Ischemic Stroke Survivors Research Articles

Abstract TMP32: Race and Ethnic Differences in Rehabilitation and Functional Recovery Post-Stroke Within the Florida Stroke Registry - Transitions of Care

Introduction: Historically, non-Hispanic black (NHB) and Hispanic stroke survivors have been discharged at a poorer functional level than non-Hispanic whites (NHW). The purpose of this study was to examine race and ethnic differences in rehabilitation prescription and participation at time of discharge (DC) and in modified Rankin Scale (mRS) at 30- and 90-days post-stroke. Methods: The Transitions of Stroke Care Disparities Study is designed to reduce disparities and optimize post-stroke care in hospital-to-home transitions. Survivors of ischemic stroke and intracerebral hemorrhage from a subset of 165 hospitals in the Florida Stroke Registry were included in the Get with the Guidelines-Stroke® (GWTG-S) database. Race and ethnicity, therapy prescription and participation, and mRS were extracted from GWTG-S, and by self-report at 30- and 90-days after DC. Race and ethnic differences were assessed in therapy prescription, participation, and mRS using binary logistic regression adjusted for age, sex, stroke severity (NIHSS), and DC walking ability. Results: In 1,129 stroke survivors (mean age 64y, 45% women, 55% NHW, 23% NHB, 22% Hispanic, 76% independent walkers at DC), 29% were prescribed inpatient and 50% outpatient rehabilitation at DC. Multivariable analysis showed NHW were significantly less likely to be prescribed inpatient therapy compared to NHB [OR 0.56, 95%CI (0.35-0.88)] or Hispanics [OR 0.50, 95%CI (0.31-0.80)]. Hispanic individuals [OR 1.69, 95%CI (1.20-2.38)] were significantly less likely to be prescribed outpatient therapy compared to NHW or NHB. No differences in therapy participation were seen between NHW and NHB [OR 1.16, 95%CI (0.69-1.97)] or Hispanics [OR 1.41, 95%CI (0.82-2.43)]. No differences in mRS were seen between NHW and NHB [30-days, OR 0.85, 95% CI (0.52-1.39); 90-days, OR 0.68, 95%CI (0.42-1.11)] or Hispanics [30-days, OR 0.63, 95% CI (0.37-1.10); 90-days, OR 0.61, 95%CI (0.36-1.03)]. Conclusions: Although there were significant race and ethnic differences in therapy prescription setting, no race and ethnic differences were seen in therapy participation or in mRS at either 30- or 90-days. Further research is warranted to examine race and ethnic differences in stroke recurrence and readmission rates.

Abstract 120: CCR5 Polymorphism - A Possible Protective Factor for Post-Stroke PTSD Symptoms

Background: Current data suggest 25-30% of stroke survivors will develop post-traumatic stress disorder (PTSD) symptomatology. This common and disabling disorder is thought to be caused by exposure to a traumatic, life-threatening event. It is unrelated to stroke severity and is one of the barriers to successful recovery from the stroke. We have recently reported on the naturally occurring loss-of-function mutation (LOFM) in the C-C Chemokine receptor 5 gene (CCR5-Δ32) as a protective factor in post-stroke recovery and depression. We sought to examine whether it also prevents the development of PTSD symptoms after stroke or transient ischemic attack (TIA). Methods: Participants were survivors of first-ever mild-moderate ischemic stroke or TIA from the TABASCO prospective cohort study, who underwent a 3T MRI, and were examined by a multi-professional team 6, 12, and 24 months after the event, using direct interviews, depression scales, neurological, neuropsychological, and functional evaluations. PTSD symptoms were assessed using the PTSD Checklist (PCL). CCR5-Δ32 status and PTSD Checklist data were available for 432 patients. Results: Forty-eight participants (11%) developed probable PTSD (PCL ≥44) during the first year after the stroke/TIA. CCR5 -Δ32 carriers presented fewer PTSD symptoms (lower PCL scores) 6, 12, and 24 months after the index event, compared with non-carriers (p=0.002, p<0.001, p=0.011, respectively). The association remained significant after adjustment for age, gender, education, depression or administration of anti-depressants during the follow-up period, ethnicity, and new infarct on MRI. Compared to baseline, CCR5 -Δ32 non-carriers tended to remain stable or develop worse PTSD symptoms over time, while CCR5 -Δ32 carriers tended to improve. Conclusions: We report that carriers of the CCR5 -Δ32 allele had a lower tendency to develop PTSD symptoms post-stroke. These findings might have clinical significance in stroke recovery. They also suggest a mechanism-based treatment target for post-stroke depression. Drugs mimicking this LOFM exist and could offer a novel treatment for this serious and underdiagnosed complication of stroke.

