Canadian Journal of Neurological Sciences最新文献

Background: The depression, obstructive sleep apnea and cognitive impairment (DOC) screen assesses three post-stroke comorbidities, but additional information may be gained from the time to complete the screen. Cognitive screening completion time is rarely used as an outcome measure.

Objective: To assess DOC screen completion time as a predictor of cognitive impairment in stroke/transient ischemic attack clinics.

Methods: Consecutive English-speaking stroke prevention clinic patients consented to undergo screening and neuropsychological testing (n = 437). DOC screen scores and times were compared to scores on the NINDS-CSC battery using multiple linear regression (controlling for age, sex, education and stroke severity) and receiver operating characteristic (ROC) curve analysis.

Results: Completion time for the DOC screen was 3.8 ± 1.3 minutes. After accounting for covariates, the completion time was a significant predictor of the speed of processing (p = 0.002, 95% CI: -0.016 to -0.004), verbal fluency (p < 0.001, CI: -0.012 to -0.006) and executive function (p = 0.004, CI: -0.006 to -0.001), but not memory. Completion time above 5.5 minutes was associated with a high likelihood of impairment on executive and speed of processing tasks (likelihood ratios 3.9-5.2).

Conclusions: DOC screen completion time is easy to collect in routine care. People needing over 5.5 minutes to be screened likely have deficits in executive functioning and speed of processing - areas commonly impaired, but challenging to screen for, after stroke. DOC screen time provides a simple, feasible approach to assess these under-identified cognitive impairments.

Background: Although evidence supports the improved safety profile of direct oral anticoagulants (DOACs) over warfarin (WF), outcomes among elderly traumatic brain injury (TBI) patients on this regimen remain unclear. This study describes the association between anticoagulation status (DOAC vs. WF use) and the rates of occurrence of intracranial hemorrhage (ICH), hematoma progression, need for surgical intervention and mortality in elderly TBI cases.

Methods: This retrospective cohort study from 2014 to 2019 included all trauma patients > 65 years on either WF or DOACs at the time of injury. The primary outcome was the rate of ICH after TBI. Multivariable regression analysis identified independent predictors of functional dependency and mortality.

Results: A total of 501 elderly TBI patients (mean age = 82 years old) were included. WF users had higher CT Marshall scores (p = 0.007), more severe TBI (GCS < 8) (p = 0.003) and higher rates of subdural hematomas compared to the DOAC group (p = 0.003). Patients on DOACs had lower rates of ICH (42% vs. 57%, p = 0.001) and hospitalization (30% vs. 41%, p = 0.013) and better Glasgow outcome scale-extended scores at hospital discharge (mean 6.98 vs. 6.41, p = 0.005). Multicompartment ICH (OR 2.30, p = 0.027) and longer hospitalization (OR 0.04, p < 0.001) were associated with higher functional dependency rates, while higher CT Marshall scores (OR 1.09, p < 0.001) and poorer baseline frailty status (OR 0.62, p = 0.026) predicted increased mortality risk.

Conclusion: Elderly TBI patients on DOACs have lower rates of ICH, lower need for hospitalization and better functional outcomes at discharge compared to those taking WF. These findings need further confirmation using prospective multicenter studies.

Increased rehabilitation intensity, the number of minutes of therapy per day, is associated with improved outcomes. However, it is unclear whether males and females receive the same inpatient stroke rehabilitation intensity. A sub-analysis of a retrospective population-based cohort study of adults (5877 females, 6893 males) with stroke discharged to inpatient rehabilitation between 2017 and 2021 was conducted. The mean rehabilitation intensity was 75.86 min/day for males and 73.33 min/day for females (p < .0001). Males <80 years of age were more likely to receive higher rehabilitation intensity than females. Future research should explore what factors account for this sex difference.