Stroke Impairment Research Articles

Abstract TP34: Association between Acute Stage Blood Pressure Variability and Post-Stroke Cognitive Impairment in Atrial Fibrillation-Related Acute Ischemic Stroke

Abstract TP34: Association between Acute Stage Blood Pressure Variability and Post-Stroke Cognitive Impairment in Atrial Fibrillation-Related Acute Ischemic Stroke

Abstract TMP113: Sex differences in the effects of social isolation on behavioral and metabolic parameters in a model of cerebral amyloid angiopathy

Introduction: The prevalence of social isolation (SI) increases with aging and contributes to poor health outcomes and increased risk of cognitive impairment, especially in Aβ-related diseases. Cerebral amyloid angiopathy (CAA) is characterized by amyloid β (Aβ) deposition in the cortical and leptomeningeal vessels, and is a leading cause of hemorrhagic stroke and age-related cognitive impairment. How social isolation affects vascular amyloid deposition, cognitive decline and social behavior in CAA is unknown. Methods: TgSwDI mice carrying Swedish, Dutch, and Iowa mutations of human amyloid precursor protein were used as a CAA model. Male and female C57BL/6 wildtype (WT) and CAA mice were randomly assigned to pair housing (PH) or SI at 3 months of age. Affective and social behaviors were assessed at baseline and every 3 months thereafter using the tail suspension test (TST) and three-chamber social interaction test. At 9 months post-SI, cognitive behaviors and general well-being were measured using fear conditioning (FC) and the nesting test, respectively. Body weights were recorded, and white adipocyte size was measured using immunostaining. Results: SI led to increased immobility in the TST at 3- and 6-months post-SI in both male and female WT and CAA mice, suggesting depressive-like behavior (n=5-8/grp, p<0.05). Isolated CAA mice displayed greater cognitive deficits in FC, while only male WT SI mice showed impaired cognition (n=5-12/grp, p<0.005). Sex differences in social behavior were observed in isolated CAA mice. Specifically, at 6 months post-SI, female CAA mice displayed deficits in sociability and social novelty (n=4-9/grp, p<0.05), which was not seen in male CAA mice. SI negatively impacts the general well-being in both male WT and CAA SI animals (n=5-12/grp, p<0.005). Preliminary findings showed increased white adipocyte size in male WT SI mice with a similar trend in male CAA SI animals, pointing to potential metabolic effects of isolation. Conclusion: SI induced cognitive decline in both male and female CAA mice. Behavioral differences between sexes were noted in CAA mice including nesting ability, sociability, and depressive-like behaviors. Further research is needed to determine the cellular and molecular mechanism underlying SI-induced metabolic changes in CAA.

2875 The association between multiple long-term conditions, person- and disease-related factors and adverse inpatient outcomes

Abstract Introduction People living with multiple long-term conditions (MLTC) are more likely to experience hospital admission, which is often associated with unintended consequences. Preventing or providing alternatives to admission by predicting adverse admission-related outcomes is important. This study aims to provide an overview of the association between MLTCs and adverse outcomes following hospital admission through a systematic review of systematic reviews. Method We searched Medline, Embase, CINAHL, Web of Science and PsycINFO for systematic reviews assessing risk factors/predictors of functional decline (FD), nursing home admission (NHA), or changes in quality of life among adults (≥18 years) experiencing unscheduled acute hospital admission. Eligible reviews had to assess MLTC (LTC counts, indices, or individual LTCs), either alone or with other predictors. Titles/abstracts and full texts were screened in duplicate and candidate predictors were extracted. Results 14 systematic reviews assessed predictors of FD (n = 8) or NHA (n = 6). Reviews focused on studies of general inpatients/mixed presentations (n = 8: 6 FD, 2 NHA); hip fracture (n = 2: 1 FD, 1 NHA); stroke (n = 2: 1 FD, 1 NHA) and cognitive impairment (n = 1, NHA) or delirium (n = 1, NHA). Assessment of MLTC was heterogenous: comorbidity indices (n = 4), counts of LTC (n = 2), specific LTC (n = 8), and ‘comorbidity’ without further qualification (n = 3). Higher comorbidity indices, higher counts, and a range of specific comorbidities (most notably dementia) were associated with FD and NHA. Reviews assessing MLTC alongside other predictors highlighted a broad range of sociodemographic, functional, social, and admission-related factors that were associated with FD and NHA. In general, reviews did not assess the relative importance of MLTC alongside other predictors. Conclusion While MLTC may predict unwanted outcomes following admission their qualification is often inconsistent and their relative importance as predictors, alongside broader factors such as social complexity, is rarely assessed in existing systematic reviews.