Abstract 67: Risk and Time-Course of Post-Stroke Dementia: A Population-Wide Cohort Study, 2002-2022

Background: People with acute stroke are at high risk of dementia. Population-wide data on the risk and time-course of dementia after stroke are lacking. Methods: We conducted a population-wide analysis of over 15 million people in Ontario, Canada between 2002-2022. Using linked administrative databases, we compared all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI) by matching 1:1 on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities, and excluded people with prior dementia. We evaluated the rate of dementia per 100 person-years using a validated definition which included hospitalization, physician claims, and medications, and calculated cause-specific hazard ratios overall and across follow-up time. Results: We identified 180,940 people with acute stroke, of which 33,765 (18.7%) developed dementia over mean follow-up of 5.5 years (max 20y). The rate of dementia per 100 person-years was highest after acute stroke compared to the general population (3.40 vs. 1.88) and compared to AMI (3.23 vs. 1.81). The overall risk of dementia was higher in those with acute stroke compared to the general population (HR 1.79, 95% CI 1.76-1.82; Figure 1A), and particularly after ICH (HR 2.43, 2.31-2.57). The results were similar when compared to AMI (HR 1.77, 1.74-1.80; Figure 1C). There was an almost 3-fold elevation of dementia risk in the first year after stroke, decreasing to 1.5-fold by 5 years and remaining elevated even 20 years after (Figure 1B/1D). Conclusion: In this large, population-wide study almost one fifth of people developed dementia after stroke, with an 80% higher risk of developing dementia compared to matched controls. The risk was highest early after stroke but remained elevated 20 years after, raising the urgency of developing interventions for dementia prevention in acute and chronic survivors of stroke.

Abstract TP56: Addressing Written Stroke Education and Post-Discharge Prescription Filling for Ischemic Stroke Survivors

Background: Poor adherence to prescribed medication and prescription filling can have dire consequences on patient outcomes. It is important that patients understand how their medications reduce the progression or worsening of their diagnosis. Understanding can be enhanced through literacy assessment and implementation of educational materials. At a CSC, it was identified that only 33% of Acute Ischemic Stroke (AIS) and TIA survivors filled new prescriptions within one week of being discharged home. Purpose To evaluate inpatient written stroke education book for its health and grade literacy, make targeted modifications, then assess its impact on prescription filling within one week of discharged home for stroke survivors. Methods: We conducted a pre-post design EBP QI project. The original and modified book was evaluated using the Patient Education Materials Assessment Tool (PEMAT) and the Flesh-Kincaid Grade Level (FKGL) tool. Based on these scores, targeted modifications were made to remove content, add infographics, and free text areas. The modified book was implemented in October 2023. Group one received the original book between Jan-May 2021, while group two received the modified book between November 2022-Jan 2023. Prescription filling rates were collected from post-discharge phone-call questionnaires and included AIS and TIA survivors, discharged home, > 18 years of age, and completed the phone call questionnaire. Mann-Whitney two-sample rank-sum test was completed to assess for statistical significance among groups. Statistical significance was set at 0.05. Results: Prior to the book revisions the FKGL was at the 11 th grade level, and the PEMAT scores indicated 55.3% understandability, and 56% actionability. Following modifications, the FKGL was at the 7 th grade level, and the PEMAT scores indicated 89.9% understandability and 95% actionability. The rate of prescriptions filled was evaluated pre (n= 98, 33%) and post modification (n=52, 56%) and was statistically significant (U= 1959, z=-2.73, p=0.006). Conclusion: Addressing the literacy and grade level of written stroke education improved prescription filling in AIS and TIA survivors discharged home. Further research may focus on additional barriers to prescription filling.

