Post-stroke Period Research Articles

Abstract WP75: Association Between Sleep-disordered Breathing And Post-stroke Fatigue

Background: Post-stroke fatigue (PSF) is a common and often disabling symptom, the etiology of which is poorly understood. Sleep-disordered breathing (SDB) is also highly prevalent among stroke survivors. We explored the relationship between SDB and PSF over time in a bi-ethnic cohort. Methods: Ischemic stroke (IS) patients within the Brain Attack Surveillance in Corpus Christi (BASIC) project were identified through active and passive surveillance, and were offered home SDB screening with a well-validated cardiopulmonary sleep apnea testing device, the ApneaLink Plus. The primary exposure was the respiratory event index (REI). The primary outcome was PSF as measured by the SF-36 vitality scale (lower scores reflect greater fatigue). SDB and PSF were measured at baseline, 3, 6, and 12 months post-stroke. A linear regression model, using GEE to account for repeated measures, was used to examine the associations between REI and PSF at each time point adjusting for sociodemographics, stroke severity, depressive symptoms, pre-stroke fatigue, and comorbidities. Results: SDB screening and at least one PSF assessment were completed by 462 IS patients, who were 44% female, 61% Mexican American (MA), 26% non-Hispanic white, 7% Black, and 5% other race/ethnicity. Median NIHSS was 2 (IQR: 1-4). Multivariable regression model results are presented in the Table. Higher REI at 3 months was associated with greater PSF at 3 months (β= -1.87, 95%CI -3.47, -0.27), but there was no association between REI and PSF at 6 or 12 months. Across timepoints, female sex, depressive symptoms at time of assessment, pre-stroke medication for depression, higher levels of pre-stroke fatigue, and vascular risk factor burden were associated with greater PSF, whereas MA ethnicity was associated with less PSF. Conclusions: Higher REI was associated with greater PSF in the early post-stroke period, but no association was observed at 6 months and beyond. MA ethnicity seems to be protective against PSF.

The ethical pathway – Does the perceived realisation of the individuals’ values change during the post-stroke time?

Background Stroke causes ethically challenging changes in the lives of individuals with stroke (IwS). However, it is unclear whether the changes are stable or dynamic. In this study, a novel concept ‘ethical pathway’ is used to describe the potential changes in the perceived realisation of IwS’ values in temporal passage post-stroke. Ethical pathway includes three central values of nursing: dignity, privacy and autonomy. Aim of the study was to analyse the perceived ethical pathway of IwS over a non-limited post-stroke period, with the purpose to understand the existence of the IwS’ ethical pathway in theoretical level. Design A descriptive and correlational design. Methods The volunteer participants were recruited via the Finnish Brain Association. Data were collected with questions of background variables and the Ethical Pathway of Individuals with Stroke (EPIS) instrument and analysed statistically. The Ethics Committee of the University approved the study and permission for data collection was obtained from the association. Results Sixty-one IwS participated in the study. The ethical pathway varied during the post-stroke time. Of the values, dignity and privacy were realised lower with longer post-stroke time. The life situational factors were associated with the realisation of the values, but not consistently.

An Integrative Review of the Utilization of the Perceived Stress Scale in Stroke Recovery.

