Pub Date : 2024-09-01Epub Date: 2024-05-15DOI: 10.1161/STROKEAHA.124.046992
Jenny L Wilson, Alison Christy, Alexis N Simpkins
{"title":"Important Considerations for Diagnosing and Managing Neonatal Ischemic Stroke.","authors":"Jenny L Wilson, Alison Christy, Alexis N Simpkins","doi":"10.1161/STROKEAHA.124.046992","DOIUrl":"10.1161/STROKEAHA.124.046992","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1161/STROKEAHA.124.046821
Alexander Hayes, Scott E Kasner, Christopher G Favilla, Aaron Rothstein, Jens Witsch, Roy H Hamilton, Kelly L Sloane
Transient ischemic attack (TIA) is traditionally viewed as a self-resolving episode of neurological change without persistent impairments and without evidence of acute brain injury on neuroimaging. However, emerging evidence suggests that TIA may be associated with lingering cognitive dysfunction. Cognitive impairment is a prevalent and disabling sequela of ischemic stroke, but the clinical relevance of this phenomenon after TIA is less commonly recognized. We performed a literature search of observational studies of cognitive function after TIA. There is a consistent body of literature suggesting that rates of cognitive impairment following TIA are higher than healthy controls, but the studies included here are limited by heterogeneity in design and analysis methods. We go on to summarize recent literature on proposed pathophysiological mechanisms underlying the development of cognitive impairment following TIA and finally suggest future directions for further research in this field.
传统观点认为,短暂性脑缺血发作(TIA)是一种可自行缓解的神经系统病变,没有持续性损伤,神经影像学上也没有急性脑损伤的证据。然而,新出现的证据表明,TIA 可能与挥之不去的认知功能障碍有关。认知功能障碍是缺血性卒中常见的致残性后遗症,但 TIA 后这一现象的临床相关性较少被认识到。我们对 TIA 后认知功能的观察性研究进行了文献检索。大量文献一致表明,TIA 后认知功能障碍的发生率高于健康对照组,但由于设计和分析方法的异质性,本文纳入的研究受到了限制。我们接着总结了有关 TIA 后认知功能受损的病理生理机制的最新文献,最后提出了该领域未来的研究方向。
{"title":"Not So Transient?: A Narrative Review on Cognitive Impairment After Transient Ischemic Attack.","authors":"Alexander Hayes, Scott E Kasner, Christopher G Favilla, Aaron Rothstein, Jens Witsch, Roy H Hamilton, Kelly L Sloane","doi":"10.1161/STROKEAHA.124.046821","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.046821","url":null,"abstract":"<p><p>Transient ischemic attack (TIA) is traditionally viewed as a self-resolving episode of neurological change without persistent impairments and without evidence of acute brain injury on neuroimaging. However, emerging evidence suggests that TIA may be associated with lingering cognitive dysfunction. Cognitive impairment is a prevalent and disabling sequela of ischemic stroke, but the clinical relevance of this phenomenon after TIA is less commonly recognized. We performed a literature search of observational studies of cognitive function after TIA. There is a consistent body of literature suggesting that rates of cognitive impairment following TIA are higher than healthy controls, but the studies included here are limited by heterogeneity in design and analysis methods. We go on to summarize recent literature on proposed pathophysiological mechanisms underlying the development of cognitive impairment following TIA and finally suggest future directions for further research in this field.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-29DOI: 10.1161/STROKEAHA.124.047907
Melanie Walker, Emma Federico, Josh L Espinoza, Christopher L Dupont
{"title":"Unveiling Molecular Diversity in Cerebral Thrombi via Spatial Transcriptomics.","authors":"Melanie Walker, Emma Federico, Josh L Espinoza, Christopher L Dupont","doi":"10.1161/STROKEAHA.124.047907","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.047907","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1161/STROKEAHA.124.048352
Sanjula D Singh, Jasper R Senff, Jose Rafael Romero
{"title":"Is Psychosocial Health a Neglected Modifier of the Link Between Cerebral Small Vessel Disease and Dementia?","authors":"Sanjula D Singh, Jasper R Senff, Jose Rafael Romero","doi":"10.1161/STROKEAHA.124.048352","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048352","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1161/STROKEAHA.124.047455
Surabhee Eswaran, David S Knopman, Silvia Koton, Anna M Kucharska-Newton, Albert C Liu, Chelsea Liu, Pamela L Lutsey, Thomas H Mosley, Priya Palta, A Richey Sharrett, Kevin J Sullivan, Keenan A Walker, Rebecca F Gottesman, Renee C Groechel
Background: Associations between magnetic resonance imaging markers of cerebral small vessel disease (CSVD) and dementia risk in older adults have been established, but it remains unclear how lifestyle factors, including psychosocial health, may modify this association.
