Post-stroke Cognitive Impairment Research Articles

Abstract TMP101: Post-stroke Cognitive Impairment And The Risk Of Recurrent Stroke And Death: Systematic Review And Meta-analysis

Post-stroke cognitive impairment (PSCI) occurs in 20-40% of patients 3-6 months after stroke. However, the question regarding risks of recurrent stroke and death in patients with PSCI remains controversial. The goal of this study was to conduct meta-analysis of published literature to estimate the risks of stroke recurrence and death associated with PSCI, as well as to assess the quality of these studies, and to identify sources of variation. Electronic databases (PubMed, EMbase, Google Scholar, Cochrane Library, and Scopus) were screened for eligible studies published from 1992 to 2019. Study quality was assessed using the Newcastle Ottawa Scale. Risk of bias in non-randomized and randomized studies was assessed using ROBINS-E and RoB 2 tools, respectively. Funnel plots and selection models were used for evaluating publication bias. Heterogeneity was assessed using a combination of statistics: I 2 , Q -statistic, and Kendall τ 2 . Estimates were obtained using a random effects model and restricted maximum likelihood estimation. Pooled estimates for the two outcomes of interest were calculated as hazard ratios (HR) with 95% confidence intervals (CIs). We included eight studies examining the effect of PSCI on risk of stroke recurrence. We found no evidence of potential publication bias among the included studies in stroke recurrence (χ 2 =3.440, p=0.487) and mortality (χ 2 =3.797, p=0.150). Pooled data from the eight studies involving n=1,840 PSCI and n=5,824 non-PSCI showed that the hazard of recurrent stroke risk was significantly higher in individuals with PSCI compared to non-PSCI participants (HR = 1.71; 95% CI: 1.45 - 2.01; I 2 = 0%). Seventeen studies were included examining the impact of PSCI on mortality risk. The pooled data from these studies comprised n=7,591 PSCI and n=22,328 non-PSCI study participants. The pooled hazard of mortality was significantly higher in the PSCI group relative to the non-PSCI group (HR = 1.98; 95% CI: 1.64 - 2.40; I 2 = 82.95%). This meta-analysis shows an increased risk of mortality and recurrent stroke in patients with PSCI. Post-stroke cognitive testing may identify patients at a higher risk of stroke recurrence and death who may require more aggressive interventions for secondary prevention.

Abstract TMP26: Effect Of Pioglitazone On Recurrent Stroke Risk In Patients With Post-stroke Cognitive Impairment And Insulin Resistance: Subgroup Analysis Of IRIS Trial

Patients with post-stroke cognitive impairment are at higher risk of recurrent stroke but the effect of pioglitazone on that risk has not been explored. The goal of this study was to determine the effect of pioglitazone on the risk of recurrent vascular events in patients with post-stroke cognitive impairment (PSCI) and insulin resistance (IR). We studied patients enrolled in Insulin Resistance Intervention after Stroke (IRIS) trial with a baseline Modified Mini-Mental State Examination (3MS) cognitive exam at median of 79 days after their stroke. We considered a baseline score of ≤ 88 on the 3MS to indicate global PSCI, and domain-specific summary scores in the lowest quartile to indicate language, attention, orientation, memory and visuospatial impairments. The primary endpoint of the study was recurrent stroke and MI. We studied n=3,338 patients. In fully adjusted Cox proportional hazards models for recurrent stroke, the hazard ratio (HR) for the effect of pioglitazone compared to placebo differed by post-stroke memory impiarment status (interaction p = 0.01). Pioglitazone was associated with 51% lower risk of recurrent stroke in patients with post-stroke memory impairment [HR = 0.49 (95% CI: 0.30 - 0.81); p = 0.005], but not in those without it [HR = 1.01 (95% CI: 0.75- 1.36); p = 0.942]. In fully adjusted Cox proportional hazards models for MI, the HR for the effect of pioglitazone compared to placebo differed by global PSCI status (interaction p = 0.03). Pioglitazone was associated with 77% lower risk of MI in patients with post-stroke global PSCI [HR = 0.23 (95% CI: 0.08, 0.71); p = 0.01], but not in those without it [HR = 0.88 (95% CI: 0.59, 1.31); p = 0.53]. These data indicate that simple cognitive testing after 3 months from stroke may serve as a precision medicine tool to identify patients at higher risk who may benefit from pioglitazone treatment. This approach can be tested in secondary stroke prevention clinical trials.