BACKGROUND: Stroke survivors (SS) may experience alterations in physical and cognitive processes that increase stress and reduce well-being. Timely and accurate measurement of stress throughout the continuum of recovery is necessary to inform targeted interventions that will improve quality of life for this group. OBJECTIVE: The aim of this study was to describe the utilization of the Perceived Stress Scale (PSS) during recovery in SS. METHODS: A comprehensive literature search was conducted using CINAHL, PsycINFO, PubMed, and Scopus databases. Studies were included if they captured primary data collection using any version of the PSS at any time point in the poststroke recovery period and were published in English between 2011 and 2022. Systematic reviews and meta-analyses were excluded. Evidence was synthesized, and themes were discussed. RESULTS: Among 397 studies, a total of 13 met inclusion criteria. Of these, 8 were cross-sectional studies, 3 were longitudinal studies, 1 was a randomized controlled trial, and the remaining study was a prospective nonrandomized trial. The PSS-10 (n = 7, 54%) was the most used version of the instrument, followed by the PSS-14 (n = 3, 23%) and PSS-4 (n = 2, 15.4%), with the modified PSS-10 being used in only 1 (7.6%) study. The PSS surveys were administered at various time points, ranging from the first day of admission to 3, 6, 9, or 12 months after discharge. Perceived stress may continue to negatively influence SS's psychological and physical well-being throughout the chronic phase of recovery. CONCLUSIONS: Stress is a unique and individualized experience that influences recovery trajectories in SS, an experience often overlooked or marginalized by clinicians and healthcare providers. To help mobilize strategies to achieve long-term health and wellness goals, future studies should explore and tailor interventions to minimize the influence of stress, as identified by the PSS, on well-being and quality of life during poststroke recovery.

Restoring Voluntary Bimanual Activities of Patients with Chronic Hemiparesis through a Foot-Controlled Hand/Forearm Exoskeleton.

A significant number of stroke patients are permanently left with a hemiparetic upper limb after the poststroke six-month golden recovery period, resulting in a drastic decline in their quality of life. This study develops a novel foot-controlled hand/forearm exoskeleton that enables patients with hemiparetic hands and forearms to restore their voluntary activities of daily living. Patients can accomplish dexterous hand/arm manipulation on their own with the assistance of a foot-controlled hand/forearm exoskeleton by utilizing foot movements on the unaffected side as command signals. The proposed foot-controlled exoskeleton was first tested on a stroke patient with a chronic hemiparetic upper limb. The testing results showed that the forearm exoskeleton can assist the patient in achieving approximately 107°of voluntary forearm rotation with a static control error less than 1.7°, whereas the hand exoskeleton can assist the patient in realizing at least six different voluntary hand gestures with a success rate of 100%. Further experiments involving more patients demonstrated that the foot-controlled hand/forearm exoskeleton can help patients in restoring some of the voluntary activities of daily living with their paretic upper limb, such as picking up food to eat and opening water bottles to drink, and etc. This research implies that the foot-controlled hand/forearm exoskeleton is a viable way to restore the upper limb activities of stroke patients with chronic hemiparesis.

Diagnostic Inexperience of Takayasu Arteritis in Pediatric Neurology: A Case Report and Mini-Review of the Literature

Takayasu arteritis (TA) is a chronic inflammatory vasculitis involving the aorta and its main branches. It usually starts with systemic inflammatory signs after ten years of age. Neurological symptoms seen depend on aneurysmatic, stenotic and thromboembolic events in the affected vessels. It is rarely seen in childhood and presentation with epileptic seizure is extremely rare in infantile age. In this case report, a 22-month-old child who was admitted with epileptic seizure and had a large infarction in the area matching the right middle cerebral artery (MCA) watershed. Symptoms and imaging findings due to infarction developed hours after epileptic seizure. First, low molecular weight heparin treatment was started. Following the development of multiple aneurysmatic-stenotic lesions in the left brachial artery and profunda branch, diagnosed as TA. It was added to oral steroid and azathioprine. Resistant seizures were controlled with levetiracetam and valproic acid in the poststroke period. Multidisciplinary follow-up is ongoing with anticoagulant, antiepileptic and immunosuppressive treatments. TA rarely occurs in the infantile period with acute neurological symptoms such as epileptic seizure and stroke. It is important to make diagnosis early in order to reduce the neurological comorbidities that may occur in the long term.

Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance-an Experimental Study.