Methods: Social support and social isolation were assessed among participants of the community-based ARIC (Atherosclerosis Risk in Communities) Study, via self-reported questionnaires (1990-1992). Following categorization of both factors, participants were classified as having strong or poor mid-life social relationships. At visit 5 (2011-2013), participants underwent 3T brain magnetic resonance imaging quantifying CSVD measures: white matter hyperintensity volume, microbleeds (subcortical), infarcts (lacunar), and white matter integrity (diffusion tensor imaging). Incident dementia cases were identified from the time of imaging through December 31, 2020 with ongoing surveillance. Associations between CSVD magnetic resonance imaging markers and incident dementia were evaluated using Cox proportional-hazard regressions adjusted for demographic and additional risk factors (from visit 2). Effect modification by mid-life social relationships was evaluated.
Results: Of the 1977 participants with magnetic resonance imaging, 1617 participants (60.7% women; 26.5% Black participants; mean age at visit 2, 55.4 years) were examined. In this sample, mid-life social relationships significantly modified the association between white matter hyperintensity volume and dementia risk (P interaction=0.001). Greater white matter hyperintensity volume was significantly associated with risk of dementia in all participants, yet, more substantially in those with poor (hazard ratio, 1.84 [95% CI, 1.49-2.27]) versus strong (hazard ratio, 1.26 [95% CI, 1.08-1.47]) mid-life social relationships. Although not statistically significant, subcortical microbleeds in participants with poor mid-life social relationships were associated with a greater risk of dementia, relative to those with strong social relationships, in whom subcortical microbleeds were no longer associated with elevated dementia risk.
Conclusions: The elevated risk of dementia associated with CSVD may be reduced in participants with strong mid-life social relationships. Future studies evaluating psychosocial health through the life course and the mechanisms by which they modify the relationship between CSVD and dementia are needed.
{"title":"Psychosocial Health and the Association Between Cerebral Small Vessel Disease Markers With Dementia: The ARIC Study.","authors":"Surabhee Eswaran, David S Knopman, Silvia Koton, Anna M Kucharska-Newton, Albert C Liu, Chelsea Liu, Pamela L Lutsey, Thomas H Mosley, Priya Palta, A Richey Sharrett, Kevin J Sullivan, Keenan A Walker, Rebecca F Gottesman, Renee C Groechel","doi":"10.1161/STROKEAHA.124.047455","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.047455","url":null,"abstract":"<p><strong>Background: </strong>Associations between magnetic resonance imaging markers of cerebral small vessel disease (CSVD) and dementia risk in older adults have been established, but it remains unclear how lifestyle factors, including psychosocial health, may modify this association.</p><p><strong>Methods: </strong>Social support and social isolation were assessed among participants of the community-based ARIC (Atherosclerosis Risk in Communities) Study, via self-reported questionnaires (1990-1992). Following categorization of both factors, participants were classified as having strong or poor mid-life social relationships. At visit 5 (2011-2013), participants underwent 3T brain magnetic resonance imaging quantifying CSVD measures: white matter hyperintensity volume, microbleeds (subcortical), infarcts (lacunar), and white matter integrity (diffusion tensor imaging). Incident dementia cases were identified from the time of imaging through December 31, 2020 with ongoing surveillance. Associations between CSVD magnetic resonance imaging markers and incident dementia were evaluated using Cox proportional-hazard regressions adjusted for demographic and additional risk factors (from visit 2). Effect modification by mid-life social relationships was evaluated.</p><p><strong>Results: </strong>Of the 1977 participants with magnetic resonance imaging, 1617 participants (60.7% women; 26.5% Black participants; mean age at visit 2, 55.4 years) were examined. In this sample, mid-life social relationships significantly modified the association between white matter hyperintensity volume and dementia risk (<i>P</i> interaction=0.001). Greater white matter hyperintensity volume was significantly associated with risk of dementia in all participants, yet, more substantially in those with poor (hazard ratio, 1.84 [95% CI, 1.49-2.27]) versus strong (hazard ratio, 1.26 [95% CI, 1.08-1.47]) mid-life social relationships. Although not statistically significant, subcortical microbleeds in participants with poor mid-life social relationships were associated with a greater risk of dementia, relative to those with strong social relationships, in whom subcortical microbleeds were no longer associated with elevated dementia risk.</p><p><strong>Conclusions: </strong>The elevated risk of dementia associated with CSVD may be reduced in participants with strong mid-life social relationships. Future studies evaluating psychosocial health through the life course and the mechanisms by which they modify the relationship between CSVD and dementia are needed.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-26DOI: 10.1161/STROKEAHA.124.047483
Vivek Yedavalli, Hamza Adel Salim, Janet Mei, Dhairya A Lakhani, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Adam A Dmytriw, Adrien Guenego, Tobias D Faizy, Jeremy J Heit, Gregory W Albers, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E Hillis, Raf Llinas
Background: Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores.
