Elderly Stroke Research Articles

Cerebral Angiogenesis and Neurogenesis in The Treatment of Ischemic Stroke in Elderly and Geriatric Patients

Cerebral Angiogenesis and Neurogenesis in The Treatment of Ischemic Stroke in Elderly and Geriatric Patients

Subjective global assessment of malnutrition and dysphagia effect on the clinical and Para-clinical outcomes in elderly ischemic stroke patients: a community-based study

BackgroundMalnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke.MethodsIn the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed.ResultsOur findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07).ConclusionThis study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.

Application Of Active Range Of Motion In Nursing Services And Care In Elderly With Stroke

Stroke is a big problem for the elderly in low-income countries (developing countries) than in high-income countries (developed countries). The Range of Motion Active stroke intervention is one of the non-pharmacological therapy efforts, exercises that are carried out to maintain or improve the level of perfection and the ability to move joints normally and completely to increase muscle mass and muscle tone. This study aims to identify the effect of providing Active Range of Motion exercise therapy in nursing services and care for the elderly with stroke problems. This type of research is a case study design research, which is a form of research (inquiry) or case studies and interventions about a problem that has a specificity (particularity). The results showed that the provision of Active Range of Motion was scored with the Pretest and Posttest scores. There is a change in the value of muscle strength in elderly stroke after being given Active Range of Motion exercise from the value of the muscle strength scale 2 to 3, 3 to 4, and 4 to 5. with data on the characteristics of stroke patients, namely age, gender and activities such as rarely exercising and not exercising repeatedly, this shows that the more frequent Active Range of Motion exercises can affect the assessment of muscle strength in stroke patients.

An innovative training based on robotics for older people with subacute stroke: study protocol for a randomized controlled trial

BackgroundStroke is a leading cause of disability, injury, and death in elderly people and represents a major public health problem with substantial medical and economic consequences. The incidence of stroke rapidly increases with age, doubling for each decade after age 55 years. Gait impairment is one of the most important problems after stroke, and improving walking function is often a key component of any rehabilitation program. To achieve this goal, a robotic gait trainer seems to be promising. In fact, some studies underline the efficacy of robotic gait training based on end-effector technology, for different diseases, in particular in stroke patients. In this randomized controlled trial, we verify the efficacy of the robotic treatment in terms of improving the gait and reducing the risk of falling and its long-term effects.MethodsIn this single-blind randomized controlled trial, we will include 152 elderly subacute stroke patients divided in two groups to receive a traditional rehabilitation program or a robotic rehabilitation using G-EO system, an end-effector device for the gait rehabilitation, in addition to the traditional therapy. Twenty treatment sessions will be conducted, divided into 3 training sessions per week, for 7 weeks. The control group will perform traditional therapy sessions lasting 50 min. The technological intervention group, using the G-EO system, will carry out 30 min of traditional therapy and 20 min of treatment with a robotic system. The primary outcome of the study is the evaluation of the falling risk. Secondary outcomes are the assessment of the gait improvements and the fear of falling. Further evaluations, such as length and asymmetry of the step, walking and functional status, and acceptance of the technology, will be carried.DiscussionThe final goal of the present study is to propose a new approach and an innovative therapeutic plan in the post-stroke rehabilitation, focused on the use of a robotic device, in order to obtain the beneficial effects of this treatment.Trial registrationClinicalTrials.gov NCT04087083. Registered on September 12, 2019