Most stroke survivors continue to live with disabilities and may require physical rehabilitation to control the trunk and balance during the post-stroke period. The cause of lack of trunk control and balance among stroke patients is the weakened trunk muscle strength. To study the effect of proprioceptive neuromuscular facilitation (PNF) neck pattern and trunk-specific exercise on trunk control and balance among stroke patients. The study was conducted at the medical wards of Saveetha Medical College and Hospital, Chennai, India. Sixty patients with stroke who met the inclusion criteria participated in the study. This is a quasi-experimental study. PNF trunk-specific exercise was administered to the experimental group for 45 min of 28 sessions, which contained 15 min of stretching exercise and 30 min trunk-specific exercise. The control group received routine hospital care services. The study's primary outcome was balance and trunk control, measured by the Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS) before the intervention and at the end of the intervention of 28 days. Within-group analysis, paired t test showed a significant improvement comparing the trunk control and balance score before (13.40±1.04 & 25.40±1.81) and after (15.03±0.96 & 27.07± 1.48) the intervention in the experimental group (p < .001). Between-group analysis, both the experimental and control group post-test mean score of TIS (15.03±0.96 &13.70±1.15) and BBS (27.07±1.48 & 25.30±1.73) showed significant difference (p < .001). PNF neck pattern and trunk-specific exercise used in this study effectively improved balance and trunk control among patients with stroke.

Predictors of suicidal ideation among acute stroke survivors

• Risk of suicide ideation and depression is high in the early post-stroke period • Severity of stroke disability is associated with post-stroke suicidal ideation • Post-stroke suicidal ideation is associated with ischemic stroke and a longer hospital stay : The risk of suicide in patients with stroke is high compared to the general population. To identify specific subgroups at higher risk of suicide in the early post-stroke period, we examined the relationship between the acute stroke-related clinical variables, patient demographics, depression, and suicidal ideation (SI). : We reviewed prospectively collected data from the comprehensive stroke center with patients who had an ischemic or hemorrhagic stroke and screened for depression with the Patient Health Questionnaire 9-Item (PHQ-9) at 90 days post-stroke outpatient follow-up. Question 9 of the PHQ-9 was screened for the presence of SI. : A total of 6.7% of patients reported SI. There were significant differences between groups among patients who reported SI as compared to those without SI with respect to ischemic stroke (p=0.026), longer hospital stay (p=0.009), and higher disability modified Rankin scale score at seven days post-stroke (p=0.014). : We did not have access to the number of stroke survivors with SI who attempted suicide. : Our results show that screening based on PHQ-9 can identify the stroke survivors at risk of suicide and then enable additional risk assessment and stratify the patient to appropriate mental health support, thus reducing suicide, a preventable condition.

Structural and functional alterations within the Papez circuit in subacute stroke patients.

Beyond causing local injury, stroke disrupts structural and functional organization of the brain networks, exposing patients to a high risk of cognitive impairment by affecting the neural network activity. However, the impact of these pathological changes on cognition-related neural circuits is not well understood. In this study, we mainly focused on structures and directed functional connectivity within the Papez circuit in subacute stroke patients. Forty-five stroke patients and thirty-four age-, sex-matched healthy controls were included in our study. The Papez circuit gray matter were measured to explore ischemia-induced structural alterations. And Granger causality analysis with the hippocampus as seed regions was performed to identify alterations of directional functional connectivity within the neural circuit. We also explored the associations between cerebral changes with cognitive status. Compared with healthy controls, stroke patients revealed marked atrophy in gray matter of the Papez circuit, including ipsilateral hippocampus, amygdala, thalamus, and caudal anterior cingulate gyrus. Additionally, there are alterations in the directed functional connections between the bilateral hippocampus and cingulate gyrus within the Papez circuit. These altered effective connectivities were correlated with cognitive function after cerebrovascular event. Taken together, in the early post-stroke period, disruptions of the Papez circuit in both architecture and directed functional connectivity have already occurred and might affect the cognitive function. These findings have prompted researchers to better understand the potential mechanisms underlying vascular cognitive impairment and to investigate new therapeutic targets that could reduce cognitive burden.