Abstract WP240: TRPM2 Channel Deletion In Neurons Reduces Injury Following Ischemic Stroke And Improves Post-stroke Cognitive Function

Background: Emerging evidence implicates post-stroke cognitive impairment as a major contributor to long-term disability. Therefore, optimal therapeutic targets reduce acute ischemic injury and enhance post-stroke brain function. Strong data demonstrates that a novel TRPM2 channel antagonist (tat-M2NX) provides neuroprotection and improves synaptic function, thereby reducing post-stroke cognitive impairment (PSCI). Hypothesis: Knockout of neuron-specific TRPM2 channel expression reduces infarct volume and enhances functional recovery following MCAO Methods: Transient MCAO (60 min) was performed on adult (8-10 week) male and female TRPM2 neuron-specific KO (TRPM2fl/fl, CaMKII Cre) and TRPM2 floxed controls (TRPM2fl/fl)Hemispheric infarct volume analyzed from MRI (T2) images 3 days post-injury by a blinded investigator. Extracellular field recordings of CA1 neurons were performed in acute hippocampal slices prepared 7 days after recovery from MCAO to analyze synaptic placticity (LTP). Results: We observed that neuronal-specific TRPM2 channel knockout reduces acute ischemic injury (infarct volume) in male animals, while having minimal effect on female mice. Consistent with the hypothesis that neuronal TRPM2 channels contribute to ischemia-induced synaptic dysfunction, recordings obtained in brain slices from neuronal TRPM2 channel KO mice (TRPM2fl/fl-CaMKII CRE) mice 7 days after recovery from 60 min MCAo exhibited intact hippocampal plasticity compared to control TRPM2fl/fl mice not expressing CRE. Male sham control mice exhibit robust LTP of 163±10.4% (n=3) compared to 115±5.6% (n=4) in TRPM2fl/fl mice after MCAO. Neuronal KO exhibited 175±9.8% (n=2). Similarly, female mice had control LTP of 170±6.8% (n=4) compared to 125±6.8% (n=3) in TRPM2fl/fl mice after MCAO. Neuronal KO exhibited 208±7.8% (n=5, p<0.05 ANOVA compared to TRPM2fl/fl MCAO). Conclusion: Our data highlight that TRPM2 channels expressed in neurons contribute to both acute injury following transient ischemic stroke and subacute/chronic functional recovery.

Abstract TP189: Identifying Stroke Patients At Risk For Cognitive Impairment And Dementia Using Electronic Health Record Data And Machine Learning

Background: Stroke patients are at high risk of developing cognitive impairment and dementia. Failure to identify cognitive impairment in time could hasten the progression of dementia and impact the rehabilitation plan. Therefore, a reliable method is needed to determine a stroke survivor’s susceptibility to post-stroke cognitive impairment and dementia (PSCID). Method: We conducted a retrospective cohort study of cryptogenic stroke (CS) patients from January 1, 2017, to February 28, 2022, using EHR data to query for PSCID onset. A machine learning (ML) model was created to forecast the occurrence of PSCID during follow-up. The features used in the model included elements from EHR that were found to be associated with PSCID in other studies, including sociodemographic, medical, and mental morbidities. Logistic Regression, Random Forest (RF) Classifier, and Gradient Boosting are examples of ML algorithms that were used. The final model used RF Classifier due to its superior performance. Results: Of 390 CS patients (62±16 years, 56.4% male) included in the analysis, 110 (28.2%) had documented PSCID in EHR following the initial stroke. We evaluated our model in a repeated (n=100) 10-fold cross validation scheme and used Synthetic Minority Oversampling Technique (SMOTE) to compensate for class imbalance. We identified the most informative ten features using an Extra Tree classifier, which are age, transient ischemic attack, sex, smoking, diabetes, hypertension, atherosclerosis, anemia, and atrial fibrillation. Using these features, our RF classifier reached a performance of 71.2±6.5% accuracy, 70±4.9% precision, 75±12% recall, and 0.777±0.082 AUC. Conclusion: Our model could predict the CS patients at risk for PSCID with reasonable accuracy using only ten features. Future work should involve a larger cohort along with more advanced machine learning algorithms to enhance the prediction performance.