EEG Responses to Upper Limb Pinprick Stimulation in Acute and Early Subacute Motor and Sensorimotor Stroke: A Proof of Concept.

Electroencephalogram (EEG) during pinprick stimulation has the potential to unveil neural mechanisms underlying sensorimotor impairments post-stroke. A proof-of-concept study explored event-related peak pinprick amplitude and oscillatory responses in healthy controls and in people with acute and subuacutemotor and sensorimotor stroke, their relationship, and to what extent EEG somatosensory responses can predict sensorimotor impairment. In this study, 26 individuals participated, 10 people with an acute and early subacute sensorimotor stroke, 6 people with an acute and early subacute motor stroke, and 10 age-matched controls. Pinpricks were applied to the dorsa of the impaired hand to collect somatosensory evoked potentials. Time(-frequency) analyses of somatosensory evoked potential (SEP) data at electrodes C3 and C4 explored peak pinprick amplitude and oscillatory responses across the three groups. Also, in stroke, (sensori-)motor impairments were assessed with the Fugl Meyer Assessment Upper Extremity (FMA) and Erasmus modified Nottingham Sensory Assessment (EmNSA) at baseline and 7 to 14days later. Mixed model analyses were used to address objectives. It was demonstrated that increased beta desynchronization magnitude correlated with milder motor impairments (R2adjusted = 0.213), whereas increased beta resynchronization and delta power were associated to milder somatosensory impairment (R2adjusted = 0.550). At the second session, larger peak-to-peak SEP amplitude and beta band resynchronization at baseline were related to greater improvements in EMNSA and FMA scores, respectively, in the sensorimotor stroke group. These findings highlight the potential of EEG combined with somatosensory stimuli to differentiate between sensorimotor and motor impairments in stroke, offering preliminary insights into both diagnostic and prognostic aspects of upper limb recovery.

Test-retest reliability and responsiveness of an adapted version of the ABILHAND questionnaire to assess performance in bimanual daily life activities in stroke patients in sub-Saharan Africa.

The ABILHAND is a widely used questionnaire assessing bimanual daily life activities in adults with stroke. A recently modified version tailored for the sub-Saharan African population (ABILHAND-Stroke Benin) has been created. This study aimed to investigate its test-retest reliability and responsiveness. The study included 132 adults with stroke with a mean (SD) age = 54.6 (11.2) years and 40% women. The mean (SD) time since stroke was 15.2 (12) months for the subsample (n = 51) included in the reliability analysis and 1 (0.6) month for the subsample (n = 81) of the responsiveness analysis. Participants were assessed within a week interval with the ABILHAND-Stroke Benin questionnaire for the reliability analysis. As for the responsiveness analysis, they were additionally assessed with the ACTIVLIM-Stroke questionnaire, the Box and Block Test (BBT), and the Stroke Impairment Assessment Set, at baseline (T1), 2-month later (T2), and on average of 1.5 (0.5) years after stroke (T3). The ABILHAND-Stroke Benin questionnaire showed an excellent test-retest reliability (intraclass correlation coefficient = 0.98, P < 0.001, minimal detectable change = 10.3%). Regarding the responsiveness analysis, participants showed a larger improvement during the acute phase (T1-T2) compared with the chronic phase (T2-T3). Changes with the ABILHAND-Stroke Benin questionnaire were significantly correlated with changes with the other outcome measures (correlations ranged from 0.36 to 0.70, P < 0.05) except with the BBT less affected hand. The ABILHAND-Stroke Benin questionnaire demonstrates an excellent test-retest reliability and was responsive to changes in adults with stroke.