Methods: In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita-East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow <30% and ≥50 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score <6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) <34%, 38%, 42%, and relative cerebral blood flow >20%, 30%, 34%, 38%, and time-to-maximum >4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4-6). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT.
Results: We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV<42% ≥68 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4-6) with an area under the curve of 0.90 (95% CI, 0.82-0.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the ≥68 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum >8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV<42% ≥68 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75-1.00]).
Conclusions: CBV<42% ≥68 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.
{"title":"Decreased Quantitative Cerebral Blood Volume Is Associated With Poor Outcomes in Large Core Patients.","authors":"Vivek Yedavalli, Hamza Adel Salim, Janet Mei, Dhairya A Lakhani, Aneri Balar, Basel Musmar, Nimer Adeeb, Meisam Hoseinyazdi, Licia Luna, Francis Deng, Nathan Z Hyson, Adam A Dmytriw, Adrien Guenego, Tobias D Faizy, Jeremy J Heit, Gregory W Albers, Hanzhang Lu, Victor C Urrutia, Kambiz Nael, Elisabeth B Marsh, Argye E Hillis, Raf Llinas","doi":"10.1161/STROKEAHA.124.047483","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.047483","url":null,"abstract":"<p><strong>Background: </strong>Recent large core trials have highlighted the effectiveness of mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion. Variable perfusion-imaging thresholds and poor Alberta Stroke Program Early Computed Tomography Score reliability underline the need for more standardized, quantitative ischemia measures for MT patient selection. We aimed to identify the computed tomography perfusion parameter most strongly associated with poor outcomes in patients with acute ischemic stroke-large vessel occlusion with significant ischemic cores.</p><p><strong>Methods: </strong>In this study from 2 comprehensive stroke centers from 2 comprehensive stroke centers within the Johns Hopkins Medical Enterprise (Johns Hopkins Hospita-East Baltimore and Bayview Medical Campus) from July 29, 2019 to January 29, 2023 in a continuously maintained database, we included patients with acute ischemic stroke-large vessel occlusion with ischemic core volumes defined as relative cerebral blood flow <30% and ≥50 mL on computed tomography perfusion or Alberta Stroke Program Early Computed Tomography Score <6. We used receiver operating characteristics to find the optimal cutoff for parameters like cerebral blood volume (CBV) <34%, 38%, 42%, and relative cerebral blood flow >20%, 30%, 34%, 38%, and time-to-maximum >4, 6, 8, and 10 seconds. The primary outcome was unfavorable outcomes (90-day modified Rankin Scale score 4-6). Multivariable models were adjusted for age, sex, diabetes, baseline National Institutes of Health Stroke Scale, intravenous thrombolysis, and MT.</p><p><strong>Results: </strong>We identified 59 patients with large ischemic cores. A receiver operating characteristic curve analysis showed that CBV<42% ≥68 mL is associated with unfavorable outcomes (90-day modified Rankin Scale score 4-6) with an area under the curve of 0.90 (95% CI, 0.82-0.99) in the total and MT-only cohorts. Dichotomizing at this CBV threshold, patients in the ≥68 mL group exhibited significantly higher relative cerebral blood flow, time-to-maximum >8 and 10 seconds volumes, higher CBV volumes, higher HIR, and lower CBV index. The multivariable model incorporating CBV<42% ≥68 mL predicted poor outcomes robustly in both cohorts (area under the curve for MT-only subgroup was 0.87 [95% CI, 0.75-1.00]).</p><p><strong>Conclusions: </strong>CBV<42% ≥68 mL most effectively forecasts poor outcomes in patients with large-core stroke, confirming its value alongside other parameters like time-to-maximum in managing acute ischemic stroke-large vessel occlusion.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1161/STROKEAHA.124.048458
Célia Delcamp, Ramesh Srinivasan, Steven C Cramer
In many branches of medicine, treatment is guided by measuring its effects on underlying physiology. In this regard, the efficacy of rehabilitation/recovery therapies could be enhanced if their administration was guided by measurements that directly capture treatment effects on neural function. Measures of brain function via EEG may be useful toward this goal and have advantages such as ease of bedside acquisition, safety, and low cost. This review synthetizes EEG studies during the subacute phase poststroke, when spontaneous recovery is maximal, and focuses on movement. Event-related measures reflect cortical activation and inhibition, while connectivity measures capture the function of cortical networks. Several EEG-based measures are related to motor outcomes poststroke and warrant further evaluation. Ultimately, they may be useful for clinical decision-making and clinical trial design in stroke neurorehabilitation.