Predictors of cognitive and emotional symptoms 12 months after first-ever mild stroke

ABSTRACT Even mild strokes may affect the patients’ everyday life by impairing cognitive and emotional functions. Our aim was to study predictors of such impairments one year after first-ever mild stroke. We included cognitively healthy patients ≤ 70 years with acute mild stroke. Vascular risk factors, sociodemographic factors and stroke classifications were recorded. At one-year post-stroke, different domains related to cognitive and emotional function were assessed with validated instruments. Logistic regression analyses were performed to identify predictors of cognitive and emotional outcome. Of 117 patient assessed at follow-up, only 21 patients (18%) scored within the reference range on all cognitive and emotional assessments. Younger age, multiple infarcts, and being outside working life at stroke onset were independent predictors of cognitive impairments (psychomotor speed, attention, executive and visuospatial function, memory). Female gender and a higher National Institutes of Health Stroke Scale (NIHSS) score at discharge were significantly associated with emotional impairments (anxiety, depressive symptoms, fatigue, apathy, emotional lability) after one year, but these associations were only seen in the unadjusted models. In conclusion, patients in working age may profit from a follow-up during the post-stroke period, with extra focus on cognitive and emotional functions.

The role of social resources and trajectories of functional health following stroke

Stroke is a major cause of disability in old age. Research has revealed that social resources available after the onset of stroke can mitigate functional prognosis. However, most studies have conceptualized resources as static rather than dynamic and have not measured changes in social resources from the pre-to post-stroke periods. To better understand the recovery process following stroke, we examined how social resources available before its onset and changes from pre-to post-stroke were associated with trajectories of functional health following stroke. Data were derived from an up to 19-year longitudinal study of a nationally representative sample of Japanese adults aged 60 years and older. We identified 389 people who experienced self- or proxy-reported first stroke during follow-up (age at stroke onset: M = 75.9, SD = 6.8; 49.1% women). The average number of observations was 4.6 (SD = 1.6, range 2–7). Functional health was measured with self- or proxy-reported basic and instrumental activities of daily living. Social resources were indexed as residential status, contact with own non-coresident children, social participation, and perceived support. Analyses were adjusted for age at stroke onset, sex, education, health condition, and cognitive function. A multiphase growth model indicated that individuals who participated more frequently in social groups prior to stroke exhibited less functional deterioration post-stroke than those who participated less frequently. Whereas contact frequency with non-coresident children typically declined following stroke, the analysis further revealed that individuals who maintained contact frequency from pre-to post-stroke showed less steep functional decline over time in the post-stroke period despite minor individual differences. We found that social resources before stroke onset and changes in the resources following stroke may play a protective role against adverse prognoses. Inclusive communities may help older adults remain independent even after serious health events.

Parkinsonism and progressive atypical psychiatric symptoms in the post-stroke subacute period

Parkinsonism and progressive atypical psychiatric symptoms in the post-stroke subacute period

Coverage and equity of essential care services among stroke survivors in the Western Province of Sri Lanka: a community-based cross-sectional study