Static and dynamic brain functional connectivity patterns in patients with unilateral moderate-to-severe asymptomatic carotid stenosis.

Asymptomatic carotid stenosis (ACS) is an independent risk factor for ischemic stroke and vascular cognitive impairment, affecting cognitive function across multiple domains. This study aimed to explore differences in static and dynamic intrinsic functional connectivity and temporal dynamics between patients with ACS and those without carotid stenosis. We recruited 30 patients with unilateral moderate-to-severe (stenosis ≥ 50%) ACS and 30 demographically-matched healthy controls. All participants underwent neuropsychological testing and 3.0T brain MRI scans. Resting-state functional MRI (rs-fMRI) was used to calculate both static and dynamic functional connectivity. Dynamic independent component analysis (dICA) was employed to extract independent circuits/networks and to detect time-frequency modulation at the circuit level. Further imaging-behavior associations identified static and dynamic functional connectivity patterns that reflect cognitive decline. ACS patients showed altered functional connectivity in multiple brain regions and networks compared to controls. Increased connectivity was observed in the inferior parietal lobule, frontal lobe, and temporal lobe. dICA further revealed changes in the temporal frequency of connectivity in the salience network. Significant differences in the temporal variability of connectivity were found in the fronto-parietal network, dorsal attention network, sensory-motor network, language network, and visual network. The temporal parameters of these brain networks were also related to overall cognition and memory. These results suggest that ACS involves not only changes in the static large-scale brain network connectivity but also dynamic temporal variations, which parallel overall cognition and memory recall.

Health status correlates of malnutrition diagnosed based on the GLIM criteria in older Polish adults-Results of the PolSenior 2 study.

Older individuals are at risk of malnutrition resulting from chronic diseases-related body and muscle mass reduction. In turn, nutritional deficiencies may enhance catabolic processes, leading to accelerated aging and comorbidity, thus creating a vicious cycle. Our study aimed to assess the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to determine the health correlates of malnutrition in a representative sample of community-dwelling older adults. We used the GLIM criteria to diagnose malnutrition in 5,614 participants of the PolSenior2 study. The PolSenior2 study was a population-based survey designed to assess the medical, psychological, social, and economic characteristics of community-dwelling older adults. Malnutrition was diagnosed in 13.4% of the participants using the GLIM criteria. Results of multiple logistic regression showed that the risk of depression [OR 4.18, p<0.001], peptic ulcer disease [OR 2.73, p<0.001], past stroke [OR 1.71, p<0.001], cognitive impairment [OR 1.34, p = 0.015], and chronic pain [OR 1.23, p = 0.046] were independent correlates of malnutrition. Due to the high risk of malnutrition, special attention should be paid to individuals in late old age. Suspected malnutrition should also be considered in people at risk of depression, with peptic ulcer disease, past stroke, and cognitive impairment. Chronic pain should also prompt the diagnosis for malnutrition.

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial

Introduction Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, “Smart Reminder” (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. Methods Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. Results The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). Conclusion The 4-week telerehabilitation program using a “SR” device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.

The immunology of stroke and dementia.

Ischemic stroke and vascular cognitive impairment, caused by a sudden arterial occlusion or more subtle but protracted vascular insufficiency, respectively, are leading causes of morbidity and mortality worldwide with limited therapeutic options. Innate and adaptive immunity have long been implicated in neurovascular injury, but recent advances in methodology and new experimental approaches have shed new light on their contributions. A previously unappreciated dynamic interplay of brain-resident, meningeal, and systemic immune cells with the ischemic brain and its vasculature has emerged, and new insights into the frequent overlap between vascular and Alzheimer pathology have been provided. Here, we critically review these recent findings, place them in the context of current concepts on neurovascular pathologies and Alzheimer's disease, and highlight their impact on recent stroke and Alzheimer therapies.

Somatosensory-Evoked Potentials and Clinical Assessments of Sensory Function Over Time in Patients With Subacute Stroke.

