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1.
JAMA ; 323(5): 444-454, 2020 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-32016308

RESUMO

Importance: Neurological disorders have been linked to suicide, but the risk across a broad spectrum of neurological disorders remains to be assessed. Objectives: To examine whether people with neurological disorders die by suicide more often than other people and to assess for temporal associations. Design, Setting, and Participants: Nationwide, retrospective cohort study on all persons 15 years or older living in Denmark, from 1980 through 2016 (N = 7 300 395). Exposures: Medical contact for head injury, stroke, epilepsy, polyneuropathy, diseases of myoneural junction, Parkinson disease, multiple sclerosis, central nervous system infections, meningitis, encephalitis, amyotrophic lateral sclerosis, Huntington disease, dementia, intellectual disability, and other brain diseases from 1977 through 2016 (n = 1 248 252). Main Outcomes and Measures: Death by suicide during 1980-2016. Adjusted incidence rate ratio (IRRs) were estimated using Poisson regressions, adjusted for sociodemographics, comorbidity, psychiatric diagnoses, and self-harm. Results: Of the more than 7.3 million individuals observed over 161 935 233 person-years (49.1% males), 35 483 died by suicide (median duration of follow-up, 23.6 years; interquartile range, 10.0-37.0 years; mean age, 51.9 years; SD, 17.9 years). Of those, 77.4% were males, and 14.7% (n = 5141) were diagnosed with a neurological disorder, equivalent to a suicide rate of 44.0 per 100 000 person-years compared with 20.1 per 100 000 person-years among individuals not diagnosed with a neurological disorder. People diagnosed with a neurological disorder had an adjusted IRR of 1.8 (95% CI, 1.7-1.8) compared with those not diagnosed. The excess adjusted IRRs were 4.9 (95% CI, 3.5-6.9) for amyotrophic lateral sclerosis, 4.9 (95% CI, 3.1-7.7) for Huntington disease, 2.2 (95% CI, 1.9-2.6) for multiple sclerosis, 1.7 (95% CI, 1.6-1.7) for head injury, 1.3 (95% CI, 1.2-1.3) for stroke, and 1.7 (95% CI, 1.6-1.8) for epilepsy. The association varied according to time since diagnosis with an adjusted IRR for 1 to 3 months of 3.1 (95% CI, 2.7-3.6) and for 10 or more years, 1.5 (95% CI, 1.4 to 1.6, P < .001). Compared with those who were not diagnosed with a neurological disorder, those with dementia had a lower overall adjusted IRR of 0.8 (95% CI, 0.7-0.9), which was elevated during the first month after diagnosis to 3.0 (95% CI, 1.9-4.6; P < .001). The absolute risk of suicide for people with Huntington disease was 1.6% (95% CI, 1.0%-2.5%). Conclusions and Relevance: In Denmark from 1980 through 2016, there was a significantly higher rate of suicide among those with a diagnosed neurological disorder than persons not diagnosed with a neurological disorder. However, the absolute risk difference was small.


Assuntos
Doenças do Sistema Nervoso/psicologia , Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Esclerose Amiotrófica Lateral/psicologia , Traumatismos Craniocerebrais/psicologia , Dinamarca/epidemiologia , Feminino , Humanos , Doença de Huntington/psicologia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/psicologia , Suicídio/psicologia , Adulto Jovem
2.
Medicine (Baltimore) ; 99(6): e19062, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028426

RESUMO

BACKGROUND: The efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) for functional independence and depression prevention in early stage of post-stroke (within 1 month after stroke onset) are still unclear. METHODS: Relevant randomized controlled trials (RCTs) comparing early SSRIs therapy with placebo were sought from PubMed, Cochrane Library, Medline, and Embase. Primary outcomes were functional independence and depression occurrence. Secondary outcomes contained the improvement of Fugl-Meyer motor scale (FMMS) score and adverse events. We used fixed or random effects model to pooled effect estimates. And we chose risk ratio (RR) or mean differences (MDs) with the 95% confidence intervals (CIs) for data analysis. RESULTS: We included 10 RCTs with total 5370 patients. The outcome of functional independence showed no significant difference between SSRIs and placebo group (RR, 1.28; 95% CI, 0.96-1.72; P = .10; I = 92%). However, depression occurrence differed significantly between these 2 groups, which favored SSRIs group (RR, 0.78; 95% CI, 0.67-0.90; P = .001; I = 23%). In addition, we observed that the side effects of SSRIs were seizure and nausea. Except psychiatric disorders/insanity rate was less in SSRIs group than placebo group (RR, 0.66; 95% CI, 0.48-0.90; P = .009) (I = 0%), other adverse events were revealed non-significant in our meta-analysis. CONCLUSIONS: Our meta-analysis revealed that early SSRIs therapy were effective to prevent post-stroke depression. However, SSRIs did not improve patient's post-stroke functional independence. In addition to increase the occurrence of seizure and nausea, SSRIs were relatively safe.


