Aim:We hypothesized twofold: 1) the treatment effect of vessel recanalization in patients with core volume >50ml but ASPECTS≥6 is not different compared to high ASPECTS patients with core volume <50ml, and 2) recanalization is associated with core overestimation.Methods:We conducted an observational study analyzing ischemic stroke patients consecutively treated with MT after triage by multimodal-CT. Functional endpoint was the rate of functional independence at day-90 defined as modified Rankin Scale (mRS) 0-2. Imaging endpoint was core overestimation, which was considered when CTP-derived core was larger than final infarct volume assessed on follow-up imaging. Recanalization was evaluated with the eTICI (extended Thrombolysis in Cerebral Infarction) scale. Multivariable logistic regression analysis and prospensity score matching (PSM) were used to assess the association of recanalization (eTICI≥2b) with functional outcome and core overestimation.Results:Of 630 patients with ASPECTS≥6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS≥6 (+25.8%,95%CI: 16.3-35.4,p<0.001) compared to patients with ASPECTS≥6 and core volume <50 ml (+14.9%,95%CI: 5.7-24.1,p=0.002). Recanalization (aOR: 3.87, 95%CI: 1.66-9.00, p=0.002) and higher core volume (aOR: 1.04,95%CI: 1.02-1.05,p<0.001) were significantly associated with core overestimation.Conclusions:In patients with ASPECTS≥6, core volumes did not significantly modify outcomes following recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with a large ischemic core but minor ischemic changes on non-enhanced CT.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140806404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/17474930241252556
Melmar Folloso, Steven Villaraza, Yi-Wen Lo, Pek-Lan Khong, Tomotaka Tanaka, Saima Hilal, Narayanaswamy Venketasubramanian, Christopher Li-Hsian Chen
BACKGROUND:There are major challenges in determining the aetiology of vascular cognitive impairment (VCI) clinically, especially in the presence of mixed pathologies, such as vascular and amyloid. Most recently, two criteria (American Heart Association/American Stroke Association [AHA/ASA] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V]) have been proposed for the clinical diagnosis of VCI but have not as yet been validated using neuroimaging.AIMS:This study aims to determine whether the AHA/ASA and DSM-V criteria for VCI can distinguish between cases with predominantly vascular pathology and cases with mixed pathology.METHODS:186 subjects were recruited from a cross-sectional memory clinic-based study at the National University Hospital, Singapore. All subjects underwent clinical and neuropsychological assessment, MRI and [11C] PiB PET scans. Diagnosis of the etiological subtypes of VCI [probable vascular mild cognitive impairment (VaMCI), possible VaMCI, non-VaMCI, probable vascular dementia (VaD), possible VaD, non-VaD] were performed following AHA/ASA and DSM-V criteria. Brain amyloid burden was determined for each subject with standardised uptake value ratio (SUVR) values ≥ 1.5 classified as amyloid positive.RESULTS:Using κ statistics, both criteria had excellent agreement for probable VaMCI, probable VaD, and possible VaD (κ=1.00), and good for possible VaMCI (κ=0.71). Using the AHA/ASA criteria, the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) was significantly lower compared to possible VaMCI (26.7%), non-VaMCI (33.3%), possible VaD (73.3%) and non-VaD (76.2%) )(p<0.001). Similarly, using the DSM-V criteria the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) were significantly lower compared to possible VaMCI (26.3%), non-VaMCI (32.1%), possible VaD (73.3%) and non-VaD (76.2%)(p<0.001). In both criteria, there was good agreement in differentiating individuals with non-VaD and possible VaD, with significantly higher (p<0.001) global [11C]-PiB SUVR, from individuals with probable VaMCI and probable VaD, who had predominant vascular pathology.CONCLUSIONS:The AHA/ASA and DSM-V criteria for VCI can identify VCI cases with little to no concomitant amyloid pathology, hence supporting the utility of AHA/ASA and DSM-V criteria in diagnosing patients with predominant vascular pathology.