Objective: To demonstrate the utility of somatosensory evoked potentials (SEPs) following median nerve stimulation for chronological assessment of sensory function in patients with subacute stroke during rehabilitation. Design: Retrospective study. Patients: Forty-seven patients with hemiparesis due to stroke during the subacute phase. Methods: We screened 363 patients who underwent SEP measurements at a rehabilitation hospital. Among them, 47 who underwent SEP measurements within 1 week after admission and at least 2 weeks after the initial assessment were included in this study. Sensorimotor assessments, including the Semmes-Weinstein monofilament test (SWMT), pain sensation, position sensation, two-point discrimination, and Stroke Impairment Assessment Set (SIAS) motor tests simultaneously with SEP measurements were available for 20 of the 47 patients. The relationship between the SEP peak count and each sensorimotor assessment was examined. Results: SEP amplitudes and latencies showed no significant differences between the initial and second assessments (paired t-test, p > 0.05). However, the counts of SEP peaks after NI (N20) increased (Wilcoxon signed-rank test, p < 0.05), indicating changes in the SEP waveform. Furthermore, strong correlations were observed between SEP peak counts, stage, and all functional assessments (counts and SWMT, RS = -0.77, p < 0.001; counts and pain sensation, RS = -0.71, p < 0.001; counts and position sensation, RS = 0.75, p < 0.001; counts and two-point discrimination, RS = -0.74, p < 0.001; stage and SWMT, RS = -0.74, p < 0.001; stage and pain sensation, RS = -0.69, p < 0.001; stage and position sensation, RS = 0.74, p < 0.001; and stage and two-point discrimination, RS = -0.75, p < 0.001; all Spearman's rank correlation coefficients). Conclusion: Despite the limitations of the retrospective study design, our study highlights the utility of SEPs for evaluating sensory function in patients with subacute stroke, setting the foundation for further investigations on the use of SEPs to assess functional changes in patients with subacute stroke undergoing rehabilitation.

Therapeutic potentials of mesenchymal stem cells for cognitive impairment in stroke: Evidence from preclinical studies

Therapeutic potentials of mesenchymal stem cells for cognitive impairment in stroke: Evidence from preclinical studies

Effects of Prone Posture Maneuver to Ameliorate Pusher Behavior in Acute Stroke: A Retrospective Study.

Background: Pusher behavior after stroke is an important sequela that interferes with rehabilitation and independence in activities of daily living. As represented by visual or vestibular feedback, conventional methods require substantial assistance and time commitments, but have limited effectiveness. A recent case series suggests that prone posture may alleviate pusher behavior in patients with acute stroke. This study was conducted to retrospectively investigate the effects of prone posture maneuvers. Methods: This retrospective cross-sectional observational study was conducted in a stroke care unit at a university hospital. In total, 37 acute stroke cases presenting with pusher behavior were included from 787 eligible patients. Individuals with pusher behavior were conditioned with prone posturing for 10 min for 2 consecutive days, in addition to regular daily rehabilitation training. The Scale for Contraversive Pushing (SCP) values, Stroke Impairment Assessment Set (SIAS), and functional activities were assessed before, immediately after, and three days after the intervention. Results: The SCP value and the ability to roll over and sit balanced significantly improved compared with the baseline (p < 0.05) and persisted for 3 days after the intervention. Multiple regression analysis identified the SIAS motor score as a determinant of SCP changes. Conclusions: The prone posture maneuver promptly and consistently suppressed pusher behavior, particularly in patients with mild paresis, as indicated by SCP values in acute stroke cases. The uncontrolled, single-site, and retrospective features of the current study require further investigation.

Endothelial Cell Senescence Effect on the Blood-Brain Barrier in Stroke and Cognitive Impairment.