Abstract WP109: Framework for Evaluating Sequential Patterns in Post-Acute Transitions of Care Among Ischemic and Hemorrhagic Stroke Survivors: Analysis of Medicare Beneficiaries in the State of Texas

Background: Utilizing medical claims derived information, we evaluated temporal trends in post-acute care utilization pathways among patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH). Methods: Data were retrieved from a CMS Qualified Entity housing healthcare utilization data for ≥80% of the Texas state population (100% of Medicare Fee-for-Service). Analytical sample included all Medicare enrollees with a primary discharge diagnosis (AIS or ICH) from 2016 to 2020. Episodes of care within 1 year of discharge were collated and categorized “Discharged”, “Inpatient Rehab”, “Skilled Nursing”, “Hospice”, “Readmission”, or “Death”. Sequential pattern mining was used to calculate conditional probabilities (likelihoods) of post-discharge transitions of care. Prediction rules were generated by converting care sequences into antecedent-consequent pairs. Rule based performance was evaluated by extracting 90 day sequences (antecedent) and assigning predictions of 1 year settings (consequent) based on highest likelihoods (Panel A). Results: A total of 82,829 AIS and 12,761 ICH hospitalizations were analyzed (described in Panel B). An example rulebook of care sequences and associated likelihoods of subsequent transitions for ICH is depicted in Panel C. Whereas ICH survivors entering inpatient rehab had respective likelihoods of 11.2% and 16.2% for subsequently being admitted to hospice care or death, those entering skilled nursing facilities had respective likelihoods of 21.9% and 30.5%. Using 90 day transition of care sequences, predictive accuracy of exact 1 year setting for AIS was 65.3% (1 attempt) and 84.0% (2 attempts); for ICH, the respective accuracy was 50.9% and 82.3% (Panel D). Conclusion: Post stroke transitions of care patterns may yield insights as to the long-term trajectory of outcomes. Predictive capability is expected to strengthen with planned multi-modal integration of EMR-derived clinical and imaging features.

Abstract WMP33: Translating Evidence Into Practice: Early Supported Discharge in Intracerebral Hemorrhage

Background: The 2022 guidelines from the American Heart Association/American Stroke Association underscore the significance of coordinated multidisciplinary care and early discharge planning for spontaneous intracerebral hemorrhage (ICH) patients. Early Supported Discharge (ESD) programs have been found to curtail hospital stays for ICH patients. Purpose: This Quality Improvement initiative aimed to optimize our ESD program, originally designed for acute ischemic stroke patients, by expanding eligibility to encompass mild to moderate spontaneous ICH patients. The primary objectives were to evaluate the effects on the hospital length of stay and discharge-to-home rates. Methods: In 2020, a collaboration between our acute care hospital and homecare organization led to the development of an ESD program, Homeward Stroke Recovery, for ischemic stroke survivors in local catchment areas. Eligibility criteria were broadened to include ICH patients in July 2022. Descriptive statistics were used to track the program's performance, specifically discharge-to-home rates and hospital length of stay for ICH survivors discharged with Homeward Stroke Recovery. Results: Following the expansion of Homeward Stroke Recovery Program eligibility, the discharge-to-home rate for ICH patients at the site increased by 14.2% (27.5% to 41.7%). Additionally, the median length of stay decreased by 2 days (6 days to 4 days). Conclusions: In conclusion, our Quality Improvement project has successfully enhanced the Homeward Stroke Recovery program. This was achieved by aligning eligibility criteria with evidence-based recommendations for patients with mild to moderate spontaneous ICH, leading to a substantial positive impact on patient outcomes. The outcomes of this initiative not only affirm the efficacy of broadening eligibility for ESD programs but serves as a beacon and blueprint to widen scope through evidence-guided improvements.