{"title":"The AHA/ASA & DSM-V diagnostic criteria for vascular cognitive impairment identify cases with predominant vascular pathology.","authors":"Melmar Folloso, Steven Villaraza, Yi-Wen Lo, Pek-Lan Khong, Tomotaka Tanaka, Saima Hilal, Narayanaswamy Venketasubramanian, Christopher Li-Hsian Chen","doi":"10.1177/17474930241252556","DOIUrl":"https://doi.org/10.1177/17474930241252556","url":null,"abstract":"BACKGROUND:There are major challenges in determining the aetiology of vascular cognitive impairment (VCI) clinically, especially in the presence of mixed pathologies, such as vascular and amyloid. Most recently, two criteria (American Heart Association/American Stroke Association [AHA/ASA] and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-V]) have been proposed for the clinical diagnosis of VCI but have not as yet been validated using neuroimaging.AIMS:This study aims to determine whether the AHA/ASA and DSM-V criteria for VCI can distinguish between cases with predominantly vascular pathology and cases with mixed pathology.METHODS:186 subjects were recruited from a cross-sectional memory clinic-based study at the National University Hospital, Singapore. All subjects underwent clinical and neuropsychological assessment, MRI and [11C] PiB PET scans. Diagnosis of the etiological subtypes of VCI [probable vascular mild cognitive impairment (VaMCI), possible VaMCI, non-VaMCI, probable vascular dementia (VaD), possible VaD, non-VaD] were performed following AHA/ASA and DSM-V criteria. Brain amyloid burden was determined for each subject with standardised uptake value ratio (SUVR) values ≥ 1.5 classified as amyloid positive.RESULTS:Using κ statistics, both criteria had excellent agreement for probable VaMCI, probable VaD, and possible VaD (κ=1.00), and good for possible VaMCI (κ=0.71). Using the AHA/ASA criteria, the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) was significantly lower compared to possible VaMCI (26.7%), non-VaMCI (33.3%), possible VaD (73.3%) and non-VaD (76.2%) )(p<0.001). Similarly, using the DSM-V criteria the amyloid positivity of probable VaMCI (3.8%) and probable VaD (15%) were significantly lower compared to possible VaMCI (26.3%), non-VaMCI (32.1%), possible VaD (73.3%) and non-VaD (76.2%)(p<0.001). In both criteria, there was good agreement in differentiating individuals with non-VaD and possible VaD, with significantly higher (p<0.001) global [11C]-PiB SUVR, from individuals with probable VaMCI and probable VaD, who had predominant vascular pathology.CONCLUSIONS:The AHA/ASA and DSM-V criteria for VCI can identify VCI cases with little to no concomitant amyloid pathology, hence supporting the utility of AHA/ASA and DSM-V criteria in diagnosing patients with predominant vascular pathology.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-23DOI: 10.1177/17474930241252530
Mirthe Coenen, Floor A.S. de Kort, Nick A. Weaver, Hugo J. Kuijf, Hugo Paul Aben, Hee-Joon Bae, Régis Bordet, Christopher LH Chen, Anna Dewenter, Thomas Doeven, Thibaut Dondaine, Marco Duering, Rong Fang, Ruben S van der Giessen, Jonguk Kim, Beom Joon Kim, Paul L.M. de Kort, Peter Koudstaal, Minwoo Lee, Jae-Sung Lim, Renaud Lopes, Robert J. van Oostenbrugge, Julie Staals, Kyung-Ho Yu, Geert Jan Biessels, J. Matthijs Biesbroek
BACKGROUNDPost-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear.AIMWe determined if WMH in strategic white matter tracts explain cognitive performance after stroke.METHODSIndividual patient data from 9 ischemic stroke cohorts with MRI were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major and left inferior fronto-occipital fasciculus.RESULTSThe total study sample consisted of 1568 patients (39.9% female, mean age: 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed, and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume.CONCLUSIONSThese results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH.DATA AVAILABILITYThe Meta VCI Map consortium is dedicated to data sharing, following our guidelines.