Age is an important risk factor of stroke, cognitive decline, and dementia. Senescent endothelial cells (ECs) accumulate with advancing age through exposure to cellular stress, such as that exerted by hypertension and diabetes. These senescent ECs have altered characteristics, such as altered tight junction proteins, use of a more indiscriminate transcellular transport system, increased inflammation, and increased immune cell interactions. ECs are the main component of the blood-brain barrier (BBB), separating the brain from systemic circulation. As senescent ECs accumulate in the BBB, their altered functioning results in the disruption of the barrier. They have inadequate barrier-forming properties, disrupted extracellular matrix, and increased transcytosis, resulting in an overly permeable barrier. This disruption of the BBB can have important effects in stroke and cognitive impairment, as presented in this review. Besides increasing the permeability of the BBB, senescent ECs can also impair angiogenesis and vascular remodeling, which in ischemic stroke may increase risk of hemorrhagic transformation and worsen outcomes. Senescent ECs may also contribute to microvascular dysfunction, with disruption of cerebral perfusion and autoregulation. These may contribute to vascular cognitive impairment along with increased permeability. With an aging population, there is growing interest in targeting senescence. Several ongoing trials have been evaluating whether senolytics can slow aging, improve vascular health, and reduce the risk of stroke and cognitive decline.

The Association of β2-Microglobulin with Physical Performance in Chinese Hemodialysis Patients with and without Diabetes.

Higher β2-Microglobulin (β2-MG) is associated with aging, stroke and cognitive impairment, which are all connected with poor physical fitness. Poor physical function is ascribed to increasing mortality. However, there has been an academic dispute over the association of serum β2-MG with survival rate. Furthermore, diabetes mellitus (DM) has been well linked to poor physical function and a high level of β2-MG. We hypothesized that higher β2-MG could be associated with worse physical performance in hemodialysis (HD) patients, and that association could vary with diabetes. We conducted a multicenter cross-sectional study at seven HD centers in Shanghai and Suzhou, respectively, in China, where a collection was made of the clinical characteristics, laboratory indicator, physical performance and DM assessment. The physical function was measured by the Short Physical Performance Battery (SPPB), and SPPB score ≤9 as the cutoff for low physical performance.The patients were divided into two groups of low and high physical performance, before categorized into four subgroups based on the absence of diabetes and SPPB scores. Logistic regression analyses were conducted to explore the association of β2-MG with physical performance. The final analysis involved a total of 780 patients, 251(32.2%) having diabetes. In the total population, β2-MG was lower in those with low SPPB than in those with high SPPB. Only in non-diabetic patients, β2-MG was lower in the low SPPB group, and positively associated with SPPB and its three compenents scores. Regardless of diabetes status, those who had low SPPB were prone to be older, accompanied by the poor nutritional status. Addtionally, the diabetes patients tended to have shorter HD duration and higher body mass index than the non-diabetic patients. Both before and after the covariates adjusted, β2-MG was significantly associated with physical performance in HD patients without diabetes. Low level of β2-MG was significantly associated with poor physical performance in Chinese HD patients without DM.

Improving the global understanding of CADASIL‐ a monogenic cause of vascular dementia

AbstractBackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare, hereditary cerebrovascular disease which causes stroke, complex migraine, and cognitive impairment. Given its monogenic nature, CADASIL is considered a ‘pure’ model of small vessel disease and vascular dementia. CADASIL is caused by NOTCH3 pathogenic variants with a broad resulting phenotypic spectrum. There are few CADASIL cohort studies worldwide, often with small or moderate samples, such that any study protocol variation limits the comparability of conclusions across populations. Our recently established Global CADASIL Consortium (GCC) will collate current research and develop guidelines for harmonised protocols and minimum datasets. Further, we have begun the first Australian cohort study of CADASIL, AusCADASIL, to determine the phenotypic presentation, progression, and pathogenic variants in this population.MethodLiterature search, publicising at the 2023 VASCOG conference, and chain‐referrals were used to identify CADASIL researchers and experts who may be interested in contributing to the global collaborative effort. Study meta‐data sharing is ongoing including demographics, clinical, genetic, and imaging outcomes.AusCADASIL will include 150 participants with genetically‐confirmed CADASIL, family history of CADASIL or suspected CADASIL symptoms, and 150 NOTCH3‐negative controls; to be assessed at six main sites. Participants will complete a comprehensive medical, neuropsychological, neurological, ocular, blood biomarker and genetic assessment, including annual follow‐up for 4 years to monitor progression. Data from this cohort will contribute to the international consortium.ResultThe GCC, comprised of 75 individuals from 18 countries, has begun by sharing meta‐data from 10 cohorts based in Australia, East Asia, Netherlands, USA, Spain, France, United Kingdom, and Finland with recruited sample sizes ranging from 20‐520 individuals, and discussing development of working groups. Recruitment for AusCADASIL opened in November 2023 and assessments will begin in early 2024.ConclusionThere is increased global interest in CADASIL as a model for small vessel disease and vascular dementia. This recently established international body is committed to improving the understanding of CADASIL, harmonising assessment protocols and pooling data for larger analyses of biomarkers. AusCADASIL is the first Australian cohort study of CADASIL and will contribute to international efforts.

