Chronic Stroke Research Articles

Effects of Home-Based Daily Respiratory Muscle Training on Swallowing Outcomes in Patients with Chronic Stroke: Protocol for a Randomized Controlled Trial.

(1) Background: Swallowing disorders are common following a stroke. This study aims to evaluate the effects of a home-based daily intervention focused on inspiratory and expiratory muscle training on swallowing outcomes in patients with chronic stroke. (2) Methods: This manuscript presents the protocol of a single-blind randomized clinical trial. Patients with chronic stroke will be randomly assigned to either an experimental or a control group. The experimental group will undergo daily home-based respiratory muscle training in addition to standard speech and language therapy, while the control group will receive only the standard intervention. The main outcome measures will include the aspiration risk, the strength of respiratory muscles, and peak cough flow. (3) Results: It is hypothesized that patients receiving home-based respiratory training in addition to standard therapy will achieve significant improvements in aspiration risk, respiratory muscle strength, and cough efficacy in comparison with those included in the control group. The results will be published as a manuscript. (4) Conclusions: This study aims to provide evidence on the effectiveness of home-based respiratory muscle training in enhancing swallowing function and respiratory parameters in patients with chronic stroke.

Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study.

To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n = 3) providing the intervention and individual semi-structured interviews with the participants (n = 15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. The following themes were identified: (1) Equal partnership; (2) Enhancing clinician confidence; and (3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation as a potential barrier. Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention.

Effect of PM2.5 on burden of mortality from non-communicable diseases in northern Thailand.

Particulate pollution, especially PM2.5from biomass burning, affects public and human health in northern Thailand during the dry season. Therefore, PM2.5exposure increases non-communicable disease incidence and mortality. This study examined the relationship between PM2.5and NCD mortality, including heart disease, hypertension, chronic lung disease, stroke, and diabetes, in northern Thailand during 2017-2021. The analysis utilized accurate PM2.5data from the MERRA2 reanalysis, along with ground-based PM2.5measurements from the Pollution Control Department and mortality data from the Division of Non-Communicable Disease, Thailand. The cross-correlation and spearman coefficient were utilized for the time-lag, and direction of the relationship between PM2.5and mortality from NCDs, respectively. The Hazard Quotient (HQ) was used to quantify the health risk of PM2.5to people in northern Thailand. High PM2.5 risk was observed in March, with peak PM2.5concentration reaching 100 µg/m3, with maximum HQ values of 1.78±0.13 to 4.25±0.35 and 1.45±0.11 to 3.46±0.29 for males and females, respectively. Hypertension significantly correlated with PM2.5levels, followed by chronic lung disease and diabetes. The cross-correlation analysis showed a strong relationship between hypertansion mortality and PM2.5at a two-year time lag in Chiang Mai (0.73) (CI [-0.43-0.98], p-value of 0.0270) and a modest relationship with chronic lung disease at Lampang (0.33) (a four-year time lag). The results from spearman correlation analysis showed that PM2.5concentrations were associated with diabetes mortality in Chiang Mai, with a coefficient of 0.9 (CI [0.09-0.99], p-value of 0.03704). Lampang and Phayao had significant associations between PM2.5 and heart disease, with coefficients of 0.97 (CI [0.66-0.99], p-value of 0.0048) and 0.90 (CI [0.09-0.99], p-value of 0.0374), respectively, whereas Phrae had a high coefficient of 0.99 on stroke.

Visuospatial Skills Explain Differences in the Ability to Use Propulsion Biofeedback Post-stroke.

Visual biofeedback can be used to help people post-stroke reduce biomechanical gait impairments. Using visual biofeedback engages an explicit, cognitively demanding motor learning process. Participants with better overall cognitive function are better able to use visual biofeedback to promote locomotor learning; however, which specific cognitive domains are responsible for this effect are unknown. We aimed to understand which cognitive domains were associated with performance during acquisition and immediate retention when using visual biofeedback to increase paretic propulsion in individuals post-stroke. Participants post-stroke completed cognitive testing, which provided scores for different cognitive domains, including executive function, immediate memory, visuospatial/constructional skills, language, attention, and delayed memory. Next, participants completed a single session of paretic propulsion biofeedback training, where we collected treadmill-walking data for 20min with biofeedback and 2min without biofeedback. We fit separate regression models to determine if cognitive domain scores, motor impairment (measured with the lower-extremity Fugl-Meyer), and gait speed could explain propulsion error and variability during biofeedback use and recall error during immediate retention. Visuospatial/constructional skills and motor impairment best-explained propulsion error during biofeedback use (adjusted R 2 =0.56, P =0.0008), and attention best-explained performance variability (adjusted R 2 =0.17, P =0.048). Language skills best-explained recall error during immediate retention (adjusted R 2 =0.37, P =0.02). These results demonstrate that specific cognitive domain impairments explain variability in locomotor learning outcomes in individuals with chronic stroke. This suggests that with further investigation, specific cognitive impairment information may be useful to predict responsiveness to interventions and personalize training parameters to facilitate locomotor learning.