Abstract TMP34: Association Of Post-stroke Cognitive Impairment With Long-term Patient-reported Outcome Measures

Introduction: Post-stroke cognitive impairment/dementia (PSCID) is highly prevalent and associated with poor long-term outcomes after acute ischemic stroke (AIS). Recognition of early determinants of PSCID allows for individualized interventions to reduce long-term disability. Furthermore, investigating the relation between PSCID and patient-reported outcomes provides insight into personalized impact of post-stroke cognitive dysfunction. We aimed to identify clinical determinants of PSCID and association with patient-reported outcome measures (PROMs) at 3- and 12-month after AIS. Methods: 138 AIS patients with no previous history of dementia were included. Clinical variables were acquired on hospital admission. Patients underwent a telephone interview at 3- and 12-months post-stroke including the Telephone Interview for Cognitive Status (TICS), modified Rankin scale (mRS), Barthel Index (BI) and PROM-10 questionnaires. PSCID was defined as TICS < 36 at 12-month post-stroke. Linear regression analyses were performed to identify predictors of 12-month TICS score and association with 3- and 12-month PROMs. Results: At 12 months post-stroke, 113 participants (82%) had PSCID. AIS patients with PSCID had higher rates of mRS ≥ 2 at 3-months (61.8% vs. 32%, p = 0.01), worse BI at 12-months (93.12 vs. 102, p < 0.01) and lower 12-month PROMs T Mental scores (48.22 vs. 52.41, p < 0.05). In linear regression analysis, worse functional and patient-reported outcomes at 3- and 12-months were independently associated with lower 12-month TICS (Table) . Conclusions: Large proportion of AIS patients experience PSCID at 12-months after stroke. 3-month PROMs, especially in the physical domain, are independently associated with worse cognitive measures at 12-months post-stroke. Moreover, PROMs at 12-months after AIS are strongly associated with PSCID. Incorporating PROMs in the ambulatory setting may offer additional insight into cognitive impairment after stroke.

Is cognitive reserve associated with the prevention of cognitive decline after stroke? A Systematic review and meta-analysis.

To conduct a systematic review and meta-analyses of the effect of socio-behavioral cognitive reserve (CR) proxies on cognitive decline after stroke. Three journal search and indexing databases (PubMed, Scopus and Web of Sciences) were crossed to examine the scientific evidence systematically. In addition, meta-analytic techniques, using mixed-effect methods, were carried out to estimate the impact (pooled effect size) of CR proxies on either dementia incidence or cognitive decline after stroke. Twenty-two studies were included in the systematic revision, whereas nineteen of them were eligible for the meta-analysis. The findings showed that high education is associated with a decreased rate of post-stroke dementia. Moreover, other CR proxies (e.g., occupation, bilingualism or social interaction) demonstrate a protective effect against non-dementia cognitive decline after stroke, although some inconsistencies were found in the literature. Regarding the meta-analysis, occupational attainment and education) showed a protective effect against post-stroke cognitive impairment diagnosis in comparison with a mixed category of different CR proxies. Second, a main cognitive change effect was found, pointing to greater cognitive change after stroke in those with low vs. high CR. Our findings emphasize that CR may prevent cognitive decline after stroke, but this effect can be modulated by different factors such the CR proxy and individual characteristics such as age or type of lesion. The methodological divergences of the studies (i.e., follow-up intervals, cognitive outcomes) need unification to diminish external sources of variability for predicting rates of cognitive decline after stroke.

Efficacy and safety of oxiracetam in patients with vascular cognitive impairment: A multicenter, randomized, double-blinded, placebo-controlled, phase IV clinical trial

BackgroundOxiracetam may have a modest effect on preventing cognitive decline. Exercise can also enhance cognitive function. This trial aims to investigate the effect of oxiracetam on post-stroke cognitive impairment and explore whether this effect is modified by exercise. Furthermore, the mechanisms that mediate this effect will be investigated through a neural network analysis. MethodsThis is a multicenter, randomized, double-blind, placebo-controlled phase IV trial. Patients who complained of cognitive decline 3 months after stroke and had a high risk of cognitive decline were eligible. Patients were randomly assigned to receive either 800 mg of oxiracetam or placebo twice daily for 36 weeks. After randomization, a predetermined exercise protocol was provided to each participant, and the degree of physical activity was assessed using wrist actigraphy at 4, 12, 24, and 36 weeks. Resting-state functional MRI was obtained in baseline and 36-week follow-up. Co-primary endpoints are changes in the Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. Secondary endpoints include changes in the NINDS-CSN VCIHS-Neuropsychology Protocol, Euro QoL, patient's global assessment, and functional network connectivity. If there is a significant difference in physical activity between the two groups, the interaction effect between physical activity and the treatment group will be examined. A total of 500 patients were enrolled from February 2018, and the last patient's final follow-up was completed in September 2022. ConclusionThis trial is meaningful not only to prove the efficacy of oxiracetam, but also evaluate whether exercise can modify the effects of medication and how cognitive function can be restored.Trial registrationhttp://cris.nih.go.kr (KCT0005137).