National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly

ObjectiveOctogenarians were excluded and/or underrepresented in the major endovascular thrombectomy (EVT) randomized controlled trials, but continue to make up a growing proportion of stroke patients. To evaluate real-world trends in utilization and outcome of EVT in patients ≥80 years in a large nationally representative database. MethodsUsing the Nationwide Inpatient Sample (2014-2016), we identified patients admitted to United States hospitals with acute ischemic stroke (AIS) who also underwent EVT. The primary endpoint was good outcome (discharge to home/acute rehabilitation center). Poor outcome (discharge to skilled nursing facility or hospice and in-hospital mortality), intracerebral hemorrhage and in-hospital mortality were secondary outcome measures. ResultsIn 376,956 patients with AIS, 6,230(1.54%) underwent EVT. 1,547(24.83%) were ≥80. The rate of EVT in AIS patients ≥80 more than doubled from 0.83%(n = 317) in 2014 to 1.83%(n = 695) in 2016. The rate of good outcome in patients ≥80 was 9%, significantly lower than younger patients (26%, p<0.001). In-hospital mortality was 19% in patients ≥80 compared to 13% in the younger cohort (p < 0.001). There was no difference in the rate of hemorrhagic transformation between octogenarians and younger patients (18.52% vs 17.01%, p=0.19). In patients ≥80 years of age, decreasing baseline comorbidity burden independently predicted good outcome (OR 0.258, 95% CI [0.674– 0.935]). ConclusionsA two-fold increase in the utilization of EVT in patients ≥80 years of age was seen from 2014 to 2016. While the comparative rate of good outcome is significantly lower in this age group, elderly patients with fewer comorbidities demonstrated better outcomes after EVT.

Abstract WP36: National Trends in Utilization and Outcome of Endovascular Thrombectomy for Acute Ischemic Stroke in Elderly

Background: The efficacy of endovascular thrombectomy (EVT) for large vessel occlusion in elderly is controversial as this age group is often excluded or under-represented in major randomized clinical trials. We evaluated the real-world trends in utilization and outcome of EVT in patients ≥80 years in a nationally representative database. Methods: Using nationwide inpatient sample (2014-2016), we identified patients admitted to hospitals in the United States with acute ischemic stroke who underwent EVT. Baseline demographics and clinical outcome were assessed among patients with age ≥80 years and those with age &lt;80 years. The primary endpoint was favorable outcome defined as discharge to home or acute rehabilitation center. Hemorrhage and in-hospital mortality rates were assessed as secondary outcome measures. Multivariate analysis was performed to identify independent predictors of favorable clinical outcome in elderly. Results: A total of 6,230 patients were identified and 1,547 (24.83%) of them were ≥80. The number of patients ≥80 years who underwent EVT increased from 323 (22%) in 2014 to 695 (28%) in 2016. The rate of favorable outcome in elderly was 9% which was significantly lower than in younger patients (22%). In-hospital mortality was 19% in patients ≥80 years compared to 13% in their younger counterpart. There was no difference in the rate of hemorrhagic transformation between octogenarians and younger patients (3.2% vs 2.6%). Among patient ≥80, decreasing baseline comorbidity burden (Elixhauser Comorbidity Index) [OR; (95% CI): 1.24; (1.04-1.47)] was an independent predictor of favorable outcome. Conclusions: Two-fold increase in the number of EVT was seen from 2014 to 2016 among patients ≥80 years old. Although the rate of favorable outcome is lower in this age group, comparison to a historical control group suggests significant outcome benefit from EVT in these patients. Future prospectively designed studies are warranted for further characterization of the risks and benefit of EVT in elderly.

Abstract 156: Recurrent Stroke in Middle-Aged Lacunar Stroke Survivors: Understanding Risk Factors and Vulnerability in an Important Target Population