Vagus Nerve Stimulation Paired With Rehabilitation for Chronic Stroke: Characterizing Responders.

Implantable vagus nerve stimulation (VNS) paired with volitional upper extremity rehabilitation can improve impairment and function among moderately to severely impaired, chronic stroke survivors. This study is a retrospective analysis of the in-clinic rehabilitation phase of the blinded, placebo-controlled, randomized pivotal VNS-REHAB trial to determine whether dosing parameters during in-clinic paired VNS therapy were associated with responder status and whether covariates might impact that determination. Data were limited to 53 participants in the active VNS group who had received VNS implants prior to undergoing 6weeks of in-clinic rehabilitation paired with VNS. Tasks were standardized across all participants. Dosing parameters included number of stimulations and task time. The primary outcome was the Fugl-Meyer Upper Extremity Assessment (FMA-UE), evaluated at the end of 6weeks (Post-1). Participants were classified a priori as responders based on an improvement of≥6 points on the FMA-UE from baseline to Post-1. Dosing parameters were not associated with FMA-UE responder status at the end of 6weeks. Covariates including age, gender, paretic hand, baseline severity, and chronicity of stroke were also not significant associations of response. While responders to VNS could be defined, therapy dosing and participant attributes did not provide greater specification for association of responder status. Limitations of this study include small sample size and non-linearity of the FMA-UE. Future studies will include reassessing responder categorization using more linear scales and examining stroke lesion characteristics to determine whether these measures are more sensitive to dosing parameters. for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://www.w3.org/1999/xlink ).

The Blood-Cerebrospinal Fluid Barrier Dysfunction in Brain Disorders and Stroke: Why, How, What For?

Ischemic stroke (IS) results in the interruption of blood flow to the brain, which can cause significant damage. The pathophysiological mechanisms of IS include ionic imbalances, oxidative stress, neuroinflammation, and impairment of brain barriers. Brain barriers, such as the blood-brain barrier (BBB) and the blood-cerebrospinal fluid (CSF)barrier (B-CSF), protect the brain from harmful substances by regulating the neurochemical environment. Although the BBB is widely recognized for its crucial role in protecting the brain and its involvement in conditions such as stroke, the B-CSF requires further study. The B-CSF plays a fundamental role in regulating the CSF environment and maintaining the homeostasis of the central nervous system (CNS). However, the impact of B-CSF impairment during pathological events such as IS is not yet fully understood. In conditions like IS and other neurological disorders, the B-CSF can become compromised, allowing the entry of inflammatory substances and increasing neuronal damage. Understanding and preserving the integrity of the B-CSF are crucial for mitigating damage and facilitating recovery after ischemic stroke, highlighting its fundamental role in regulating the CNS during adverse neurological conditions.

Sensor-Based Balance Training with Exergaming Feedback in Subjects with Chronic Stroke: A Pilot Randomized Controlled Trial.

As one of the leading causes of disability in the world, stroke can determine a reduction of balance performance with a negative impact on daily activity and social life. In this study, we aimed to evaluate the effects of sensor-based balance training with exergaming feedback on balance skills in chronic stroke patients. 21 individuals (11F, 57.14 ± 13.82 years) with a single event of ischemic stroke were randomly assigned to the sensor-based balance training group (SB-group) or the usual care balance training group (UC-group). Both groups received 10 add-on sessions with exergaming feedback (SB-group) or conventional training (UC-group). Clinical and instrumental evaluation was performed before (t0), after (t1), and after one month (t2) from intervention. Participation level was assessed using the Pittsburgh Rehabilitation Participation Scale at the end of each session. The SB-group showed an improvement in postural stability (p = 0.02) when compared to the UC-group. In the evaluation of motivational level, the score was statistically higher in the SB-group with respect to the UC-group (p < 0.01). Except for the improvement in postural stability, no difference was recorded in clinical score, suggesting a comparable gain in both groups. However, patients undergoing sensor-based training exhibited a higher participation score, ultimately indicating the use of this training to improve the adherence to rehabilitation settings, especially in patients with lower compliance.

Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial.

Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability. Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ± 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST. We report clinically meaningful (≥ 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST. Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration.

Age-related differences in the number of chronic diseases in association with trajectories of depressive symptoms: a population-based cohort study

BackgroundThe number of chronic diseases has been associated with changes in depressive symptoms over time among middle-aged and older adults. This study aimed to explore the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.MethodsA total of 12,974 middle-aged and older Chinese adults (≥ 45 years) participated in the China Health and Retirement Longitudinal Study (CHARLS) in waves 2011, 2013, 2015, 2018, and 2020. The number of chronic diseases was determined by self-reported hospital diagnosis of hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, heart diseases, stroke, kidney diseases, digestive diseases, emotional, nervous, or psychiatric problems, memory-related disease, arthritis or rheumatism, asthma, and then obtaining the total number of chronic diseases. Depressive symptoms were measured by the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Group-based trajectory modeling (GBTM) was adopted to capture the trajectories of depressive symptoms over time. Multinomial logistic regressions were conducted to examine the association between the number of chronic diseases and trajectories of depressive symptoms and the role of age in this association.ResultsFour distinct trajectories of depressive symptoms were observed in 34.68% individuals in mild, 40.76% in moderate, 19.41% in increasing, and 5.15% in severe group. Compared to participants without chronic diseases, those with one, two, three or more chronic diseases had a 1.81, 3, and 7.49-fold higher risk of developing severe depressive symptom trajectory, respectively. Moreover, the association between the number of chronic diseases and severe depressive symptoms trajectory differed by age (45–59 and ≥ 60 years) (P for interaction < 0.05).ConclusionParticipants with middle age may play a promoting role in the association between the number of chronic disease and severe depressive symptoms. The severe depressive symptoms intervention may be more beneficial for middle-aged adults.

Role and Outcomes of Supported Community Living Programs in Post-Hospital Brain Injury Rehabilitation Programs.

(1) To determine the proportion of participants admitted to supported community living (SCL) programs over the course of 5 years who improve, decline, or maintain functioning and community integration and (2) to examine the associations of time since injury, time in program, and age to their functional trajectory. Data from SCL programs serving individuals with acquired brain injury (ABI). 104 individuals with traumatic brain injury (TBI), stroke, or other ABI. Sex, age, time since injury, Mayo-Portland Adaptability Inventory (4th edition; MPAI-4). Retrospective analyses of MPAI-4 total and MPAI-4 indices using Linear Mixed Models (LMM) of Rasch-derived T-scores from admission to 5 years into service delivery. MPAI-4total, index, and subscale scores for yearly intervals of SCL services from admission to 5years showed a high degree of stability in function (defined using the standard error of measurement (SEM) for the MPAI-4, defined as change≥3T-score points) with all intervals showing at least 89% of patients with improved scores or no change. The rate of change over time did not significantly vary by time since injury, time in the program, or age. The expectations for services in the SCL portion of the care continuum for ABI are unique. Unlike intensive rehabilitation programs which focus on improvement often earlier in the course of recovery, the goal of SCL services is sustained functioning over the long term. Analyses reported here indicate this can be achieved for at least 5years, potentially mitigating the increased risk for rehospitalization and increased care needs in the ABI population. This study highlights a key finding of MPAI-4 stability within these understudied brain injury service lines. Additional exploration of comorbidities and more nuanced delineation of diagnostic information could further clarify factors influencing outcome stability over time.

Diffusion Models for Counterfactual Generation and Anomaly Detection in Brain Images.

Segmentation masks of pathological areas are useful in many medical applications, such as brain tumour and stroke management. Moreover, healthy counterfactuals of diseased images can be used to enhance radiologists' training files and to improve the interpretability of segmentation models. In this work, we present a weakly supervised method to generate a healthy version of a diseased image and then use it to obtain a pixel-wise anomaly map. To do so, we start by considering a saliency map that approximately covers the pathological areas, obtained with ACAT. Then, we propose a technique that allows to perform targeted modifications to these regions, while preserving the rest of the image. In particular, we employ a diffusion model trained on healthy samples and combine Denoising Diffusion Probabilistic Model (DDPM) and Denoising Diffusion Implicit Model (DDIM) at each step of the sampling process. DDPM is used to modify the areas affected by a lesion within the saliency map, while DDIM guarantees reconstruction of the normal anatomy outside of it. The two parts are also fused at each timestep, to guarantee the generation of a sample with a coherent appearance and a seamless transition between edited and unedited parts. We verify that when our method is applied to healthy samples, the input images are reconstructed without significant modifications. We compare our approach with alternative weakly supervised methods on the task of brain lesion segmentation, achieving the highest mean Dice and IoU scores among the models considered.