Altered static and dynamic functional network connectivity in post-stroke cognitive impairment

Post-stroke cognitive impairment (PSCI) is a common symptom following brain stroke, yet the mechanisms remain unknown. This study aimed to investigate alterations of static and dynamic functional network connectivity (sFNC and dFNC) in PSCI patients. We prospectively recruited 17 PSCI patients and 24 Healthy controls (HC). Restingstate fMRI (rs-fMRI) and Mini-Mental State Examination (MMSE) were performed. Independent component analysis combined with sliding-window and K-means clustering approach were applied to examine the FNC among 11 resting-state networks: auditory network (AUDN), left executive control network (lECN), language network (LN), precuneus network (PCUN), right executive control network (rECN), salience network (SN), visuospatial network (VN), dorsal default mode network (dDMN), higher visual network (hVIS), primary visual network (pVIS), and ventral mode network (vDMN). The FNC and dynamic indices (fraction time, mean dwell time, transition number) were calculated. Static and dynamic measures were compared between two groups and the correlation between clinical and imaging indicators was analyzed. For sFNC, PSCI group showed decreased interactions in dDMN-vDMN, vDMN-SN, dDMN-hVIS, AUDN-rECN, and AUDN-VN. For dFNC, we derived 3 states of FNC that occurred repeatedly. Significant group differences were found, including decreased interactions in the AUDN-VN, AUDN-pVIS in state 2 and dDMN-VN in state 3. The mean dwell time in PSCI group was longer in state 1, and negatively correlated with MMSE score. These results demonstrated that PSCI patients are characterized with altered sFNC and dFNC, which could help us explore the neural mechanisms of the PSCI from a new perspective.

Incidence of post-stroke cognitive impairment in patients with first-ever ischemic stroke: a multicenter cross-sectional study in China

Post-stroke cognitive impairment (PSCI) is a common sequela after stroke. China has a large population of stroke survivors, but a large-scale survey on the incidence and risk factors for PSCI has not been undertaken. We aimed to calculate the incidence and risk factors for vascular cognitive symptoms among first-ever stroke survivors in China through a multicenter cross-sectional study. From May 1, 2019 to November 30, 2019, patients with a clinical diagnosis of first-ever ischemic stroke were recruited from 563 hospitalized-based stroke center networks in 30 provinces of China. Cognitive impairment was measured by 5-min National Institute of Neurological Disease and Stroke-Canadian Stroke Network (NINDS-CSN) at 3-6 months after the indexed stroke. Stepwise multivariate regression and stratified analysis were performed to assess the association between PSCI and demographic variables. A total of 24,055 first-ever ischemic stroke patients were enrolled, with an average age of 70.25±9.88 years. The incidence of PSCI as per the 5-min NINDS-CSN was 78.7%. Age ≥75 years old (OR: 1.887, 95%CI: 1.391-2.559), western regional residence (OR: 1.620, 95%CI: 1.411-1.860) and lower education level were associated with increased PSCI risk. Hypertension might be related to non-PSCI (OR: 0.832, 95%CI: 0.779-0.888). For patients under 45 years old, unemployment was an independent risk factor for PSCI (OR: 6.097, 95%CI: 1.385-26.830). For patients who were residents of the southern region (OR: 1.490, 95%CI: 1.185-1.873) and non-manual workers (OR: 2.122, 95%CI: 1.188-3.792), diabetes was related to PSCI. PSCI is common in Chinese patients with first-ever stroke, and many risk factors are related to the occurrence of PSCI. The Beijing Hospitals Authority Youth Program (No. QMS20200801); Youth Program of the National Natural Science Foundation of China (No. 81801142); the Key Project of Science and Technology Development of China Railway Corporation (No. K2019Z005); The Capital Health Research and Development of Special (No. 2020-2-2014); Science and Technology Innovation 2030-Major Project (No. 2021ZD0201806).