Assuntos
Antidepressivos de Segunda Geração/uso terapêutico , Depressão/prevenção & controle , Inibidores de Captação de Serotonina/uso terapêutico , Acidente Vascular Cerebral/psicologia , Atividades Cotidianas/psicologia , Humanos , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos
3.
BMC Neurol ; 20(1): 4, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910805

RESUMO

BACKGROUND: Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain. METHODS: Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009-2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression. RESULTS: A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years post-stroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain. CONCLUSION: Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.


Assuntos
Dor , Acidente Vascular Cerebral , Idoso , Estudos Transversais , Feminino , Seguimentos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/etiologia , Dor/psicologia , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários , Suécia/epidemiologia
4.
J Stroke Cerebrovasc Dis ; 29(1): 104478, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704124

RESUMO

BACKGROUND AND PURPOSE: Vision, Aphasia, Neglect (VAN) is a large vessel occlusion (LVO) screening tool that was initially tested in a small study where emergency department (ED) nurses were trained to perform VAN assessment on stroke code patients. We aimed to validate the VAN assessment in a larger inpatient dataset. METHODS: We utilized a large dataset and used National Institute of Health Stroke Scale (NIHSS) performed by physicians to extrapolate VAN. VAN was compared to NIHSS greater than or equal to 6 and established prehospital LVO screening tools including Rapid Arterial Occlusion Evaluation scale (RACE), Field Assessment Stroke Triage for Emergency Destination (FAST-ED), and Cincinnati Pre-hospital Stroke Scale (CPSS). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under receiver operating characteristics curve was calculated to estimate the predictive value of LVO. RESULTS: VAN was comparable in sensitivity (79% versus 80%) and NPV (88% versus 87%) to NIHSS greater than or equal to 6. It was superior in specificity (69% versus 57%), PPV (53% versus 46%) and accuracy to NIHSS greater than or equal to 6 (72% versus 64%) with significant receiver operating curve (.74 versus .69, P = .02). VAN also had comparable area under the curve when compared to RACE, FAST-ED, and CPSS however slightly lower accuracy (69%-73%) compared to RACE (76%), FAST-ED (77%), and CPSS (75%). VAN had the highest NPV among all screening assessments (88%). CONCLUSIONS: VAN is a simple screening tool that can identify LVOs with adequate accuracy in hospital setting. Future studies need to be conducted in prehospital setting to validate its utility to detect LVOs in the field.


Assuntos
Afasia/diagnóstico , Isquemia Encefálica/diagnóstico , Técnicas de Apoio para a Decisão , Avaliação da Deficiência , Debilidade Muscular/diagnóstico , Músculo Esquelético/inervação , Acidente Vascular Cerebral/diagnóstico , Visão Ocular , Idoso , Idoso de 80 Anos ou mais , Afasia/fisiopatologia , Afasia/psicologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/psicologia , Bases de Dados Factuais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Debilidade Muscular/fisiopatologia , Debilidade Muscular/psicologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Extremidade Superior
5.
J Stroke Cerebrovasc Dis ; 29(2): 104462, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31761737

RESUMO

BACKGROUND: Needs of patients that go unmet after a stroke can compromise the speed and extent of recovery. While unmet needs in long-term survivors has been studied, less is known about the unmet needs of acute stroke survivors. We examine unmet needs in the immediate postdischarge period among 160 participants in the (blinded for review) a transitional care intervention conducted in (blinded for review [1 US state]) during 2016 and 2017. METHODS: Bivariate and multivariate analyses using Poisson models were used to examine the relationship between total number of unmet needs and demographics, stroke type and severity, stroke effects, and stroke risk factors. RESULTS: The mean number of unmet needs was 4.55; number of unmet needs ranged from 2 to9; all participants had some unmet need. The most common unmet needs were stroke education (73.8%), financial (33.8%), and health-related (29.4%). In the final multivariate model income and education were inversely associated with number of unmet needs. As total number of stroke effects increased, so did number of unmet needs. Demographic variables (age, gender, and race), stroke risk factors, stroke type, and stroke severity were not statistically significantly associated with the number of unmet needs. CONCLUSIONS: These results identify that in the acute post discharge period stroke survivors have many unmet needs that range from physical to psychosocial. Targeting interventions to those with the potential for greater numbers of unmet needs might be a salient clinical approach to improving stroke recovery and rehabilitation.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Determinação de Necessidades de Cuidados de Saúde , Acidente Vascular Cerebral/terapia , Cuidado Transicional , Adolescente , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Educação de Pacientes como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
6.
J Stroke Cerebrovasc Dis ; 29(1): 104466, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31734125