Abstract WP53: Bringing Comprehensive Stroke Care Home: Supporting Early Supported Discharge

Background and Issues: Despite holding the highest certification as a Comprehensive Stroke Center, the project site's 'Discharge-to-Home' performance for ischemic stroke survivors ranked below the median compared to similar academic medical centers. Although an innovative Early Supported Discharge (ESD) program was available for patients who met geographical criteria, the utilization of these services was not optimal. Purpose: This Quality Improvement initiative aimed to investigate the impact of an early collaborative discharge planning process led by a multidisciplinary healthcare team on 'Discharge-to-Home' rates of ischemic stroke patients eligible for the site's ESD program, Homeward Stroke Recovery. Methods: Meleis' Transition Theory was used to shape the development of streamlined workflows, simplifying the identification of eligible patients and reducing the time taken to refer them to Homeward Stroke Recovery through enhancements to the electronic medical record system. Additionally, robust team education was provided to improve discharge coordination and improve the utilization of available ESD services. Existing system data was leveraged, and new data flows were created to monitor program-specific metrics. Descriptive statistics were used to examine the effect of an early collaborative discharge planning process on ‘Homeward Stroke Recovery Discharge Rates’ for ischemic stroke survivors. Results: There was a notable increase of 5.6% in the 'Homeward Stroke Recovery Discharge Rate' from Fiscal Year 2022 to Fiscal Year 2023 (rising from 43.9% to 49.5%). Conclusions: In conclusion, this Quality Improvement project successfully addressed the challenge of suboptimal 'Discharge-to-Home' rates for ischemic stroke patients eligible for the site’s ESD program. The observed 5.6% increase in the 'Homeward Stroke Recovery Discharge Rate' between Fiscal Year 2022 and Fiscal Year 2023 reflects the positive impact of the interventions performed, highlighting the importance of multidisciplinary teamwork and systematic improvements in healthcare delivery.

Abstract TMP31: Rapid Intravenous Glyceryl Trinitrate in Ischemic Damage (RIGID): A Potential Neuroprotection Strategy for Acute Ischemic Stroke (AIS) Patients

Background: Despite advances in intravenous thrombolysis and endovascular thrombectomy, numerous acute ischemic stroke survivors continue to experience various disability levels. The nitric oxide (NO) donor, Glyceryl Trinitrate (GTN), has been identified as a potential neuroprotective agent against ischemic damage. This study evaluates the safety and preliminary efficacy of intravenous GTN administration in AIS patients. Methods: We conducted a prospective, double-blind, randomized controlled trial at Beijing Luhe Stroke Center (ChiCTR2100046271). AIS patients within 24 hours of onset were evenly divided into GTN or control groups (n=20 each). The GTN group received intravenous GTN (5 mg in 50 ml saline at a rate of 0.4 mg/h for 12.5 h/day over 2 days), while controls were administered an equivalent volume of 0.9% saline. Both groups followed standard Stroke Guidelines for treatment. Safety measures focused on SBP<110mmHg and headache occurrence. Efficacy was assessed via the 90-day modified rankin scale (mRS) and the national institutes of health stroke scale (NIHSS) scores. Results: Of the 40 AIS patients, baseline characteristics such as age, gender, risk factors, and mRS scores showed no significant difference between the groups. Safety measures of SBP<110mmHg and headache occurrence were also comparable. Overall, 90-day mRS(1 vs 1) and NIHSS (1 vs1 )did not significantly differ between groups. However, the GTN-treated group showed a superior NIHSS recovery (ΔNIHSS 4.5 Vs 3, p=0.028), indicating that GTN can well-allow patients to recover within the same time frame. Subgroup analyses revealed a noteworthy benefit of GTN in the 90-day NIHSS score for non-thrombolysis patients (1 vs 2, p=0.016). Moreover, GTN benefited mild stroke patients (NIHSS score <6) at 90 days (p=0.025). Conclusion: The RIGID study confirms the safety of intravenous GTN for AIS patients. Notably, while overall 90-day mRS and NIHSS scores between the GTN and control groups did not significantly vary, the GTN group displayed a pronounced improvement in NIHSS recovery. Additionally, GTN demonstrated particular efficacy for non-thrombolysis patients and those with mild stroke symptoms, suggesting its potential as a tailored intervention in specific AIS subgroups.