BackgroundStroke survivors require continuing services to limit disability. This study assessed the coverage and equity of essential care services received during the first six months of post-stroke follow-up of stroke survivors in the Western Province of Sri Lanka.MethodsA multidisciplinary team defined the essential post-stoke follow-up care services and agreed on a system to categorize the coverage of services as adequate or inadequate among those who were identified as needing the said service. We recruited 502 survivors of first ever stroke of any type, from 11 specialist hospitals upon discharge. Six months following discharge, trained interviewers visited their homes and assessed the coverage of essential services using a structured questionnaire.ResultsForty-nine essential post-stroke follow-up care services were identified and categorized into six domains: monitoring of risk conditions, treatment, services to limit disabilities, services to prevent complications, lifestyle modification and supportive services. Of the recruited 502 stroke survivors, 363 (72.3%) were traced at the end of 6 months. Coverage of antiplatelet therapy was the highest (97.2% (n = 289, 95% CI 95.3- 99.1)) while referral to mental health services (3.3%, n = 12, 95% CI 1.4–5.1) and training on employment for the previously employed (2.2%, n = 4, 95% CI- 0.08–4.32), were the lowest among the six domains of care. In the sample, 59.8% (95% CI 54.76–64.48) had received an ‘adequate’ level of essential care services related to treatment while none received an ‘adequate’ level of services in the category of support services. Disaggregated service coverage by presence and type of limb paralysis within the domain of services to prevent complications, and by sex and education level within the domain of education level, show statistically significant differences (p < 0.05).ConclusionsApart from treatment services to limit disabilities, coverage of essential care services during the post-stroke period was inadequate. There were no apparent inequities in the coverage of vast majority of services. However focused policy decisions are required to address these gaps in services.

Impact Of Balance Training and Coordination Exercises in Post Hemiplegic Stroke Patients

A medical condition that occurs due to interrupted blood supply to the brain leading to restricted oxygen supply to the tissues resulting in cell death is known as “stroke”. It is considered as a second leading cause of death globally and a major cause of disabilities for the patients surviving from its fatality. Monoplegia, Diplegia, Hemiplegia, Quadriplegia, hemiparesis are all the different gifts of the stroke given to multiple patients suffering from it. Objective: The aim of the study was to evaluate the difference between the hemiplegic stroke patients who have undergone physical therapy treatment in contrast to those patients who have not taken any physical therapy treatment. Methods: Cross sectional study design was selected for the performance of the research. Research setting was a Government Sector Hospital. Specific balance and coordination exercises were given to the hemiplegic stroke patients and their effect was observed in the term of their recovery speed. Out of sample of 40 individuals, some have taken physical therapy rehabilitation with varying number of sessions and intensity of exercises while in contrast, some have not taken any physical therapy from scratch following stroke. Brunel Balance Assessment (BBA) scale was measured in relation to the effect of exercises given to the patients. Results: The data analysis has shown significant improvement in balance and different fine motor movements in post training group as compared to those who have not taken physical therapy rehabilitation. Data analysis has clearly shown that percentage of improvement in the condition of patients is directly related to the frequency of exercise given to them in their post stroke period. The BBA scale was having higher values in the patients undergoing physical therapy rehabilitation as compared to the patients who have not undergone any sort of physical therapy rehabilitation. Conclusion: Balance and coordination exercises have impact in the post hemiplegic stroke patients

Treatment in a Stroke Unit and Risk Factor Control Reduce Recurrent Stroke Risk

Introduction: Risk factor control is an important predictor of risk of stroke recurrence. The attributable fraction which estimates the excess risk among the exposed stroke survivors has not been studied previously. We studied the attributable fraction for stroke recurrence in consecutive incident cases of recurrent stroke. Methods: A case-control study with incident cases of recurrent stroke and controls matched for age and poststroke period was done. A structured interview was done to collect data on sociodemographic variables, lifestyle, and medication adherence. The risk factors, treatment of index stroke, and outcome were collected. Logistic regression analysis was done to find out the factors associated with stroke recurrence. Attributable fraction and average attributable fraction were calculated. Results: Among the 103 matched pairs, more than 70% were rural residents. Male gender (OR 2.59; 95% CI 1.05–6.42), the presence of depression (OR 8.67; 95% CI 2.80–26.84), memory problem (OR 10.12; 95% CI 2.48–41.34), uncontrolled diabetes (OR 3.19; 95% CI 1.42–7.19), cardioembolic stroke (OR 4.45; 95% CI 1.12–17.62), and index stroke not being treated in a stroke unit (OR 6.60; 95% CI 2.86–15.23) were associated with increased risk of stroke recurrence. The maximum average attributable fraction for stroke recurrence risk was attributed to index stroke not being treated in the stroke unit and uncontrolled diabetes. Conclusion: The index stroke treated in a comprehensive stroke care unit and control of risk factors can reduce recurrent stroke risk among stroke survivors. This population-attributable risk is important in planning secondary stroke prevention strategies.