TCM in post stroke brain remodeling: Research advances

Brain functional remodeling is fundamental to the recovery from stroke and is one of the hot topics in modern brain science research, involving various factors such as neurophysiology, neurochemistry, and neuroimaging. Traditional Chinese Medicine (TCM), with its multi-target and multi-stage effects on the body, has unique advantages in improving neurological functions and promoting brain functional remodeling. Current research mainly focuses on monotherapy with Chinese herbs, compound prescriptions, and acupuncture, among other aspects. This paper summarizes their effects and related mechanisms, aiming to provide theoretical support for the clinical application of TCM in promoting brain function recovery after stroke.

Articulated ankle-foot orthoses associated with home-based task-specific training improve functional mobility in patients with stroke: a randomized clinical trial

ABSTRACT Introduction We compared fixed and articulated ankle-foot orthoses (AFOs) in home-based mobility tasks to assess short-term mobility, dynamic balance, quality of life, anxiety/depression, disability level, stroke severity, autonomy, human functioning, and patient satisfaction. Methods This was a two-arm, parallel-group, randomized controlled trial with concealed allocation, assessor blinding, and a complete case analysis involving patients with chronic stroke. The participants were randomized into two groups: fixed (n = 24) and articulated (n = 23) AFOs. The AFOs were custom-fabricated, and both groups performed four-week home-based mobility tasks five days weekly. Primary outcome measures included changes in balance and mobility assessed using the Tinetti Performance-Oriented Mobility Assessment (POMA), Timed Up and Go (TUG) test, and Functional Ambulation Category (FAC). Secondary outcomes included quality of life, anxiety/depression, disability, stroke severity, autonomy, human functioning, and patient satisfaction. Results In a between-group comparison, after adjusting for age, sex, stroke severity, and thrombolysis, the articulated AFO group showed better performance in the TUG test (p = 0.020; d = 0.93), POMA-Gait (p = 0.001; d = 0.53), POMA-Total (p = 0.048; d = 0.98), and FAC (p = 0.003; d = 1.03) than the fixed AFO group. Moreover, significant difference was noted in human functioning (moving around using equipment)between the groups (p = 0.047; d = 92). Conclusion A program involving home-based mobility tasks and articulated AFOs improved functional mobility after stroke.

B - 92 Memory Rehabilitation Following Stroke and Traumatic Brain Injury

Abstract Objective Several Meta analyses suggest mixed but objective support for internal strategies. Typically, successful rehabilitation involves at least 8 hour of memory training and often results in 0.25 to 0.50 standard deviation (SD) improvements depending on how long post injury. Intervention dose, strategies, level of impairment, and patient self-awareness and motivation all appear relevant. Methods Data is taken from 21 continuous referrals. Three individuals did not want to work on memory strategies, so their data was separated from the rest. Participants: 18 individuals with acquired brain injuries, with an average age of 51.6 and about 15 years of education, who were 76.6 days post brain injury. Intervention: Each individual was involved in 8 weeks of transdisciplinary rehabilitation. Many goals were addressed and memory rehabilitation was treated via 1 or 2 weekly sessions with a neuropsychologist. Internal and external strategy use was taught. Individuals received 8 to 10 hours of memory rehabilitation involving repetitive practice of clustering, semantic clustering, organizing information into sentences or stories, rhyming, and acronyms. Results Delayed List Recall significantly improved from standard scores of 73.5 to 89.7 and the delayed Story Recall improved from 75 to 90. The mean improvement was nearly 1 standard deviation across measures. Conclusions Individuals showed significant improvement in immediate and delayed recall memory scores. These individuals showed more than 0.5 SD short-term memory (STM) gain and also self-reported improved STM. Durability of gains was not measured in follow-ups. These interventions improve memory skills, but not all patients choose to participate in this type of treatment.