DL-3-n-butylphthalide (NBP) alleviates poststroke cognitive impairment (PSCI) by suppressing neuroinflammation and oxidative stress.

Currently, the recovery of cognitive function has become an essential part of stroke rehabilitation. DL-3-n-butylphthalide (NBP) is a neuroprotective reagent and has been used in stroke treatment. Clinical studies have confirmed that NBP can achieve better cognitive outcomes in ischemic stroke patients than in healthy controls. In this study, we aimed to investigate the influences of NBP on cognitive function in an ischemic reperfusion (I/R) rat model. Our results showed that NBP profoundly decreased neurological scores, reduced cerebral infarct areas and enhanced cerebral blood flow (CBF). NBP potently alleviated poststroke cognitive impairment (PSCI) including depression-like behavior and learning, memory and social cognition impairments, in I/R rats. NBP distinctly suppressed the activation of microglia and astrocytes and improved neuron viability in the ischemic brain. NBP inhibited the expression of inflammatory cytokines, including interleukin-6 (IL-6), interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α), by targeting the nuclear factor kappa B/inducible nitric oxide synthase (NF-κB/iNOS) pathway and decreased cerebral oxidative stress factors, including reactive oxygen species (ROS) and malondialdehyde (MDA), by targeting the kelch like ECH associated protein 1/nuclear factor-erythroid 2 p45-related factor 2 (Keap1/Nrf2) pathway in the ischemic brain. The current study revealed that NBP treatment improved neurological function and ameliorated cognitive impairment in I/R rats, possibly by synergistically suppressing inflammation and oxidative stress.

Post-Stroke Insomnia Increased the Risk of Cognitive Impairments: A Hospital-Based Retrospective Cohort Study

ABSTRACT Objectives/Background Insomnia is a common sleep complaint among patients who had a stroke and has been recognized as an independent risk factor for cognitive impairment. However, the relationship between poststroke insomnia and cognitive impairment over time is under-researched. Therefore, we examined the association between poststroke insomnia and the risk of cognitive impairment. Participants Stroke participants who had a stroke and were 20 years and older Methods This multicenter hospital-based retrospective cohort study with a 13-year follow-up period (2004–2017). The diagnosis of stroke, insomnia, and cognitive impairment was based on the International Classification of Diseases. The study participants who experienced a stroke were divided into two cohorts: those who also had insomnia and those who did not have insomnia. A Cox proportional-hazards regression model was used. Results A total of 1,775 patients with a mean age of 67.6 years were included. Of these patients, 146 and 75 patients were diagnosed with insomnia and cognitive impairment during the follow-up period, respectively. The cumulative incidence of cognitive impairment in the stroke with insomnia cohort was significantly lower than that in the stroke without insomnia cohort (log-rank test, P < .001). The adjusted hazard ratio and 95% confidence interval (CI) of the stroke with insomnia cohort indicated a higher risk of cognitive impairment compared with the stroke without insomnia cohort (adjusted hazard ratio: 2.38; 95% CI: 1.41–4.03). Conclusions Patients who had a stroke and were diagnosed with insomnia exhibited a substantial increased risk of cognitive impairment over time.

Iron chelation therapy to prevent poststroke cognitive impairments: role of diabetes and sex.