Sex differences in post-stroke cognitive decline: A population-based longitudinal study of nationally representative data.

BackgroundSex differences in post-stroke cognitive decline have not been systematically evaluated in a nationally representative cohort. We use a quasi-experimental design to investigate sex differences in rate of post-stroke cognitive decline.MethodsUtilizing the event study design, we use the Health and Retirement Study (HRS) data (1996–2016) to evaluate the differences (percentage points [95% Confidence interval]) in the rate of change in cognitive function, measured using the modified version of the Telephone Interview for Cognitive Status (TICS-m) score, before and after incident stroke, and among patients with and without incident stroke. We estimated this event study model for the overall study population and separately fit the same model for male and female participants.ResultsOf 25,872 HRS participants included in our study, 14,459 (55.9%) were females with an overall mean age (SD) of 61.2 (9.3) years. Overall, 2,911 (11.3%) participants reported experiencing incident stroke. Participants with incident stroke (vs. no stroke) had lower baseline TICS-m score (15.6 vs. 16.1). Among participants with incident stroke, the mean pre-stroke TICS-m score was higher than the mean post-stroke TICS-m score (14.9 vs. 12.7). Event study revealed a significant short-term acceleration of cognitive decline for the overall population (4.2 [1.7–6.6] percentage points, p value = 0.001) and among female participants (5.0 [1.7–8.3] percentage points, p value = 0.003). We, however, found no evidence of long-term acceleration of cognitive decline after stroke. Moreover, among males, incident stroke was not associated with significant changes in rate of post-stroke cognitive decline.ConclusionFemales, in contrast to males, experience post-stroke cognitive deficits, particularly during early post-stroke period. Identifying the sex-specific stroke characteristics contributing to differences in post stroke cognitive decline may inform future strategies for reducing the burden of post-stroke cognitive impairment and dementia.

Inhibition of Ferroptosis Using UAMC‐3203 in the Post‐stroke Period Does Not Impact Cognitive Outcomes in Diabetic Rats

IntroductionPost‐stroke cognitive impairment (PSCI) contributes to significant long‐term disability in stroke victims. 30% of ischemic stroke victims in the United States also have diabetes, which increases the risk of hemorrhagic transformation as well as PSCI. Ferroptosis, an iron‐induced cell death can instigate increased oxidative stress and contribute to impaired neurovascular repair leading to PSCI in diabetes. In our previous studies, we were able to identify that treating diabetic animals with an iron chelator, deferoxamine (DFX), prevents post‐stroke vasoregression and improves functional outcomes. Furthermore, DFX prevented the activation of ferroptosis in brain microvascular endothelial cells in vitro. Untreated diabetic animals experienced progressive cognitive decline while being monitored for 8 weeks. These findings led us to speculate that endothelial ferroptosis also plays a role in vasoregression and impacts cognitive outcomes post‐stroke. Therefore, this study was designed to test the hypothesis that inhibiting ferroptosis in the post‐stroke period will improve cognitive recovery in diabetic animals.MethodsAnimals were housed in reverse light cycle. 8 weeks after diabetes onset, male rats underwent 60 min middle cerebral artery occlusion (MCAO). On Day 3, after stroke injury was confirmed by MRI, animals were randomized to UAMC‐3 (2mg/kg) or vehicle treatment for 2 weeks. Sensorimotor and cognitive behavioral tests were performed during the animals’ active hours up to 8 weeks post MCAO.Results(Table 1): 60 min occlusion caused significant acute neurological deficits. There were no differences between the groups in indices measured by novel object recognition (NOR), Y‐maze and sucrose preference tests. Interestingly, step through latency in passive avoidance test (PAT) was lower in the UAMC‐3203 group.ConclusionTreatment with a ferroptosis inhibitor for 2 weeks after stroke did not impact recognition and working memory but worsened aversive learning in diabetic male rats. Unlike our previous study in which behavior tests were performed during rats’ passive hours, there was no progressive cognitive decline in untreated animals. Further evaluation of behavior testing times as well as tissue markers of neurovascular degeneration, inflammation and ferroptosis are required to determine whether molecular and cellular markers are affected by the treatment before overt changes in behavioral outcomes.