{"title":"EEG Provides Insights Into Motor Control and Neuroplasticity During Stroke Recovery.","authors":"Célia Delcamp, Ramesh Srinivasan, Steven C Cramer","doi":"10.1161/STROKEAHA.124.048458","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.048458","url":null,"abstract":"<p><p>In many branches of medicine, treatment is guided by measuring its effects on underlying physiology. In this regard, the efficacy of rehabilitation/recovery therapies could be enhanced if their administration was guided by measurements that directly capture treatment effects on neural function. Measures of brain function via EEG may be useful toward this goal and have advantages such as ease of bedside acquisition, safety, and low cost. This review synthetizes EEG studies during the subacute phase poststroke, when spontaneous recovery is maximal, and focuses on movement. Event-related measures reflect cortical activation and inhibition, while connectivity measures capture the function of cortical networks. Several EEG-based measures are related to motor outcomes poststroke and warrant further evaluation. Ultimately, they may be useful for clinical decision-making and clinical trial design in stroke neurorehabilitation.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1161/STROKEAHA.124.044507
Eman M Khedr, Ghada Al-Attar, Julieta Rosales, Gisele Sampaio Silva, Ivy Anne Sebastian, Karen D Orjuela, Ana Cláudia de Souza
{"title":"Strategies to Advance Stroke Care in Women: An International Conversation.","authors":"Eman M Khedr, Ghada Al-Attar, Julieta Rosales, Gisele Sampaio Silva, Ivy Anne Sebastian, Karen D Orjuela, Ana Cláudia de Souza","doi":"10.1161/STROKEAHA.124.044507","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.044507","url":null,"abstract":"","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-19DOI: 10.1161/STR.0000000000000471
Patricia A Zrelak, Karen B Seagraves, Samir Belagaje, Wendy Dusenbury, James J García, Niloufar N Hadidi, Kiffon M Keigher, Mary Love, Gianluca Pucciarelli, Erica Schorr, Cesar Velasco
Introduction: Stroke can have profound psychosocial health implications. These constructs are often overlooked and undertreated yet can be as devastating as the physical, functional, and cognitive consequences after stroke.
Aim: This scientific statement aims to evaluate 5 important aspects of psychosocial health (depression, stress, anxiety, fatigue, and quality of life) after a stroke to provide a framework for related nursing care across the poststroke continuum.
Methods: A narrative review of the literature published from 2018 to 2023 was conducted with databases such as PubMed/MEDLINE, ClinicalTrials.gov, PsychInfo/EBSCOHost, PsychArticles, CINHAL, and the Cochrane Library.
Results: Findings reveal a gap in evidence-based nursing interventions for addressing poststroke psychosocial needs. Critical strategies for shaping therapeutic nursing care include enhanced screening with validated tools; educating stroke survivors, families, and staff on symptom recognition, prevention, and treatment; and ensuring appropriate pharmacological management and access to psychological and psychosocial interventions, including referrals to social services and other essential support systems. Care should be comprehensive and interdisciplinary. Nurse-led research can benefit from more inclusive inclusion, including individuals with recurrent strokes and preexisting psychosocial conditions, focusing on the impact of structural racism and care disparities and expanding evidence-based nursing interventions.