Editorial FocusIron chelation therapy to prevent poststroke cognitive impairments: role of diabetes and sexSiva S. V. P. Sakamuri, Venkata N. Sure, and Prasad V. G. KatakamSiva S. V. P. SakamuriDepartment of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, Venkata N. SureDepartment of Pharmacology, Tulane University School of Medicine, New Orleans, Louisiana, and Prasad V. G. KatakamDepartment of Pharmacology, Tulane University School of Medicine, New Orleans, LouisianaNeuroscience Program, Tulane Brain Institute, Tulane University, New Orleans, LouisianaClinical Neuroscience Research Center, Tulane University, New Orleans, LouisianaPublished Online:17 Jan 2023https://doi.org/10.1152/ajpheart.00004.2023This is the final version - click for previous versionMoreSectionsFull TextPDF (246 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations ShareShare onFacebookTwitterLinkedInWeChat "Iron chelation therapy to prevent poststroke cognitive impairments: role of diabetes and sex." American Journal of Physiology-Heart and Circulatory Physiology, 324(2), pp. H210–H211REFERENCES1. Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and ischemic stroke: an old and new relationship an overview of the close interaction between these diseases. Int J Mol Sci 23: 2397, 2022. doi:10.3390/ijms23042397.Crossref | PubMed | ISI | Google Scholar2. Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, Jickling GC. Hemorrhagic transformation in ischemic stroke and the role of inflammation. Front Neurol 12: 661955, 2021. doi:10.3389/fneur.2021.661955.Crossref | PubMed | ISI | Google Scholar3. Fang XL, Ding SY, Du XZ, Wang JH, Li XL. Ferroptosis-a novel mechanism with multifaceted actions on stroke. Front Neurol 13: 881809, 2022. doi:10.3389/fneur.2022.881809. Crossref | PubMed | ISI | Google Scholar4. Dixon SJ, Lemberg KM, Lamprecht MR, Skouta R, Zaitsev EM, Gleason CE, Patel DN, Bauer AJ, Cantley AM, Yang WS, Morrison B 3rd, Stockwell BR. Ferroptosis: an iron-dependent form of nonapoptotic cell death. Cell 149: 1060–1072, 2012. doi:10.1016/j.cell.2012.03.042. Crossref | PubMed | ISI | Google Scholar5. Abdul Y, Li W, Ward R, Abdelsaid M, Hafez S, Dong G, Jamil S, Wolf V, Johnson MH, Fagan SC, Ergul A. Deferoxamine treatment prevents post-stroke vasoregression and neurovascular unit remodeling leading to improved functional outcomes in type 2 male diabetic rats: role of endothelial ferroptosis. Transl Stroke Res 12: 615–630, 2021. doi:10.1007/s12975-020-00844-7. Crossref | PubMed | ISI | Google Scholar6. Li W, Valenzuela JP, Ward R, Abdelbary M, Dong G, Fagan SC, Ergul A. Post-stroke neovascularization and functional outcomes differ in diabetes depending on severity of injury and sex: Potential link to hemorrhagic transformation. Exp Neurol 311: 106–114, 2019. doi:10.1016/j.expneurol.2018.09.013. Crossref | PubMed | ISI | Google Scholar7. Bushnell CD, Chaturvedi S, Gage KR, Herson PS, Hurn PD, Jiménez MC, Kittner SJ, Madsen TE, McCullough LD, McDermott M, Reeves MJ, Rundek T. Sex differences in stroke: challenges and opportunities. J Cereb Blood Flow Metab 38: 2179–2191, 2018. doi:10.1177/0271678X18793324. Crossref | PubMed | ISI | Google Scholar8. Banerjee A, McCullough LD. Sex-specific immune responses in stroke. Stroke 53: 1449–1459, 2022. doi:10.1161/STROKEAHA.122.036945. Crossref | PubMed | ISI | Google Scholar9. Li W, Ward R, Valenzuela JP, Dong G, Fagan SC, Ergul A. Diabetes worsens functional outcomes in young female rats: comparison of stroke models, tissue plasminogen activator effects, and sexes. Transl Stroke Res 8: 429–439, 2017. doi:10.1007/s12975-017-0525-7.Crossref | PubMed | ISI | Google Scholar10. Li W, Abdul Y, Chandran R, Jamil S, Ward RA, Abdelsaid M, Dong G, Fagan SC, Ergul A. Deferoxamine prevents post-stroke memory impairment in female diabetic rats: potential links to hemorrhagic transformation and ferroptosis. Am J Physiol Heart Circ Physiol 324: TBA, 2023. doi:10.1152/ajpheart.00490.2022.Link | Google Scholar Back to Top Next Download PDF FiguresReferencesRelatedInformation Related ArticlesDeferoxamine prevents poststroke memory impairment in female diabetic rats: potential links to hemorrhagic transformation and ferroptosis 17 Jan 2023American Journal of Physiology-Heart and Circulatory Physiology More from this issue > Volume 324Issue 2February 2023Pages H210-H211 Crossmark Copyright & PermissionsCopyright © 2023 the American Physiological Society.https://doi.org/10.1152/ajpheart.00004.2023PubMed36607799History Received 4 January 2023 Accepted 5 January 2023 Published online 17 January 2023 Published in print 1 February 2023 Keywordscognitiveferroptosismicrogliamicrovascularneurovascular Metrics

Relationships of Low Serum Levels of Interleukin-10 With Poststroke Anxiety and Cognitive Impairment in Patients With Clinical Acute Stroke.