Exploring the use of dopaminergic medication to treat hemispatial inattention during in-patient post-stroke neurorehabilitation.

Hemispatial inattention (HSI), a lateralised impairment of spatial processing, is a common consequence of stroke. It is a poor prognostic indicator for functional recovery and interferes with the progress during in-patient neurorehabilitation. Dopaminergic medication has shown promise in improving HSI in the chronic post-stroke period but is untested in more acute settings, e.g. during in-patient neurorehabilitation. We audited the use of dopaminergic medication in ten sequential patients with post-stroke HSI, on an open-label exploratory basis. Patients' response to medication was assessed individually, using a three-week Off-On-Off protocol. We employed a mixture of bedside and functional measures, and made a multidisciplinary judgement of efficacy in individual patients. In six out of 10 patients, there was a convincing improvement of HSI while on medication, which reversed when it was paused. There was a mean 57% relative increase in target detection in the star cancellation test on the most affected side (on vs. off medication). In the six responders, medication was therefore continued throughout their admission without adverse effects. The star cancellation test was sensitive to HSI in most patients but in two cases failed to detect changes that were picked up by a functional assessment (Kessler Functional Neglect Assessment Protocol). We found this multidisciplinary approach to be feasible in an in-patient neurorehabilitation setting. We suggest further research to explore the efficacy of dopaminergic medication in improving neurorehabilitation outcomes for patients with post-stroke HSI. We suggest that more detailed N-of-1 assessments of treatment response, with internal blinding, may be a productive approach.

Prevalence and Associated Factors of Poststroke Depression among Outpatient Stroke Patients Who Have a Follow-Up at the Outpatient Neurology Clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia.

Background Poststroke depression is the most common and burdensome poststroke psychiatric complication. Studies showed discrepancies in reporting frequencies and risk factors for poststroke depression. Updated local data are relevant for efficient strategies of poststroke depression screening and prevention. Objectives To determine the prevalence and associated factors of poststroke depression among outpatient stroke patients from the outpatient neurology clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted on 249 stroke patients. Data was collected through structured questionnaire using interviews and a review of medical charts. PHQ-9 depression questionnaire was used to diagnose poststroke depression. Descriptive analysis was used to see the nature of the characteristics of interests. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using an odds ratio with 95% CI and p value < 0.05. Results Point prevalence for poststroke depression was 27.5 percent. Female gender, unemployment, low social support level, diabetes mellitus, and poststroke period under 2 years were statistically significant and independent predictors for poststroke depression. Conclusions The point prevalence estimate of poststroke depression was comparable with other studies. Low social support levels increased the odds for poststroke depression by more than eight folds. It appeared that external factors are more important in the pathogenesis of poststroke depression in the African population. Detection and prevention programs should consider disparities of poststroke depression incidence and risk factors.