Incidence of Stroke Cases at Blambangan General Hospital of Banyuwangi in January-December 2022: A Descriptive Study

Highlight: The majority of stroke cases at Blambangan General Hospital in Banyuwangi are ischemic strokes. The age group that experienced the most strokes was >40 years. The gender that experienced the most strokes was female. ABSTRACT Introduction: Stroke is a leading cause of morbidity in Indonesia. It significantly contributes to the overall burden of disease and places a substantial impact on the health of the population in Indonesia. Objective: The purpose of this study was to show the incidence of stroke cases in the Blambangan General Hospital in Banyuwangi. Understanding the prevalence of strokes at this particular hospital is critical for identifying patterns, improving patient care, and taking preventive actions to deal with this important health issue. Methods: This study used a retrospective cross-sectional sampling method to look at all 342 inpatient stroke cases that were treated in the neurology department of Blambangan General Hospital in Banyuwangi in 2022. All of their data was collected and analyzed. Results: Most cases of stroke in this study were ischemic strokes, with a total of 212 cases (62.0% of all cases). The age group that experienced the most strokes was over 40 years old (96.2%) and female (56.4%). More than half of stroke patients had hypertension, and 80.1% had diabetes mellitus. Conclusion: This study found that ischemic stroke survivors, mostly female and aged over 40, were frequently associated with diabetes mellitus and hypertension. These findings provide insights into the frequency of these stroke types within the examined population.

Deep Brain Stimulation for Ischemic Stroke Rehabilitation: from Rodents to Human

Ischemic stroke survivors often suffer from severe disability and impaired quality of life, and the current treatments are inadequate. Deep brain stimulation (DBS) is a promising strategy to enhance recovery and alleviate symptoms, as it can modulate the electrical activity of neural circuits and facilitate neuroprotection and regeneration. In this review, we conducted a comprehensive literature search and summarized the chronic sequelae and mechanisms of ischemic stroke. Then we discuss the common targets and outcomes of DBS in preclinical and clinical studies, as well as the challenges and opportunities of DBS for ischemic stroke treatment.

Factors associated with progression of arterial stiffness in ischemic stroke survivors: the Norwegian Stroke in the Young Study

Background Progressive arterial stiffening may increase the risk of recurrent cardiovascular events in ischemic stroke survivors. Information about factors associated with progressive arterial stiffening during the follow-up of young patients with ischemic stroke is lacking. Methods Arterial stiffness by carotid-femoral pulse wave velocity (cf-PWV) and ambulatory 24-hour blood pressure (24hBP) were assessed in 81 women and 190 men ≤60 years of age included in the Norwegian Stroke in the Young (NOR-SYS) study 3 months and 5.5 years after the incident ischemic stroke, representing baseline and follow-up. Covariables of change in cf-PWV were identified using linear regression analysis. Results At baseline, women had less prevalent hypertension (53% vs. 69%, p < 0.05), and lower clinic and 24hBP than men, whereas age, obesity, and prevalence of smoking and antihypertensive drug treatment did not differ. During follow-up, systolic 24hBP remained unchanged, while diastolic 24hBP fell significantly (p < 0.01). Cf-PWV was lower in women both at baseline (7.3 m/s vs. 8.1 m/s) and at follow-up (7.3 m/s vs. 8.0 m/s, both p < 0.001), but the average change during follow-up did not differ between genders. In linear regression analysis, an increase in cf-PWV at the 5-year follow-up was associated with the presence of hypertension and lower cf-PWV at baseline, and higher systolic 24hBP and lack of use of antihypertensive treatment at follow-up (all p < 0.05). Conclusion In ischemic stroke survivors participating in the NOR-SYS study, the 5-year increase in cf-PWV did not differ between genders and was associated with higher systolic 24hBP and lack of antihypertensive treatment.

The Impact of Undernutrition Risk on Rehabilitation Outcomes in Ischemic Stroke Survivors: A Hospital-Based Study.

Patients experiencing a cerebrovascular event are vulnerable to declining nutritional status, hindering rehabilitation. This study aims to analyze the association between malnutrition risk and hospital rehabilitation indicators in ischemic stroke survivors (ISS). This analytical study examined medical records of 160 adult patients (69.3 ± 13 years). Undernutrition risk (UR; independent variable) and rehabilitation indicators (dependent variables) like hospital stay, clinical outcome, functionality, stroke severity, food intake, mobility (bedridden), mechanical ventilation, and enteral nutrition were assessed. Data were dichotomized, and the chi-square test identified associations (p ≤ 0.05), followed by Poisson regression for prevalence ratios. Patients at UR had 2-fold higher risk of death (95% confidence interval [CI], 0.99-4.79), 1.8-fold higher risk of high stroke severity (95% CI, 1.06-3.11), 76% higher chance of being bedridden (95% CI, 1.28-2.44), and 3-fold higher risk of mechanical ventilation (95% CI, 1.20-9.52). UR in hospitalized ISS is associated with deteriorating rehabilitation indicators, including mobility, decreased food intake, mechanical ventilation use, and neurological deficit, indicating an increased mortality risk post-stroke.