{"title":"Strategic white matter hyperintensity locations associated with post-stroke cognitive impairment: a multicenter study in 1568 stroke patients","authors":"Mirthe Coenen, Floor A.S. de Kort, Nick A. Weaver, Hugo J. Kuijf, Hugo Paul Aben, Hee-Joon Bae, Régis Bordet, Christopher LH Chen, Anna Dewenter, Thomas Doeven, Thibaut Dondaine, Marco Duering, Rong Fang, Ruben S van der Giessen, Jonguk Kim, Beom Joon Kim, Paul L.M. de Kort, Peter Koudstaal, Minwoo Lee, Jae-Sung Lim, Renaud Lopes, Robert J. van Oostenbrugge, Julie Staals, Kyung-Ho Yu, Geert Jan Biessels, J. Matthijs Biesbroek","doi":"10.1177/17474930241252530","DOIUrl":"https://doi.org/10.1177/17474930241252530","url":null,"abstract":"BACKGROUNDPost-stroke cognitive impairment (PSCI) occurs in up to 50% of stroke survivors. Presence of pre-existing vascular brain injury, in particular the extent of white matter hyperintensities (WMH), is associated with worse cognitive outcome after stroke, but the role of WMH location in this association is unclear.AIMWe determined if WMH in strategic white matter tracts explain cognitive performance after stroke.METHODSIndividual patient data from 9 ischemic stroke cohorts with MRI were harmonized through the Meta VCI Map consortium. The association between WMH volumes in strategic tracts and domain-specific cognitive functioning (attention and executive functioning, information processing speed, language and verbal memory) was assessed using linear mixed models and lasso regression. We used a hypothesis-driven design, primarily addressing four white matter tracts known to be strategic in memory clinic patients: the left and right anterior thalamic radiation, forceps major and left inferior fronto-occipital fasciculus.RESULTSThe total study sample consisted of 1568 patients (39.9% female, mean age: 67.3 years). Total WMH volume was strongly related to cognitive performance on all four cognitive domains. WMH volume in the left anterior thalamic radiation was significantly associated with cognitive performance on attention and executive functioning and information processing speed, and WMH volume in the forceps major with information processing speed. The multivariable lasso regression showed that these associations were independent of age, sex, education, and total infarct volume and had larger coefficients than total WMH volume.CONCLUSIONSThese results show tract-specific relations between WMH volume and cognitive performance after ischemic stroke, independent of total WMH volume. This implies that the concept of strategic lesions in PSCI extends beyond acute infarcts and also involves pre-existing WMH.DATA AVAILABILITYThe Meta VCI Map consortium is dedicated to data sharing, following our guidelines.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundStroke is a leading cause of mortality and negatively affects health related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at one year post stroke, and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population.MethodsA prospective stroke register was established at the two principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at seven days, 90 days and one year post stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the United Kingdom and Zimbabwean (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at one year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables respectively, was used.ResultsEQ-5D-3L data was available for 373/460 (81.1%), 360/367 (98.1%) and 299/308 (97.1%) participants at 7 days, 90 days and one year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI:-0.16-0.59) at seven days post stroke, to 0.76 (0.47-1.0) at 90 days and remained stable at one year 0.76 (0.49-1.0). Mean QALYs at one year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid haemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, whilst being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0.ConclusionsWe generated QALYs after stroke for the first time in an African country. QALYS were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods.Data AvailabilityThe SISLE anonymised dataset is available upon request to researchers, see data access section.
{"title":"Quality of Life and Quality adjusted Life Years after stroke in Sierra Leone","authors":"Daniel Youkee, Gibrilla Deen, Catherine Sackley, Durodamil Radcliffe Lisk, Iain Marshall, Marina Soley-Bori","doi":"10.1177/17474930241249589","DOIUrl":"https://doi.org/10.1177/17474930241249589","url":null,"abstract":"BackgroundStroke is a leading cause of mortality and negatively affects health related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at one year post stroke, and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population.MethodsA prospective stroke register was established at the two principal adult tertiary government hospitals in Freetown, Sierra Leone. Participants were followed up at seven days, 90 days and one year post stroke to capture all-cause mortality and EQ-5D-3L data. QALYs were calculated at the patient level using EQ-5D-3L utility values and survival data from the register, following the area under the curve method. Utilities were based on the United Kingdom and Zimbabwean (as a sensitivity analysis) EQ-5D value sets, as there is no Sierra Leonean or West African value set. Explanatory models were developed based on previous literature to assess variables associated with HRQoL and QALYs at one year after stroke. To address missing values, Multiple Imputation by Chained Equations (MICE), with linear and logistic regression models for continuous and binary variables respectively, was used.ResultsEQ-5D-3L data was available for 373/460 (81.1%), 360/367 (98.1%) and 299/308 (97.1%) participants at 7 days, 90 days and one year after stroke. For stroke survivors, median EQ-5D-3L utility increased from 0.20 (95% CI:-0.16-0.59) at seven days post stroke, to 0.76 (0.47-1.0) at 90 days and remained stable at one year 0.76 (0.49-1.0). Mean QALYs at one year after stroke were 0.28 (SD: 0.35) and closely associated with stroke severity. Older age, lower educational attainment, patients with subarachnoid haemorrhage and undetermined stroke types all had lower QALYs and lower HRQoL, whilst being the primary breadwinner was associated with higher HRQoL. Sensitivity analysis with the Zimbabwe value set did not significantly change regression results but did influence the absolute values with Zimbabwe utility values being higher, with fewer utility values less than 0.ConclusionsWe generated QALYs after stroke for the first time in an African country. QALYS were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods.Data AvailabilityThe SISLE anonymised dataset is available upon request to researchers, see data access section.","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1177/17474930241246156
Jeffrey M Ashburner, Yuchiao Chang, Bianca Porneala, Sanjula D Singh, Nirupama Yechoor, Jonathan M Rosand, Daniel E Singer, Christopher D Anderson, Steven J Atlas
Background: Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.