Algorithm for formulation a rehabilitation diagnosis using the international classification of functioning in a patient with a stroke: clinical case

Background. The International Classification of Functioning, Disability and Health (ICF) is a universal system for assessing the health of the body as a whole, as well as problems that limit life. Using the ICF, it is possible at the level of the body, personality and society to quite accurately investigate the nature and severity of disabilities. Subsequently, this will make it possible, on a scientific basis, to substantiate the need and volume of rehabilitation measures and social protection. For medical professionals, one of the main criteria for using the ICF is the ability to formulate a rehabilitation diagnosis, which in turn makes it possible to determine the goal, objectives, rehabilitation program, and in the future to assess the effectiveness of rehabilitation measures. In the formulation of a rehabilitation diagnosis, the coding for the ICF domains is used. Rehabilitation diagnosis is a description of structural and functional disorders that have arisen in a patient as a result of a stroke, which entailed a restriction of activity and participation, the possibility of using environmental factors that may facilitate or hinder the performance of the described functions by the patient. Clinical case description. The patient, 65 years old, was admitted to the rehabilitation department with complaints of decreased muscle strength, instability when walking, limited mobility, dizziness, impaired pronunciation of words. Directional diagnosis: Ischemic stroke. After the rehabilitation diagnosis was made, the patient had an average rehabilitation potential and a relatively favorable prognosis. During rehabilitation, medical treatment, individual sessions with a psychologist, methods of rehabilitation of violations of regulatory functions, etc. were used. Upon discharge, the evaluation of the scales revealed the positive dynamics of the medical rehabilitation. Conclusion. The ICF evaluates all components of a post-stroke patient's health. The ICF is used in the preparation of a rehabilitation diagnosis and justifies the use of methods of medical rehabilitation. Formation of a rehabilitation diagnosis based on the principles of ICF is a key point in determining short-term and long-term goals for the patient, as well as assessing the rehabilitation potential and prognosis, drawing up an individual plan for medical rehabilitation and further recommendations upon discharge. Our experience of rehabilitation in the post-stroke period has shown that the use of the international classification of functioning in the formulation of a rehabilitation diagnosis in this category of patients allows for a higher efficiency of medical rehabilitation in general.

Abstract WP207: Switching Antiplatelets In Breakthrough Ischemic Stroke: Long Term Outcomes And Safety

Introduction: Previous studies have shown that switching antiplatelets after having an ischemic stroke on aspirin may have better outcomes. However, these studies included patients who were switched to dual antiplatelets, which have an established benefit in the immediate post-stroke period. The purpose of this study is to assess outcomes in patients who continue aspirin versus switch to clopidogrel after having a cerebrovascular event on aspirin. Methods: We retrospectively identified patients within 14 Southern California hospitals using ICD-9 and ICD-10 codes who had a diagnosis of ischemic stroke on aspirin from January 2017-December 2019. Outcomes included recurrent hospital admission or emergency room visit for ischemic stroke, TIA, or intracranial hemorrhage up to two years post index event. Patients were grouped by which antiplatelet was prescribed at discharge. Those prescribed dual antiplatelets or an anticoagulant were excluded. Cox regression analysis was used to estimate risk of readmission. Results: Of the 580 patients who met the inclusion criteria, 372 (64%) continued aspirin and 208 (36%) switched to clopidogrel. Those with coronary artery disease (55.0% versus 45.0%, p = 0.015), dyslipidemia (61.4% versus 38.6%, p = 0.001), diabetes (59.5% versus 40.5%, p = 0.007), and a higher NIHSS score (mean 6.06 +/- 6.96 SD versus 4.08 +/- 4.32 SD, p = 0.001) were more likely to be discharged on aspirin. There were no differences in recurrent ischemic stroke {18.8% versus 15.4%, HR 1.12 (95% CI, 0.74-1.72), p = 0.587}, ischemic stroke plus TIA {19.9% versus 18.3%, HR (95% CI, 0.84-1.86), p = 0.253}, systemic embolism {25.5% versus 21.6%, HR 1.16 (95% CI, 0.82-1.66), p = 0.413} or intracranial hemorrhage {3.2% versus 2.4%, HR 0.94 (95% CI, 0.34-2.70), p = 0.919} between those discharged on aspirin versus clopidogrel, respectively. Conclusion: This study suggests that switching antiplatelets after having an ischemic stroke on aspirin may not be warranted.