Acceptance and commitment therapy for people with depressive and anxiety symptoms following acquired brain injury: Results of the BrainACT randomized controlled trial

ObjectiveThis study aimed to investigate the effectiveness of an adapted ACT intervention (BrainACT) in people who experience anxiety and/or depressive symptoms following acquired brain injury. MethodsThe study is a multicentre randomized controlled two-arm parallel trial. In total, 72 people who survived a stroke or traumatic brain injury were randomized into an eight-session ACT or control (i.e. psycho-education and relaxation) intervention. The primary outcome measures were the Hospital Anxiety and Depression Scale (HADS) and the Depression Anxiety and Stress Scale (DASS). Secondary outcomes were ACT process measures, participation, and quality of life. Outcome assessments were performed by trained assessors, blinded to treatment condition, pre-treatment, during treatment, post-treatment, and at 7 and 12 months follow-up. ResultsThere were no differences between groups on any outcome measure. Participants in both groups significantly improved on all outcome measures, except for participation frequency. More clinically relevant long-term improvements (i.e. recovered or reliable changes on the HADS) were found in favour of ACT for depressive and anxiety symptoms. ConclusionThe study was negative on the primary outcome measures. On an individual level, this study showed that especially on the long term ACT seems to show a more clinically relevant decrease in anxiety and depressive symptoms compared to an active control intervention. However, ACT was not superior in improving ACT-related processes such as psychological flexibility, cognitive defusion, and valued living nor in increasing participation or quality of life. Further large-scale group studies are warranted. Trial registrationThe study was originally registered in the Dutch Trial Register (now Clinical Trial Registry Platform), NL-OMON50203. Registered on 18/07/2018 and now to be found under https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON50203.

Is the Silfverskiöld Test a valid tool for evaluating calf muscles spastic overactivity in patients with stroke? A retrospective observational study.

Spastic equinus (plantar flexed) foot is a common postural pattern in patients who suffer from post-stroke spasticity. To date, some clinicians use the Silfverskiöld Test in their practice to differentiate between gastrocnemius and soleus muscle overactivity in patients with spastic equinus (plantar flexed) foot. This use of the Silfverskiöld Test goes beyond its original aim, which was to distinguish isolated gastrocnemius contracture in patients with equinus deformity. The aim of this study was to investigate the Silfverskiöld Test validity for evaluating spastic equinus (plantar flexed) foot (i.e., differentiation between gastrocnemius and soleus muscle overactivity) by checking its outcome against those of selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. The design of the study was retrospective observational. The study was set in a university hospital. Sixty-seven adult stroke patients with spastic equinus (plantar flexed) foot. Each patient underwent selective diagnostic nerve block of tibial motor nerve branches to the soleus, gastrocnemius and tibialis posterior muscles. All patients were evaluated before diagnostic nerve block by means of the Silfverskiöld Test which was considered positive when ankle joint passive dorsiflexion was greater with the knee flexed than extended. Furthermore, they were assessed before and after nerve block by means of the modified Ashworth Scale and the Tardieu Scale. Our sample included 41 males and 26 females (mean age 57.6 years) suffering from spastic equinus (plantar flexed) foot due to chronic stroke (mean time from onset 2.4 years). Forty-eight patients out of 67 presented with positive Silfverskiöld Test. The χ2 test showed no association between the Silfverskiöld Test and spastic overactivity of the gastrocnemius (P=0.253), soleus (P=0.605) and tibialis posterior (P=0.462) muscles as evaluated by serial selective diagnostic block of the tibial nerve motor branches. Our findings do not support the Silfverskiöld Test as a valid tool for evaluating spastic equinus (plantar flexed) foot to differentiate between gastrocnemius, soleus and tibialis posterior spastic muscle overactivity in adult patients with stroke. The choice for an appropriate management of spastic equinus (plantar flexed) foot in adults with stroke should not be mainly defined on the base of Silfverskiöld Test.

Elder Mistreatment Within Stroke Family Caregiving.

This secondary data analysis sought to identify characteristics associated with mistreatment among chronic stroke survivors who transition to dementia. We examined baseline data from a multi-time series survey study (n = 453; where caregivers of those with stroke n = 107, and those without stroke, n = 346) on caregiving experiences influencing dementia family caregivers' abusive or neglectful behaviors. Inferential statistical analysis indicated that baseline mistreatment rates were similar across stroke and non-stroke subgroups, though this finding was not significant. Caregiver depression was significantly associated with mistreatment. Multi-morbidity, prescription medication use, and limited mobility were more common among stroke survivors. Stroke-related complications may impose a greater burden of care upon family caregivers whose care recipients also have dementia. Determining timepoints of heightened mistreatment risk for stroke survivors may significantly impact long-term trajectories of stroke management to screen and identify those who may benefit from added support and intervention.