Frequency & factors associated with elevated lipoprotein-a among Ghanaian stroke survivors

BackgroundIndigenous Africans are genetically predisposed to elevated lipoprotein-a (Lp(a)), a veritable risk factor for ischemic stroke. Recent studies have demonstrated the promising efficacy of therapeutic interventions for addressing elevated Lp(a) among patients at high risk of atherosclerotic cardiovascular events. It is important to assess the burden of elevated Lp(a) among stroke survivors of African ancestry aimed at addressing potential unmet therapeutic gaps for optimal secondary prevention. PurposeTo assess the frequency of elevated lipoprotein-a among Ghanaian stroke survivors and factors associated with it. MethodsA prospective study conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital among ischemic stroke survivors aged ≥18 years. Serum lipoprotein-a concentrations were measured using ELISA kits. A multivariate regression analysis was fitted to identify factors independently associated with elevated lipoprotein-a concentration > 30 mg/dl. ResultsAmong 116 stroke survivors, 35 (30.2%) had elevated Lp(a). The adjusted odds ratio (95% CI) of factors associated with elevated Lp(a) were female sex 3.09 (1.05–9.12), p = 0.04, diabetes mellitus 3.52 (1.32–9.40), p = 0.01, urban dwelling 4.64 (1.61–13.39), p = 0.005 and total cholesterol 1.85 (1.28–2.67), p = 0.001. Whereas the LDL cholesterol significantly decreased from baseline to month 12 among a subset of participants, the Lp(a) levels significantly increased from a baseline value of 29.38 ± 15.32 mg/dl to 40.97 ± 29.72 mg/dl, p = 0.032. ConclusionApproximately 1 in 3 Ghanaian ischemic stroke survivors harbor an elevated Lp(a) associated with female sex, urban residence, diabetes mellitus and raised cholesterol. This burden highlights an unmet therapeutic gap in secondary risk reduction in this resource-limited setting.

The effects of low-intensity resistance training with blood flow restriction versus traditional resistance exercise on lower extremity muscle strength and motor functionin ischemic stroke survivors: a randomized controlled trial

ABSTRACT Background Blood flow restriction (BFR) training can temporarily reduce cortical GABA concentrations and increase the size of motor volleys to deafferented muscles, which can promote motor recovery in stroke survivors. Objective To determine the effect of low-intensity resistance training with BFR (LIRT-BFR) on lower extremity muscle strength, balance, functional mobility, walking capacity, gait speed, anxiety, and depression in stroke survivors and to compare the results with high-intensity resistance training (HIRT). Method It was a two-arm, single-blinded, randomized controlled trial in which 32 ischemic stroke participants were randomly allocated to LIRT-BFR or HIRT group. The LIRT-BFR group received low load resistance training (40% of 1-Repetition Maximum (1-RM)) with BFR, whereas HIRT group received high load resistance training (80% of 1-RM). The 6-Minute Walk Test (6-MWT), five-time sit-to-stand test (5TSTST), Timed Up and Go (TUG) test, and Barthel index were the primary outcome measures. The secondary outcome measures included gait speed (m/s), stride length (cm), cadence (steps/min), and Hospital Anxiety and Depression. Results All the primary and secondary outcome measures were significantly improved in both groups (p < 0.05). The LIRT-BFR group showed a slightly greater, but non-significant, improvement as compared to the HIRT group in terms of mean change observed in 6-MWT (81 m vs 62 m), 5TSTST (−5.27 vs −4.81), gait speed (0.19 vs 0.12), stride length (18 vs 13), and cadence (8 vs 6). No adverse event was reported. Conclusion LIRT-BFR produced a significant improvement in muscle strength, balance, walking capacity, and anxiety and depression in ischemic stroke patients, and the improvement are comparable to HIRT. Clinical Trial Registration NCT05281679