Background: The precise role of stroke risk factors in middle-aged people remains a significant knowledge gap. Confounding risk factors conferred by young and elderly stroke are largely avoided, providing a unique opportunity to understand the relationship between traditional risk factors and stroke. We aimed to determine the predictors of stroke and myocardial infarction (MI) in a unique middle-aged cohort with MRI-defined lacunar stroke. Methods: We conducted a reanalysis of data from the Secondary Prevention of Small, Subcortical Strokes (SPS3) clinical trial. We focused on middle-aged study participants, defined as those aged 40-60 years at study entry. We used multivariate Cox regression models to estimate the risk of recurrent stroke or MI. Results: Out of 3,020 total subjects from SPS3, 1,312 (mean age 53 [SD 5], 445 females [34%]) were in the middle-aged category and were included in this analysis. Of these, there were 619 (47%) white, 297 (23%) black, and 283 (22%) Hispanic subjects. Over a mean follow-up time of 3.90 years, there were 123 strokes (2.6% per patient-year) and 33 MIs (0.7% per patient-year). The rates (% per patient-year) of having a stroke or MI differed significantly across white (n=59, 2.7%), black (n=54, 5.1%), and Hispanic (n=27, 2.8%) ethnic groups (p=0.006). Significant risk factors for recurrent stroke or MI are described for middle-aged and all SPS3 subjects in the table. Conclusions: In middle-aged individuals with prior stroke, diabetes, greater white matter disease severity, black race, and family history were potent predictors of recurrent stroke. Male sex, diabetes, and heart disease were potent predictors of MI. Compared to the entire SPS3 cohort, these predictors confer a greater risk for recurrent stroke or MI in the middle-aged. These data identify modifiable risk factors and target populations that are especially vulnerable to vascular events or complications.

Hyperhomocysteinemia can predict the severity of white matter hyperintensities in elderly lacunar infarction patients

Background and Purpose: Hyperhomocysteinemia (Hhcy) is a risk factor for stroke. Several studies have demonstrated that Hhcy was more closely linked to small vessel occlusive disease and white matter hyperintensities (WMH) in general and elderly population. Studies on WMH and homocysteine in elderly subjects are rare, and the results were inconsistent. Our study aimed to investigate the relationship between the serum homocysteine (HCY) and the severity of WMH in elderly lacunar stroke patients.Methods: Consecutive elderly (≥60 years old) lacunar infarction patients were recruited in this cross-sectional study. All patients were divided into two groups according to periventricular WMH (PVWMH) and deep WMH (DWMH) Fazekas scores. Patients with a Fazekas score (PVWMH or DWMH) of 0, 1, 2 were in mild-moderate group and 3 were in severe group. Vascular risk factors and clinical features were compared between these two groups. Multiple logistic regression analysis was used to determine the relationship between severity of WMH and vascular risk factors.Results: A total of 587 participants aged 60–95 years were enrolled. Patients with severe PVWMH (n = 178) had higher age (p = 0.030) and higher incidence of stroke history (p<0.001) than those in mild-moderate group. The level of serum HCY was significantly higher in patients with severe PVWMH (p ＝ 0.002). Patients with severe DWMH (n = 142) had higher age (p<0.001) and often had a history of stroke (p<0.001). The level of HCY was higher in patients with severe degree of DWMH, but had no significance (p ＝ 0.153). Multivariable logistic regression analyses showed Hhcy were independently associated with severe PVWMH after adjusted for age and vascular risk factors (p ＝ 0.014).Conclusions: Hhcy was independently associated with severe PVWMH of elderly lacunar stroke patients, but not DWMH.

Indicator of Dyslipidemia for Ischemic Stroke in Elderly with Hypertension

Elderly with hypertension have a greater risk for ischemic stroke. It can be caused by dyslipidemia which is an abnormal amount of lipids in the blood such as increased levels of total cholesterol, LDL cholesterol, triglycerides and decreased levels of HDL cholesterol. The aim of this study is to analyze the indicator of dyslipidemia for ischemic stroke in elderly with hypertension. This study is an observational studies of analytical epidemiology with case control study design. The subject of study is the occurrence of ischemic stroke in elderly with hypertension who were admitted to outpatient installation RSU Haji Surabaya. The sample size for case and control samples were 74 patients. Samples were taken using simple random sampling methods. The data of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides from patient medical records were analyzed using bivariate analysis (p=0.25) is selected as a candidate for the multivariate analysis with multiple logistic regression (p=0.05). Total cholesterol, LDL cholesterol and triglycerides are selected as a candidate (p=0.00, p=0.18, p=0.18). The results showed that the most influential independent variables and became a model to predict the incidence of ischemic stroke in RSU Haji Surabaya was elevated total cholesterol (p=0.03; OR=4.87; 95% CI=1.10–21, 53). It was concluded that total cholesterol had an effect on the incidence of ischemic stroke in RSU Haji Surabaya. Self-awareness is required to perform blood cholesterol screening as a prevention efforts, especially for elderly with hypertension because of greater risk for ischemic stroke.