The relationships among interleukin (IL)-10 levels, anxiety, and cognitive status after stroke remain controversial. We aimed to determine the associations of serum IL-10 levels with poststroke anxiety (PSA) and poststroke cognitive impairment (PSCI). We recruited 350 patients with stroke, of whom only 151 completed a 1-month follow-up assessment. The Mini Mental State Examination (MMSE) and Hamilton Anxiety Scale (HAMA) were used to assess the cognitive status and anxiety, respectively. Serum IL-10 levels were measured within 24 hours of admission. IL-10 levels were significantly lower in the PSA group than in the non-PSA group, and they were negatively associated with HAMA scores (r=-0.371, p<0.001). After adjusting for all potential confounders, IL-10 levels remained an independent predictor of PSA (odds ratio=0.471, 95% confidence interval=0.237-0.936, p=0.032). IL-10 levels were strongly correlated with behavior during interviews, psychic anxiety, and somatic anxiety. Patients without PSCI had higher IL-10 levels were higher in non-PSCI patients than in PSCI patients, and they were positively associated with MMSE scores in the bivariate correlation analysis (r=0.169, p=0.038), and also with memory capacity, naming ability, and copying capacity. However, IL-10 did not predict PSCI in the univariable or multivariable logistic regression. Low IL-10 levels were associated with increased risks of PSA and PSCI at a 1-month follow-up after stroke. Serum IL-10 levels may therefore be helpful in predicting PSA.

Effectiveness of repetitive transcranial magnetic stimulation on post-stroke unilateral spatial neglect

Post-stroke cognitive impairment refers to the cognitive impairment caused by stroke. Unilateral spatial neglect is the main symptom and results in remarkably lower independence in activities of daily living and participation. Recent studies suggested that repetitive transcranial magnetic stimulation (rTMS) may have a positive effect on post-stroke cognitive impairment, but no relevant systematic review has been conducted on post-stroke cognitive impairment, especially unilateral spatial neglect. Therefore, relevant studies on rTMS in the treatment of post-stroke were collected and analyzed by systematic review and meta-analysis to determine whether rTMS can improve the cognitive function of patients, especially post-stroke unilateral spatial neglect, to provide reliable evidence for rTMS intervention. PubMed, Cochrane Central Register of Controlled Trials, Embase, PsycINFO databases, Web of Science and CINAHL were searched up to February 3, 2021. Three authors screened the reviews and independently assessed their methodological quality using the Jadad scale. The number of studies finally pooled was 28, and the sample size was 819. In the overall cognition function, the efficacy of the intervention group was superior to that of the control group. This meta-analysis result indicated that rTMS influences unilateral spatial neglect. rTMS was effective in improving patients’ activities of daily living. Subgroup analysis showed the preferred items in selecting frequency pulses and session. Furthermore, rTMS could not improve unilateral spatial neglect with an onset time of less than 1 month and over 1 month. This meta-analysis shows that rTMS intervention may be a promising way to treat post-stroke cognitive impairment.

Effect of Early Yoga Practice on Post Stroke Cognitive Impairment.

Post-stroke cognitive impairment (PSCI) is a clinical entity that encompasses all types of cognitive impairment following an index stroke. Yoga has been proven to have a beneficial effect not only on cardiovascular risk factors but also on cognition. Hence, this study explored the PSCI spectrum and assessed the effect of yoga on PSCI. Forty stroke patients were enrolled in each yoga and control arm in this study. After the baseline assessment, control arm was administered standard care (including physiotherapy) while yoga arm received additional yoga intervention. Change in MoCA scores by 2 points in either direction, or FAB scale by 2 points at 6 months was taken as primary outcome, whereas improvement in MRS, CDPSS, CBS, and P300 values were considered as secondary outcomes. Significant improvements were observed in MoCA, FAB, MRS, CPDSS, and CBS scores in both groups after 6 months. However, intergroup comparisons revealed better MoCA (25.5, IQR 22-27) and FAB scores (15.5, IQR 14-17) in yoga group compared to controls (24, IQR20-25.75) and (14, IQR12-15.75). Equivalent improvement was observed in MRS and CBS scores in both groups at 6 months; however, CDPSS score was better in yoga group (p = 0.0008). Both P300 amplitudes and latencies improved in all patients and median P300 amplitudes were significantly better in control group; however, no difference could be appreciated in P300 latencies improvement on intergroup comparisons at follow-up. Study reveals that early yoga intervention in stroke survivors leads to better improvement in cognitive abilities which would further facilitate in early reduction of caregiver burden.