Features of speech disorders in patients with acute ischemic stroke

Introduction. Various speech disorders that lead to impaired communication occur in 3050% of ischemic stroke (IS) survivors. Although most attention is traditionally paid to aphasia, speech disorders also include the following: dysarthria, dysphonia (isolated or in combination with dysarthria and/or dysphagia), fluency disorders, and non-specific speech disorders associated with the severity of condition and a cognitive disorder.&#x0D; Objective: to study the variety of speech disorders and their features in patients with acute IS.&#x0D; Materials and methods. We examined 69 right-handed patients with mild-to-moderate acute IS and NIHSS score of 412. The patients were enrolled in the study on days 17 of the IS.&#x0D; Results. We found aphasia in 27/69 patients (39.1%), dysarthria in 21/69 patients (30.4%), dysphonia (isolated or in combination with dysarthria) in 17/69 patients (24.6%), fluency disorders in 19/69 patients (27.5%; 2 patients with tachylalia and 17 patients with bradylalia). In addition, 30 patients (43.5%) had dysphagia (isolated or in combination with dysarthria). At the initial examination, patients admitted within the 17 days of the acute IS onset presented with global or severe sensory and motor aphasia. At the same time, we discovered a pronounced positive dynamics in speech recovery thanks to speech therapy sessions. A significant remission in a speech disorder component led to the development of cortical aphasia affecting either anterior or posterior language areas at the end of the most acute IS period, while aphasia severity reduced to mild or moderate.&#x0D; Conclusions. A fast reduction in aphasic disorders due to the speech therapy sessions suggests that the focal and connectional diaschisis are the basis for the severe speech disorders.

Work performance questionnaire after returning to work in ischemic stroke survivors: the WPQ-INNN survey

Work performance questionnaire after returning to work in ischemic stroke survivors: the WPQ-INNN survey

Post-stroke experiences and health information needs among Chinese elderly ischemic stroke survivors in the internet environment: a qualitative study.

Elderly stroke survivors are encouraged to receive appropriate health information to prevent recurrences. After discharge, older patients seek health information in everyday contexts, examining aspects that facilitate or impair healthy behavior. To explore the experiences of older stroke patients when searching for health information, focusing on search methods, identification of health information, and difficulties faced during the search process. Using the qualitative descriptive methodology, semi-structured interviews were conducted with fifteen participants. Participants associated the health information they sought with concerns about future life prospects triggered by perceived intrusive changes in their living conditions. Based on the participants' descriptions, four themes were refined: participants' motivation to engage in health information acquisition behavior, basic patterns of health information search, source preferences for health information, and difficulties and obstacles in health information search, and two search motivation subthemes, two search pattern subthemes, four search pathway subthemes, and four search difficulty subthemes were further refined. Older stroke patients face significant challenges in searching for health information online. Healthcare professionals should assess survivors' health information-seeking skills, develop training programs, provide multichannel online access to health resources, and promote secondary prevention for patients by improving survivors' health behaviors and self-efficacy.

Prevalence and predictors of low folate levels among stroke survivors in a country without mandatory folate food fortification: Analysis of a Ghanaian sample

BackgroundWhile additional folic acid (FA) treatment has a neutral effect on lowering overall vascular risk in countries that mandate FA fortification of food, meta-analytic data suggest that folate supplementation reduces stroke risk in certain patient subgroups, and among people living in countries without mandatory folate food fortification. However, the burden of folate deficiency among adults with stroke in the world's poorest continent is unknown. PurposeTo assess the prevalence and predictors of folate deficiency among recent ischemic stroke survivors. MethodsWe analyzed data among consecutively encountered ischemic stroke patients aged ≥18 years at a tertiary medical center in Kumasi, Ghana between 10/2020 – 08/2021. We identified a modest sample of stroke free adults to serve as a comparator group. Fasting serum folate was measured using a radioimmunoassay and a cut-off of 4ng/mL used to define folate deficiency. Factors associated with serum folate concentration were assessed using a multilinear regression model. ResultsComparing stroke cases (n = 116) with stroke-free comparators (n = 20), mean folate concentration was lower among stroke cases (7 ng/ml vs. 10.2 ng/ml, p = 0.004). Frequency of folate deficiency was higher among stroke cases vs. stroke-free controls (31% vs 5%, p = 0.02). Male sex (beta coefficient of -2.6 (95% CI: -4.2, -0.9) and LDL (β: -0.76; -1.4, -0.07) were significantly associated with serum folate concentration. ConclusionAlmost one in three ischemic stroke survivors have folate deficiency potentially accentuating their risk for further adverse atherosclerotic events in a setting without folate fortification. A clinical trial of folate supplementation among stroke survivors is warranted.