The role of known risk factors and the pre-stroke lifestyle among elderly Saudi stroke patients in Riyadh City

The role of known risk factors and the pre-stroke lifestyle among elderly Saudi stroke patients in Riyadh City

Comparisons of Quality of Life and Asymmetric Atrophy in Regularly Walking Elderly Female Stroke Survivors

Regularly participating in physical activity is known to improve quality of life and body composition in elderly with stroke. However, comparatively less physical activity is performed by the stroke survivors. The factors related to inactivity in elderly female stroke survivors have not been elucidated. Therefore, this study aims to compare the quality of life factors and limb compositions between the active and inactive elderly female stroke survivors. Forty nine subjects between the ages of 65 to 75 years were selected from the KNHANES data between the years 2009 to 2011. In addition, 186 age-matched healthy peers were also selected for limb composition comparisons. The subjects were groups based on walking days per week: walkers; 3 days or more, non-walkers; less than 3 days per week. BMI and waist circumference were within the obesity ranges for both the non-walkers and walkers. As results, the trend for greater fat (±10%) and lean mass (±30%) differences were observed for non-walker and walkers, respectively. Significantly greater reasons for function limitation by stroke and hypertension were reported with significantly greater self-care difficulty was shown by the walkers. In conclusion, elderly female stroke survivals may require customized motivation and continuous support to participate in physical activity regularly.

Effect Of Education Media Video On Improve Stroke Prevention Behavior In Continued Age In Wiyurejo Pujon Malang

Background: Stroke is a disease caused by one of the pathological processes that affect the blood vessels of the brain. Efforts to reduce mortality from stroke can be done by health education about stroke disease.&#x0D; Purpose : The purpose of this research is to know the Influence of Media Video Education on the Enhancement of Prevention of Stroke in Elderly in Wiyurejo Village, Pujon Sub-district, Malang Regency.&#x0D; Methods : Pre-experimental design research design with one group pre-post test design. Population of all elderly (elderly) between 60-74 years in the Village Wiyurejo District Pujon Malang regency a number of 34 people. The sampling technique used was accidental sampling so that the sample was 32 people. Data analysis Using wilcoxon.&#x0D; Result : The results showed that stroke prevention behavior before giving video media almost half of educational (46,9%) respondents have bad behavior. After being given an educational video media showed almost half of them with sufficient behavior (43.8%).&#x0D; Conclusion : There is Influence of Educational Video Media to Improving Prevention Behavior of Stroke at Elderly in Wiyurejo Village, Pujon Sub-district, Malang Regency. Looking at the results of the study suggested that the provision of counseling about stroke prevention can be carried out repeatedly in the elderly so as to make efforts in preventing early

Prediction of Early Outcome in Ischemic Stroke in Elderly

AbstractBackground: Determining the early functional outcome of ischemic stroke is important for physicians and patients Aim: To identify the predictors of early outcome after one week from onset of ischemic strokeMethods: A total of 85 patients with first ever ischemic stroke were divided into 2 groups, favorable and unfavorable outcome, according to the 1-week modified Rankin scale (mRS). Favorable outcome was assumed if the score was zero to two, and unfavorable outcome if the score ranged from 3 to 6Results: The variables associated with unfavorable outcome were high National Institute of Health Stroke Scale score on admission (P <0.001), high mRS score on admission (P <0.001), large volume of infarction (P <0.001), presence of intracranial stenosis (P=0.034), large artery atherosclerosis stroke, cardioembolic stroke and stroke of undetermined etiology (P = 0.003), high random blood sugar on admission (P = 0.008), and the occurrence of adverse events during admission period such as increase size of infarction, chest infection, symptomatic hemorrhagic transformationConclusions: The early outcome of ischemic stroke can be predicted by combining clinical and radiological data.