Longitudinal Changes in Factors Associated with Walking Independence at Hospital Discharge in Patients with Stroke: A Retrospective Study.

Background/Objectives: Patients with stroke usually have long-term residual gait disability. However, temporal changes in factors associated with gait independence in these patients at the time of hospital discharge have not been clarified. This study aimed to determine changes over time in factors associated with gait independence in patients with stroke at the time of hospital discharge. This would predict that factors associated with the level of walking independence in patients with stroke at discharge from the hospital would show different results depending on the changes over time post-stroke onset. Methods: This retrospective observational study used data from the medical records of patients with stroke with unilateral supratentorial lesions who were admitted and rehabilitated at Tesseikai Neurosurgical Hospital between October 2020 and July 2024. The Functional Ambulation Category (FAC), Stroke Impairment Assessment Set-lower extremity motor items, Trunk Control Test, Mini-Balance Evaluation Systems Test (Mini-BESTest), and Functional Independence Measure cognitive items were assessed monthly for 3 months post-stroke onset. Participants were classified into independent and non-independent walking groups using the FAC. Logistic regression analysis was performed with walking independence at discharge and other assessment indicators as the dependent and independent variables, respectively, to identify factors influencing walking independence at discharge. Independent variables were entered by month from 1 to 3 months. Results: Logistic regression analysis revealed that Mini-BESTest scores at 2 and 3 months post-stroke onset were significantly associated with walking independence at discharge (p < 0.05). Conclusions: This study suggests the importance of assessing the Mini-BESTest scores over time, starting at 2 months post-stroke onset, when determining walking independence in patients with stroke. Providing balance training to patients with low Mini-BESTest scores between 1 and 3 months post-stroke onset may contribute to improved walking independence at discharge.

Short-Term Frequently Relapsing Ischemic Strokes Followed by Rapidly Progressive Dementia in CADASIL: A Case Report and Literature Review.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease with slow natural progression. Ischemic stroke and cognitive impairment are its most common clinical symptoms. Here, we report a rare 50-year-old woman who had rapid disease progression with c.457C>T, p.Argl53Cys heterozygous mutation in exon 4 of NOTCH3 and discuss the possible reasons. Furthermore, we summarized the clinical and neuroimaging characteristics of 14 CADASIL patients with Arg153Cys mutation in exon 4. The proband suffered acute ischemic stroke 5 times in 5 months, followed by rapidly progressive dementia (RPD) and inability to live independently, though she didn't have vascular risk factors and had been under standardized secondary prevention therapy since the first stroke. Magnetic resonance imaging showed extensive white matter hyperintensities, numerous ischemic infarcts and microbleeds, and severe brain atrophy. Her elder brother and other patients with Arg153Cys mutation in exon 4 all did not progress so quickly. Her multiple strokes may be associated with the poor self-regulation of vessels, which may promote the occurrence of RPD. Antiplatelet and anticoagulant drugs were difficult to prevent ischemic strokes. Severe imaging findings may indicate rapid progression of CADASIL. In addition, we found that headache was a very frequent symptom in CADASIL patients with Arg153Cys mutation in exon 4, accounting for 76.9%. CADASIL can also appear to have rapid progression, as illustrated by our proband, which is worthy of clinicians' attention and intervention timely. Headache may present in a relatively higher proportion of CADASIL patients with Arg153Cys mutation in exon 4.