A scoping review of recent advancements in intervention and outcome measures for post-stroke cognitive impairments

Cognitive deficit is one of the common impairments that occur post stroke and have a major effect on the quality of life of stroke survivors. However, the intervention and outcome measures used to remediate post-stroke cognitive impairments are diverse and highly heterogeneous. Therefore, a review of intervention and outcome measures for post-stroke cognitive impairments was carried out. To review all available information on the recent advancements in intervention and outcome measures for post-stroke cognitive impairments. An electronic database search was conducted in PubMed, Medline, Google Scholar, and the Cochrane Library with key search terms between 2001 and 2021. The search results were systematically screened, and data was independently extracted by three reviewers. The data was thematically analyzed and narratively synthesized. The search retrieved 2018 records, and we included 12 studies that met the inclusion criteria. Most of the studies targeted global cognitive deficits in ischemic stroke patients in the chronic phase. We categorized data based on the type of cognitive impairment, cognitive- domain targeted, intervention, and available outcome measures for post-stroke cognitive rehabilitation. Attention, memory, executive function, and global cognition were the common cognitive components targeted, managed, and assessed using an outcome measure. We found that technology is replacing conventional approaches to improve cognitive impairment. Regardless of many new developments in post-stroke cognitive rehabilitation interventions driven by technology, there is limited data available on actual implementation as a scalable solution. There is an extensive need for future research for evidence-based assessment and management of cognitive impairments in post-stroke rehabilitation.

LINC00205/miR-495-3p/TNFSF15 axis is implicated in the treatment effect of hyperbaric oxygen therapy on patients with post-stroke cognitive impairment

LINC00205/miR-495-3p/TNFSF15 axis is implicated in the treatment effect of hyperbaric oxygen therapy on patients with post-stroke cognitive impairment

Состояние когнитивных функций в остром периоде ишемического инсульта

Aim: to assess the dynamics of the state of cognitive functions in the acute period of ischemic stroke. Design: prospective study. Material and methods. The study included a group of observation of patients in the acute period of ischemic stroke in the amount of 26 people. The cognitive sphere was assessed twice: on admission to the hospital on days 2-3, and on discharge on days 8-10. Scales used to assess the cognitive sphere: Mini Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), The Clock-drawing Test (CDT). The emotional-volitional sphere was assessed using the Hospital Anxiety and Depression Scale (HADS). Data were considered statistically significant at p &lt; 0.05. Results. In a dynamic assessment, cognitive disorders in the observed group were most pronounced upon admission to the hospital. By discharge on days 8-10, according to the MMSE test, there was a positive trend, the increase was by 2b, MoCA by 2b, FAB by 1b, respectively, the results were significant (p &lt; 0.001, p &lt; 0.001, p = 0.001). In the analysis of subscales according to the MMSE test, improvements to the extract were according to word reproduction (p = 0.005), speech functions (p = 0.04). According to MoCA, the improvement in total scores was due to subscales: memory (p = 0.01), attention (p = 0.05), speech (p = 0.04), abstraction (p = 0.005). Changes in the FAB test were driven by the conceptualization function (p = 0.04) and the simple choice response (p = 0.008). Anxiety and depression were not detected in the studied patients. Conclusion. During the acute period of ischemic stroke, the degree of cognitive impairment significantly decreases by 8-10 days against the background of ongoing treatment. Keywords: stroke, cognitive impairment, dementia, post-stroke cognitive impairment, mild cognitive impairment.

Retracted: Effect of Early Cognitive Training Combined with Aerobic Exercise on Quality of Life and Cognitive Function Recovery of Patients with Poststroke Cognitive Impairment.

[This retracts the article DOI: 10.1155/2022/9891192.].

Serum Sphingosine 1-Phosphate as a Biomarker for Post-Stroke Cognitive Impairment

Serum Sphingosine 1-Phosphate as a Biomarker for Post-Stroke Cognitive Impairment