Stroke rehabilitation familiar close: developing integrated care for elderly with CVA [1

Introduction: CVA is one of the most expensive diseases in the Netherlands (2,5% of the total health cost [2]). Most patients are older and suffer chronic malfunctions despite intensive revalidation. Patients, professionals, organizations and insurance companies are not content with the current situation. Patients tend to stay too long, unnecessary or unwanted (patients) in hospitals and revalidation units. Aim of the research: The purpose of this research was to explore what kind of partnership and health services could lead to an effective and efficient offering of integrated rehabilitation care for (older) stroke patients in the region of Deventer (NL). Method of research: The research is descriptive and multiple data sources where used. The relevant literature was collected by literature studies on the important indicators for a successful partnership, quality demand, the influence of governance and legislation within the stroke rehabilitation. Opinions, experience and facts of partners, insurance companies, clients and professionals in the rehabilitant care were researched through document analysis, semi structured interviews and a member check. For the design of the new care process and cooperation in the integrated chain care for CVA patients the Development Model for Integrated Care [3][4] is applied. Results: An effective alternative partnership can be achieved by optimizing the complete chain of stroke care by system integration. In this way existing knowledge and cooperation relationships are kept intact by: - Improving innovation strength, by exchanging and sharing of knowledge and expertise by optimizing the complete chain of stroke care. - Cooperation of the hospital specialists, rehabilitation specialists and geriatric specialist within the geriatrics revalidation unit and expert teams to support care at home. - Participation in the development of the new care treatment “stroke rehabilitation familiar close” (specialized homecare). For elderly people with geriatric CVA care on demand, treatment at home, integrating and support of informal care contributes to their experience of quality of life. Recommendations: The new care treatment “stroke rehabilitation familiar close” will lead to an efficient and effective offering of integral rehabilitation to elderly chronic stroke patients at their familiar home by: - Hospital replaced care in the specialized nursing home (increasing the throughput). - A shortening of the stay in the nursing home by intensive rehabilitation treatment in cooperation with specialists from hospital and revalidation unit. - Home rehabilitation by cooperation of informal care, general practitioners, physiotherapists, expert teams (geriatric, rehabilitation, physician) and usage of eHealth technology. This will partly replace the existing medical revalidation care in nursing homes and improve the wellbeing in general of the treated patients.

Abstract WP329: 30-day Readmission After Stroke and Transient Ischemic Attack by Age and Sex

Background: 30-day readmission after hospital discharge is considered an indicator of the quality and efficiency of hospital-level care. Readmission rates are commonly reported for elderly Medicare stroke patients, but there is limited information about rates for younger stroke patients. We used a nationally representative readmission database that includes both insured and uninsured patients to compare 30-day readmission by age and sex subgroups for patients hospitalized with stroke and transient ischemic attack (TIA). Methods: Hospitalizations for subarachnoid hemorrhage (SAH; ICD-9 430; N=7061), intracerebral hemorrhage (ICH; ICD-9 431; N=17325), ischemic stroke (IS; ICD-9 433, 434, 436; N=212306), and TIA (ICD-9 435; N=67606) were identified for patients aged ≥18y in the 2013 Nationwide Readmissions Database. We fit hierarchical logistic models with hospital random intercepts and adjustment for demographic characteristics, medical history, and clinical factors to assess differences in 30-day readmission by age (18-44, 45-64, 65-84, 85+y) and sex for each condition. Results: Readmission rates were lowest for SAH (11.1%), followed by TIA (12.2%), IS (12.3%), and ICH (13.8%). Despite modest increases in readmission with age for IS and TIA, rates remained relatively stable across subgroups (table). Readmissions increased from 18-44y to 65-84y for both SAH and ICH but decreased at age 85+y. In adjusted analyses, each 5-year increase in age was associated with a 3% increase in the odds of readmission after ICH (OR 1.03, 95% CI 1.005-1.05) and 2% increase after IS (OR 1.02, 95% CI 1.01-1.03). Women aged ≥65y with IS and aged 45-64y with TIA had lower odds of readmission in risk-adjusted analyses versus men (figure). Conclusions: Readmission rates varied by age and sex subgroups, but the differences were small. Using 30-day readmissions as an indicator of care, our results suggest stroke and TIA patients receive comparable quality of care regardless of age or sex.