Aims: To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.
Methods: Cohort study that included primary care patients from two academic medical centers. Patients were aged 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003 and 2016 (development/internal validation cohort) or 2010 and 2022 (external validation cohort). Predictors of PSCI were ascertained from the electronic health record. The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included.
Results: The analysis included 332 incident diagnoses of PSCI in the development cohort (n = 3741), and 161 and 128 incident diagnoses in the internal (n = 1925) and external (n = 2237) validation cohorts, respectively. The C-statistic for predicting PSCI was 0.731 (95% confidence interval (CI): 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-23 points) risk groups. The hazard ratios (HRs) for incident PSCI were significantly different by risk categories in internal (high, HR: 6.2, 95% CI: 4.1-9.3; Intermediate, HR: 2.7, 95% CI: 1.8-4.1) and external (high, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR: 2.8, 95% CI: 1.9-4.3) validation cohorts.
Conclusion: Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.
Data access statement: Mass General Brigham data contain protected health information and cannot be shared publicly. The data processing scripts used to perform analyses will be made available to interested researchers upon reasonable request to the corresponding author.
{"title":"Predicting post-stroke cognitive impairment using electronic health record data.","authors":"Jeffrey M Ashburner, Yuchiao Chang, Bianca Porneala, Sanjula D Singh, Nirupama Yechoor, Jonathan M Rosand, Daniel E Singer, Christopher D Anderson, Steven J Atlas","doi":"10.1177/17474930241246156","DOIUrl":"10.1177/17474930241246156","url":null,"abstract":"<p><strong>Background: </strong>Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification.</p><p><strong>Aims: </strong>To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records.</p><p><strong>Methods: </strong>Cohort study that included primary care patients from two academic medical centers. Patients were aged 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003 and 2016 (development/internal validation cohort) or 2010 and 2022 (external validation cohort). Predictors of PSCI were ascertained from the electronic health record. The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included.</p><p><strong>Results: </strong>The analysis included 332 incident diagnoses of PSCI in the development cohort (n = 3741), and 161 and 128 incident diagnoses in the internal (n = 1925) and external (n = 2237) validation cohorts, respectively. The C-statistic for predicting PSCI was 0.731 (95% confidence interval (CI): 0.694-0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681-0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0-7 points), intermediate (8-11 points), and high (12-23 points) risk groups. The hazard ratios (HRs) for incident PSCI were significantly different by risk categories in internal (high, HR: 6.2, 95% CI: 4.1-9.3; Intermediate, HR: 2.7, 95% CI: 1.8-4.1) and external (high, HR: 6.1, 95% CI: 3.9-9.6; Intermediate, HR: 2.8, 95% CI: 1.9-4.3) validation cohorts.</p><p><strong>Conclusion: </strong>Five-year risk of PSCI can be accurately predicted using routinely collected data. Model output can be used to risk stratify and identify individuals at increased risk for PSCI for preventive efforts.</p><p><strong>Data access statement: </strong>Mass General Brigham data contain protected health information and cannot be shared publicly. The data processing scripts used to perform analyses will be made available to interested researchers upon reasonable request to the corresponding author.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-11DOI: 10.1177/17474930241242952
Niall M Broomfield, Joshua Blake, Fergus Gracey, Tom Steverson
Background: Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.
Aim and methods: This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.
Results: Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.
Conclusions: More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.
{"title":"Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment.","authors":"Niall M Broomfield, Joshua Blake, Fergus Gracey, Tom Steverson","doi":"10.1177/17474930241242952","DOIUrl":"10.1177/17474930241242952","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect.</p><p><strong>Aim and methods: </strong>This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment.</p><p><strong>Results: </strong>Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions.</p><p><strong>Conclusions: </strong>More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":null,"pages":null},"PeriodicalIF":6.7,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140174662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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