Abstract

This narrative review provides a summary introduction to the relationship between stroke and physical and cognitive frailty syndromes and the neuro-inflammatory similarities (including inflammaging) between the two. The review argues the potential effects of Post COVID-19 Neurological Syndrome (PCNS, also known as Long COVID) with similar pathophysiology. Many patients who have suffered from acute stroke experience long-lasting symptoms affecting several organs including fatigue, brain fog, reduced physical activity, loss of energy, and loss of cognitive reserve, culminating in the loss of independence and poor quality of life. This is very similar to the emerging reports of PCNS from different parts of the world. Stroke, particularly in older adults with comorbidities appears to impact the health and welfare of patients by reducing central neuronal input and neuromuscular function, with muscular atrophy and neuropsychiatric complications. The cumulative effects can potentially lead to a range of physical and cognitive frailty syndromes, which, in many cases may be attributed to persistent, maladapted, low grade, chronic inflammation. Meanwhile, post-COVID-19 Neurological Syndrome (also known as Long COVID Syndrome) appears to share a similar trajectory, adding further urgency for investigations into the mechanisms underlying this constellation of symptoms.

Highlights

  • StrokeStroke is a leading cause of morbidity, disability, dependency and mortality globally

  • Stroke is a leading cause of morbidity, disability, dependency and mortality globally.Age-adjusted stroke incidence ranges from 76 to 119/100,000/year depending on the country [1,2]

  • Considering the common risk factors that predict the severity of both conditions, this narrative review will discuss the potential causes of disability and frailty in stroke patients

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Summary

Stroke

Stroke is a leading cause of morbidity, disability, dependency and mortality globally. Post-stroke, over 60% of patients experience some form of disability, with half severely so. Range of syndromes from immunodeficiency [6] to musculoskeletal dysfunction [7,8,9], concurrent cardiovascular disease [10], central post-stroke pain [11], neurogenic bladder [12]. This diverse range of outcomes may occur regardless of the location of damage, if the part of the brain directly controlling the organ/system is intact [14]. Psychiatric complications from stroke are well documented and include depression, functional disability, fatigue, cognitive impairment and decreased sexual activity [15,16,17,18,19]. Pre-frailty and frailty have been linked to a high risk of cardiovascular disease and stroke [10]

Frailty
Diagnosis of Frailty
Aetiology of Frailty as a Musculoskeletal Disorder
Frailty in Stroke Patients
Motor-Cognitive Pathways Decline
Inflammatory Mediators and Other Potential Factors
Findings
Conclusions
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