Conclusions: Although there is limited high-level evidence on the nursing care for patients with suboptimal psychosocial health after stroke, nurses have a crucial role in addressing these needs. Enhanced screening, assessment, supportive services, and education are vital to ensure that patients receive the necessary treatment and care.
{"title":"Nursing's Role in Psychosocial Health Management After a Stroke Event: A Scientific Statement From the American Heart Association.","authors":"Patricia A Zrelak, Karen B Seagraves, Samir Belagaje, Wendy Dusenbury, James J García, Niloufar N Hadidi, Kiffon M Keigher, Mary Love, Gianluca Pucciarelli, Erica Schorr, Cesar Velasco","doi":"10.1161/STR.0000000000000471","DOIUrl":"https://doi.org/10.1161/STR.0000000000000471","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke can have profound psychosocial health implications. These constructs are often overlooked and undertreated yet can be as devastating as the physical, functional, and cognitive consequences after stroke.</p><p><strong>Aim: </strong>This scientific statement aims to evaluate 5 important aspects of psychosocial health (depression, stress, anxiety, fatigue, and quality of life) after a stroke to provide a framework for related nursing care across the poststroke continuum.</p><p><strong>Methods: </strong>A narrative review of the literature published from 2018 to 2023 was conducted with databases such as PubMed/MEDLINE, ClinicalTrials.gov, PsychInfo/EBSCOHost, PsychArticles, CINHAL, and the Cochrane Library.</p><p><strong>Results: </strong>Findings reveal a gap in evidence-based nursing interventions for addressing poststroke psychosocial needs. Critical strategies for shaping therapeutic nursing care include enhanced screening with validated tools; educating stroke survivors, families, and staff on symptom recognition, prevention, and treatment; and ensuring appropriate pharmacological management and access to psychological and psychosocial interventions, including referrals to social services and other essential support systems. Care should be comprehensive and interdisciplinary. Nurse-led research can benefit from more inclusive inclusion, including individuals with recurrent strokes and preexisting psychosocial conditions, focusing on the impact of structural racism and care disparities and expanding evidence-based nursing interventions.</p><p><strong>Conclusions: </strong>Although there is limited high-level evidence on the nursing care for patients with suboptimal psychosocial health after stroke, nurses have a crucial role in addressing these needs. Enhanced screening, assessment, supportive services, and education are vital to ensure that patients receive the necessary treatment and care.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-15DOI: 10.1161/STROKEAHA.124.046679
Jinru Feng, Zixiao Li
Low-intensity focused ultrasound represents groundbreaking medical advancements, characterized by its noninvasive feature, safety, precision, and broad neuromodulatory capabilities. This technology operates through mechanisms, for example, acoustic radiation force, cavitation, and thermal effects. Notably, with the evolution of medical technology, ultrasound neuromodulation has been gradually applied in treating central nervous system diseases, especially stroke. Furthermore, burgeoning research areas such as sonogenetics and nanotechnology show promising potential. Despite the benefit of low-intensity focused ultrasound the precise biophysical mechanism of ultrasound neuromodulation still need further exploration. This review discusses the recent and ongoing developments of low-intensity focused ultrasound for neurological regulation, covering the underlying rationale to current utility and the challenges that impede its further development and broader adoption of this promising alternative to noninvasive therapy.
{"title":"Progress in Noninvasive Low-Intensity Focused Ultrasound Neuromodulation.","authors":"Jinru Feng, Zixiao Li","doi":"10.1161/STROKEAHA.124.046679","DOIUrl":"https://doi.org/10.1161/STROKEAHA.124.046679","url":null,"abstract":"<p><p>Low-intensity focused ultrasound represents groundbreaking medical advancements, characterized by its noninvasive feature, safety, precision, and broad neuromodulatory capabilities. This technology operates through mechanisms, for example, acoustic radiation force, cavitation, and thermal effects. Notably, with the evolution of medical technology, ultrasound neuromodulation has been gradually applied in treating central nervous system diseases, especially stroke. Furthermore, burgeoning research areas such as sonogenetics and nanotechnology show promising potential. Despite the benefit of low-intensity focused ultrasound the precise biophysical mechanism of ultrasound neuromodulation still need further exploration. This review discusses the recent and ongoing developments of low-intensity focused ultrasound for neurological regulation, covering the underlying rationale to current utility and the challenges that impede its further development and broader adoption of this promising alternative to noninvasive therapy.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141983217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}