The Absence of Typical Stroke Symptoms and Risk Factors Represents the Greatest Risk of an Incorrect Diagnosis in Stroke Patients.

Stroke is one of the most misdiagnosed conditions that causes serious medical disabilities. Its early and accurate diagnosis by the emergency team is crucial for the patient's survival. This study aimed to determine the percentage of brain strokes incorrectly diagnosed by paramedic teams and to analyze the factors influencing incorrect diagnoses. The data of 103 patients, mean age of 68.4 ± 14.96 years, admitted in 2019 to hospital emergency departments of the two hospitals in Olsztyn, Poland, were analyzed retrospectively. All patient data were obtained from their information cards. The parameters of the patients misdiagnosed and accurately diagnosed by paramedics were analyzed with Odds Ratio (OR) calculations using IBM SPSS version 23 software. Stroke and transient ischemic attack were recognized in 77 cases (74.8%). In 26 patients (25.2%), the diagnosis made in the ambulance differed from that made in the hospital ward. The analysis of the Odds Ratio (OR) has shown that typical stroke risk factors, if present in a patient, facilitate the correct diagnosis. The greatest source of misdiagnosis of stroke by the paramedic team was the lack of hemiplegia (OR = 6.0). The absence of typical stroke risk factors and neurological stroke symptoms, such as smoking, hemiplegia, aphasia, hypercholesterolemia, arrhythmia, diabetes or a drooping corner of the mouth, constitutes a high risk of misdiagnosing stroke by the paramedic team.

The Aphasia Recovery Cohort, an open-source chronic stroke repository

Sharing neuroimaging datasets enables reproducibility, education, tool development, and new discoveries. Neuroimaging from many studies are publicly available, providing a glimpse into progressive disorders and human development. In contrast, few stroke studies are shared, and these datasets lack longitudinal sampling of functional imaging, diffusion imaging, as well as the behavioral and demographic data that encourage novel applications. This is surprising, as stroke is a leading cause of disability, and acquiring brain imaging is considered standard of care. The first release of the Aphasia Recovery Cohort includes imaging data, demographics and behavioral measures from 230 chronic stroke survivors who experienced aphasia. We also share scripts to illustrate how the imaging data can predict impairment. In conclusion, recent advances in machine learning thrive on large, diverse datasets. Clinical data sharing can contribute to improvements in automated detection of brain injury, identification of white matter hyperintensities, measures of brain health, and prognostic abilities to guide care.

Sex Differences in Hypertension and Its Management Throughout Life.

The prevalence of hypertension and uncontrolled hypertension may differ by age and sex. We included participants in the Atherosclerosis Risk in Communities study at seven study visits over 33 years (visit 1: 15 636 participants; mean age, 54 years; 55% women), estimating sex differences in prevalence of hypertension (systolic blood pressure ≥130 mm Hg; diastolic blood pressure ≥80 mm Hg; or self-reported antihypertension medication use) and uncontrolled hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg) using unadjusted and comorbidity-adjusted models. The prevalence of hypertension increased from 40% (ages, 43-46 years) to 93% (ages, 91-94 years). Within hypertensive individuals, the prevalence of uncontrolled hypertension was higher in men (33%) than women (23%) at ages 43 to 46 years but became higher in women than men starting at ages 61 to 64, with 56% of women and 40% men having uncontrolled hypertension at ages 91 to 94. This sex difference was not explained by differences in coronary heart disease, diabetes, body mass index, estimated glomerular filtration rate, number of antihypertension medications, classes of medications, or adherence to medications. In both sexes, uncontrolled hypertension was associated with a higher risk for chronic kidney disease progression (hazard ratio, 1.5 [1.2-1.9]; P=4.5×10-4), heart failure (hazard ratio, 1.6 [1.4-2.0]; P=8.1×10-7), stroke (hazard ratio, 2.1 [1.6-2.8]; P=1.8×10-8), and mortality (hazard ratio, 1.5 [1.3-1.6]; P=6.2×10-19). Sex differences in the prevalence of hypertension and uncontrolled hypertension vary by age, with the latter having implications for health throughout the life course.