Depression status and functional outcome of patients with ischemic stroke and the impact on caregivers living in Chengdu: a cross-sectional study.

To investigate the associations between risk factors and depression symptoms in ischemic stroke (IS) survivors and the effect of IS survivors' depression status and functional outcomes on caregiver burden in Chengdu, China. In this cross-sectional study, we recruited a convenience sample of patients with IS and paired caregivers living in Chengdu from February 2022 to May 2022. Depression symptoms were assessed using the 17-item Chinese Hamilton Depression Rating Scale, the social support of patients was assessed using the perceived social support scale (PSSS), caregiver burden was assessed using the Zarit burden interview (ZBI). Multivariable logistic regression analysis was used to analyze the data between risk factors and depression symptoms, and multiple linear regression models were constructed to examine the depression symptoms and functional outcomes of stroke survivors, and caregiver burden. In total, 966 IS survivors and paired caregivers were included in this study. Among IS survivors, 35.51% (343/966) experienced depression. Age [adjusted odds ratio (aOR), 1.02; 95% confidence interval (CI), 1.00-1.04; p = 0.036], the National Institutes of Health Stroke Scale (NIHSS) score (aOR, 1.57; 95% CI, 1.47-1.68; p < 0.001), and PSSS score (aOR, 0.86; 95% CI, 0.84-0.89; p < 0.001) were associated with an increased risk of depression. The NIHSS score (b = 2.57, p < 0.001), patients' depression status (b = 2.54, p < 0.001), duration of care (b = 0.359, p = 0.006), and social support of caregivers (b = -0.894, p = 0.038) were significantly associated with the ZBI score. The PSSS score was a major risk factor for the development of depression in IS survivors, and patients' depression status and severe functional deficits had a negative impact on the ZBI score of the main caregivers. Social support can reduce the ZBI score.

Alberta Stroke Program Early CT Score can Predict Severity of Spasticity and Functional Outcome in Ischemic Stroke Survivors.

Post-stroke spasticity is common and an early predictor of the severity of spasticity can help track recovery trajectory helping to modify rehabilitation plans. We explored the utility of the Alberta Stroke Program Early CT Score (ASPECTS) to predict functional motor capacity in patients after acute ischemic stroke. One hundred and one patients (mean age of 58.6 ± 7.6 years; M:F = 72: 29) with the first documented acute ischemic stroke were followed up for three to twelve months after the stroke. Cerebral lesions within the territory of the middle cerebral artery were evaluated using the ASPECTS. Spasticity was assessed using the Modified Ashworth Score (MAS) and walking with Timed Up and Go test (TUG). The associations between severity of spasticity and size/extent of infarct as derived from ASPECTS and between spasticity and functional walking in post-stroke survivors were analyzed. Among the patients studied, 61.3% (n = 62) had infarct in the region of supply of the left middle cerebral artery (MCA) and 38.7% (n = 39) had infarct in the region supplied by the right MCA. Three percent (n = 3) had a low ASPECTS, 53.6% (n = 54) had an intermediate score and 44.4% (n = 44) had a high score. The majority of patients with no to mild spasticity had high ASPECTS. Worse spasticity was significantly associated with low ASPECTS (P = 0.001). High scores in Timed Up and Go test (TUG) were associated with low ASPECTS (P < 0.001). Patients with high ASPECTS had the propensity to have subcortical infarcts (P < 0.001) when compared to those with moderate ASPECTS, who had a mix of cortical and subcortical infarcts. ASPECTS at admission in patients with acute ischemic stroke is a good predictor of post-stroke spasticity and functional walking. Low ASPECTS is associated with higher spasticity and lower functional walking status on follow-up after stroke.