RESUMO

BACKGROUND: Medical mistrust influences patients' treatment seeking, adherence, health behaviors, and minority participation in research studies. However, medical mistrust remains understudied within neurological diseases like stroke despite disproportionately affecting minority populations. OBJECTIVE: This study examines the relationship of medical mistrust with stroke knowledge among Black, Latino, Korean, and Chinese-Americans. METHODS: Subjects greater than 60 years were enrolled from senior centers to test a culturally-tailored educational curriculum around stroke risk reduction in a randomized controlled trial. A Trust Physician Scale and a modified Trust of Medical Researchers Scale measured medical mistrust. The Stroke Action Test instrument measured stroke knowledge, focusing on intent to call 911 appropriately when presented with stroke symptoms. RESULTS: Of 225 subjects, 69.5% were female (n = 157) with an average age of 73.7 years (standard deviation 6.7). Blacks had highest trust scores of physicians relative to Latino/a, Korean or Chinese subjects (P< .05). In multivariable analysis, decreased stroke knowledge was associated with decreased researcher trust at baseline (<.05), but not physician trust, when controlling for covariates. Among Latino/a, Korean, and Chinese groups, mainstream acculturation reduced the association between researcher trust and stroke knowledge. A mediation model showed no evidence of physician trust mediating researcher trust. CONCLUSIONS: Among minority seniors participating in a randomized controlled trial, decreased trust of researchers, not physicians, was associated with low baseline knowledge of stroke symptoms. Those least acculturated to US culture may be a particular focus for trust building intervention. Future studies should examine whether researcher mistrust is disproportionately preventing those with the largest knowledge gaps from participating in trials.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Grupos Minoritários/psicologia , Educação de Pacientes como Assunto/métodos , Serviços Preventivos de Saúde , Relações Profissional-Paciente , Pesquisadores/psicologia , Sujeitos da Pesquisa/psicologia , Acidente Vascular Cerebral/prevenção & controle , Confiança , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/etnologia , Envelhecimento/psicologia , Atitude do Pessoal de Saúde , Estudos Transversais , Características Culturais , Assistência à Saúde Culturalmente Competente/etnologia , Currículo , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/psicologia
7.
J Stroke Cerebrovasc Dis ; 29(2): 104513, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31784380

RESUMO

BACKGROUND AND PURPOSE: Slowed Information Processing Speed (IPS) is a commonly reported cognitive deficit following stroke, affecting up to 50% to 70 % of stroke survivors. IPS has a major influence on poststroke cognitive dysfunction, affecting quality of life and increasing dependence on others. Few studies have examined predictors of slow IPS after stroke, and there is a paucity of data in terms of long-term prevalence. This study examined baseline predictors associated with long-term slow IPS in a population-based stroke incidence cohort, 4 years after stroke onset. METHODS: Adults with stroke (n = 133, m = 71.1 ± 13.5 years) completed the Symbol Digit Modalities Test (SDMT) at 4 years poststroke. Baseline predictors were obtained within 2 weeks of the acute event. Multivariate regression linear and logistic models were used to identify baseline predictors (reported as OR with 95%CI) and prevalence of impaired IPS at 4-years. RESULTS: 51% of people with stroke had low scores on the SDMT as indicated by a score of -1.0 SD to -2.5 SD (ranging from low to very low respectively). There were significant associations between slow IPS at 4-years after controlling for age and education level and the following baseline factors: older age (>75 years) (OR 3.03, 95% CI .9-9.3,P = .05), previous stroke (OR 2.74, 95% CI 1.0-7.4,P = .05), high cholesterol (OR 2.72, 95% CI 1.3-5.4,p = .01), hypertension (OR 1.82, 95% CI 0.9-3.6,p = .05), and presence of coronary artery disease (OR 3.35, 95% CI 1.6-9.6,P = .01), or arrhythmia (OR 4.40, 95% CI 1.5-12.4,P = .01). CONCLUSIONS: Even after 4-years poststroke, slowed IPS is highly prevalent, with comorbid vascular risk factors significantly contributing to persistent impaired IPS. Early identification of adults who are at higher risk of deficits in IPS is vital to targeting the timely delivery of cognitive rehabilitation interventions, improving overall outcomes.