Abstract 140: Association Between Epilepsy and the Risk of Ischemic Stroke or Myocardial Infarction

Background: Vascular brain injury can result in epilepsy. It is posited that seizures in elderly patients might reflect subclinical vascular disease and thus herald future clinical vascular events. Hypothesis: Seizures in elderly patients are associated with an increased risk of ischemic stroke or myocardial infarction (MI). Methods: We obtained inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries ≥66 years of age. The predictor variable was epilepsy, defined as two or more inpatient or outpatient claims with a diagnosis of seizure. The primary outcome was a composite of ischemic stroke or acute MI. The predictors and outcomes were all ascertained with previously validated ICD-9-CM code algorithms. Survival statistics and Cox proportional hazards models were used to assess the relationship between epilepsy and incident ischemic stroke or MI while adjusting for demographic characteristics and vascular risk factors. Patients were censored at the first occurrence of a stroke or MI, at the time of death, or on December 31, 2014. Results: Among 1,548,556 beneficiaries with a mean follow-up of 4.4 (±1.8) years, 15,055 (1.0%) developed epilepsy and 121,866 (7.9%) experienced an ischemic stroke or acute MI. Patients with seizures were older (76.1 versus 73.7 years) and had a significantly higher burden of vascular comorbidities than the remainder of the cohort. The annual incidence of stroke or acute MI was 3.28% (95% confidence interval [CI], 3.10-3.47%) in those with seizures versus 1.79% (95% CI, 1.78-1.80%) in those without (unadjusted hazard ratio [HR], 1.89; 95% CI, 1.78-2.00). After adjustment for demographics and risk factors, epilepsy had a weak association with the composite outcome (adjusted HR, 1.36; 95% CI, 1.29-1.44), a stronger association with ischemic stroke (adjusted HR, 1.77; 95% CI, 1.65-1.90), and no association with acute MI (adjusted HR, 0.95; 95% CI, 0.86-1.04). Conclusions: We found an association between epilepsy in elderly patients and future ischemic stroke but not acute MI. Therefore, seizures might signify occult cerebrovascular disease but not necessarily occult disease in other vascular beds.

Long-term restrictions in participation in stroke survivors under and over 70 years of age

Purpose: This study aims to (1) assess differences in participation restrictions between stroke survivors aged under and over 70 years and (2) identify predictors associated with favorable and unfavorable long-term participation in both age groups.Methods: Prospective cohort study in which 326 patients were assessed at stroke onset, two months and one year after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) was used to measure participation restrictions one year after stroke. Bivariate and multivariate logistic regression analyses were performed including demographic factors, stroke-related factors, emotional functioning and comorbidity as possible predictors.Results: Stroke survivors aged over 70 years perceived more participation restrictions in comparison to stroke survivors aged under 70 years one year after stroke. Independently significant predictors for unfavorable participation outcomes were advancing age, more severe stroke and anxiety symptoms in patients aged over 70 years, and female gender, more severe stroke, impaired cognition and depression symptoms in patients aged under 70 years. Lower age was the only independent predictor associated with favorable participation after one year in stroke survivors aged over 70 years.Conclusions: This study emphasizes the need to pay more attention to participation restrictions in elderly stroke survivors.Implications for rehabilitationMore attention in the rehabilitation process should be paid to restrictions in participation of stroke survivors aged older than 70 years, taking into account the different participation needs and predictors of older stroke survivors.Early screening on the presence of anxiety symptoms could potentially prevent long-term restrictions in participation in stroke survivors aged over 70-year old.Stroke survivors experience considerable restrictions in physical activity and mobility after one year, highlighting the need for the development of community-based exercise programs for stroke survivors.