The impact of stroke impairment and phases in daily steps of stroke survivors living in community: a systematic review with meta-analysis.

to provide detailed information about the number of steps taken by stroke survivors based on their level of impairment in order to guide recommendations for PA. A meta-analysis was conducted, including studies that assessed daily steps and stroke impairment in community-dwelling stroke patients. Participants were categorized into three groups based on stroke impairment severity (minor, minor and moderate, moderate and severe) and into two groups based on stroke phase (subacute and chronic). A total of 47 studies were included, encompassing 1749 participants. There were 494 in the minor stroke group, 1097 in the minor and moderate group, and 158 in the moderate and severe group. A significant difference in daily steps was observed across these groups (P < 0.01), with the first group averaging 4645 steps/day, the second 3610 steps/day, and the third 1990 steps/day. No significant difference was found between the subacute and chronic groups in terms of daily steps (3839 vs 3783 steps/day). The study highlights the significant impact of stroke impairment on daily step count. We recommend implementing targeted interventions, particularly during the chronic phase, to increase PA levels in stroke survivors, tailored to the specific impairments of each patient.

Machine Learning-Based Model for Prediction of Post-Stroke Cognitive Impairment in Acute Ischemic Stroke: A Cross-Sectional Study.

Early identification of post-stroke cognitive impairment (PSCI) is an important challenge for clinicians. In this study, we aimed to build a machine learning-based prediction model for PSCI and uncover potential risk factors to support clinical decision-making. We collected features of 96 patients with acute ischemic stroke and measured cognitive impairment using the Mini-Mental State Examination. Three common machine learning algorithms, including support vector machine, Gaussian naive Bayes, and logistic regression, were used to build clinical prediction models for PSCI. The area under the receiver operating characteristic curve (AUROC), specificity, sensitivity, negative prediction value, positive prediction value, accuracy, and model fitting effect were used to evaluate the predictive performance of the models and further determine the clinical prediction rules. In this study, the logistic regression model showed the best performance with an AUROC of 0.86, which was higher than the values of the other two models. Moreover, the logistic regression model showed high sensitivity (0.82), specificity (0.83), negative prediction value (0.88), positive prediction value (0.75), and accuracy (0.83). This work identified the top nine factors in importance ranking as predictors of PSCI. Among them, age and urine glucose were significantly associated with PSCI (P < 0.05). Machine learning algorithms may be useful in the prediction of PSCI, especially logistic regression algorithms. In the present study, aging and hyperglycemia were independent risk factors for PSCI, and the cognition of such patients should be carefully addressed in clinical practice screening work.

Patient-Reported Outcomes in Childhood Moyamoya Arteriopathy

BackgroundLittle is known about quality of life, sleep, and mental health in children with moyamoya arteriopathy (MMA). A better understanding of patient-reported outcomes may lead to improved treatment. MethodsPatients with MMA <26 years old and their caretakers completed validated, age-appropriate questionnaires including the Pediatric Quality of Life (PedsQL) Inventory and Patient-Reported Outcomes Measurement Information System (PROMIS) measuring health-related quality of life, sleep, anxiety, depression, and overall health. ResultsAll 21 caretaker-proxies and eight of 21 patients with MMA completed questionnaires. Median age of participants with MMA was 7.8 years. The MMA cohort included 10 children with moyamoya disease and 11 with moyamoya syndrome, and 11 participants (52.4%) had a prior clinical stroke. Nine siblings unaffected by moyamoya and 20 participants with perinatal stroke were enrolled as comparator groups. Participants with MMA had greater impairment in school/work quality of life compared with normative values on caretaker and child-reported PedsQL surveys (85.5 vs 62.3 [P < 0.001] and 78.6 vs 51.2 [P = 0.017], respectively). Participants with MMA did not have significantly different physical impairment compared with normative values and siblings on caretaker and child-reported surveys. Caretaker-proxy PROMIS scores revealed high rates of moderate-severe anxiety (57.1% vs 25%, P < 0.001), sleep impairment (47.6% vs 25%, P = 0.017), and fair-poor global health (76.2% vs 25%, P < 0.001) in participants with MMA compared with the general population. ConclusionsPatients with MMA have high rates of school/work impairment, anxiety, sleep impairment, and fair-poor global health. Screening for patient-reported outcomes, even in the absence of stroke or physical impairment, may improve treatment.