An investigation into the bilateral functional differences of the lower limb muscles in standing and walking.

To date, most studies use surface electromyographic (sEMG) signals as the control source on active rehabilitation robots, and unilateral data are collected based on the gait symmetry hypothesis, which has caused much controversy. The purpose of this study is to quantitatively evaluate the sEMG activity asymmetry of bilateral muscles in lower extremities during functional tasks. Nine participants were instructed to perform static and dynamic steady state tests. sEMG signals from the tibialis anterior, soleus, medial gastrocnemius and lateral gastrocnemius muscles of bilateral lower extremities were recorded in the experiments. Muscle activities are quantified in terms of sEMG amplitude. We investigated whether characteristics of left limb and the one of the right limb have the same statistical characteristics during functional tasks using The Wilcoxon rank-sum test, and studied dynamic signal irregularity degree for sEMG activities via sample entropy. The total of muscle activities showed significant differences between left limb and right limb during the static steady state (p = 0.000). For dynamic steady states, there were significant differences for most muscle activities between left limb and right limb at different speeds (p = 0.000). Nevertheless, there was no difference between the lateral gastrocnemius for bilateral limb at 2.0 kilometers per hour (p = 0.060). For medial gastrocnemius, differences were not found between left limb and right limb at 1.0 and 3.0 kilometers per hours (p = 0.390 and p = 0.085, respectively). Similarly, there was no difference for soleus at 3.0 kilometers per hour (p = 0.115). The importance of the differences in muscle activities between left limb and right limb were found. These results can potentially be used for evaluating lower limb extremity function of special populations (elderly people or stroke patients) in an objective and simple method.

CORRELATION OF MILD COGNITIVE IMPAIRMENT, PERIODONTITIS AND STROKE IN ELDERLY INDIAN POPULATION

CORRELATION OF MILD COGNITIVE IMPAIRMENT, PERIODONTITIS AND STROKE IN ELDERLY INDIAN POPULATION

Sex Differences in Stroke Subtypes, Severity, Risk Factors, and Outcomes among Elderly Patients with Acute Ischemic Stroke.

Although the age-specific incidence and mortality of stroke is higher among men, stroke has a greater clinical effect on women. However, the sex differences in stroke among elderly patients are unknown. Therefore, we aimed to assess the sex differences in stroke among elderly stroke patients. Between 2005 and 2013, we recruited 1484 consecutive acute ischemic stroke (AIS) patients (≥75 years old) from a specialized neurology hospital in Tianjin, China. Information regarding their stroke subtypes, severity, risk factors, and outcomes at 3 and 12 months after stroke were recorded. Comparing with men, women had a significantly higher prevalence of severe stroke (17.20 vs. 12.54%), hypertension (76.42 vs. 66.39%), dyslipidemias (30.35 vs. 22.76%), and obesity (18.40 vs. 9.32%), P < 0.05. Comparing with women, men had a significantly higher prevalence of intracranial artery stenosis (23.11 vs. 17.45%), current smoking (29.60 vs. 13.05%), and alcohol consumption (12.15 vs. 0.47%), P < 0.05. Moreover, dependency was more common among women at 3 and 12 months after stroke, although the sex difference disappeared after adjusting for stroke subtypes, severity, and risk factors. Elderly women with AIS had more severe stroke status and worse outcomes at 3 and 12 months after stroke. Thus, elderly female post-AIS patients are a crucial population that should be assisted with controlling their risk factors for stroke and changing their lifestyle.