Assuntos
Encéfalo/fisiopatologia , Cognição , Disfunção Cognitiva/reabilitação , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Prevalência , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
J Stroke Cerebrovasc Dis ; 29(2): 104582, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31859033

RESUMO

BACKGROUND AND PURPOSE: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. METHODS: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. RESULTS: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. CONCLUSIONS: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.


Assuntos
Ansiedade/psicologia , Isquemia Encefálica/psicologia , Hemorragias Intracranianas/complicações , Ataque Isquêmico Transitório/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Comorbidade , Depressão/epidemiologia , Depressão/psicologia , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/psicologia , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Pessoa Solteira/psicologia , Isolamento Social , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Texas/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31847437

RESUMO

BACKGROUND: This study aims to examine the impact of individual-level and community-based factors on popular social participation activities of Chinese middle-aged and older adults post-stroke. METHODS: Sub-samples of survivors of stroke (2011: n = 413, 2013: n = 395, 2015: n = 441) recruited by the China Health and Retirement Longitudinal Study (CHARLS) were included in the analysis. Zero-inflated Poisson and multi-level logistic regression models were used to explore factors associated with social participation. RESULTS: More than half of individuals (55.0%) had no social participation and 23.4% participated in multiple social activities. The most popular social activities that individuals participated in were interacting with friends (32.6%) and going to a community club to play table games (22.7%). Multiple individual-level factors were negatively related to social participation (e.g., depressive symptoms and multiple measures of functional limitations) while the allocation of an outdoor exercise facility in the community/village was positively associated with the participation of going to a community club to play table games. CONCLUSION: Stroke survivors are at high risk of limited social participation. Policymakers and other key stakeholders should consider community design among other potential solutions when identifying ways to link at-risk stroke survivors to both opportunities for rehabilitation (e.g., physical function) and social participation.


Assuntos
Comportamento Social , Participação Social , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Idoso , China , Depressão , Exercício , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
10.
BMC Neurol ; 19(1): 277, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31706292

RESUMO

BACKGROUND AND PURPOSE: Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. METHODS: A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients' degree of overall disability, measured by the modified Rankin Scale (mRS). RESULTS: No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. CONCLUSIONS: The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. TRIAL REGISTRATION: Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).


Assuntos
Ansiedade/etiologia , Serviços de Assistência Domiciliar , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente
11.
Clin Interv Aging ; 14: 1771-1782, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695347

RESUMO

Introduction: Post-stroke delirium is a common clinical problem, occurring in 10% to 48% of patients. It has been associated with longer hospitalization times, increased mortality and worse functional outcome. In early phase of stroke, it may be regarded as particularly difficult to differentiate from other neurological symptoms. For practical purposes, there is a need to identify simple pre-operative laboratory parameters that may aid delirium diagnosis early after stroke. Our aim was to identify the incidence of early-onset (first 24 hrs) post-stroke delirium, its risk factors and outcomes (complications and mortality) in patients with first-ever acute ischemic stroke (AIS). Material and methods: A retrospective analysis of a prospective observational study (NCT03944694) was performed. Patients were screened for delirium using CAM-ICU method. Clinical and laboratory data were collected, including baseline inflammatory parameters. Results: Final analysis included 760 patients, 121 (15.9%) developed delirium. Patients with delirium were older (75.9±13.5 years, p<0.001). Most common complications in the delirium group were pulmonary (57.8% vs 21.4%, p<0.001), cardiac (38.8% vs 13.6%, p<0.001) and renal (13.2% vs 7.5%, p=0.038). Neutrophil-to-lymphocyte ratio (NLR) (6.71±9.65 vs 4.55±5.51, p<0.001), C-reactive protein level (32.59±65.94 vs 15.70±38.56, p<0.001) and troponin T level (72.59±180.15 vs 26.85±77.62, p<0.001) were higher in delirious patients and platelet-to white blood cell count ratio (PWR) (23.42±9.51 vs 27.13±10.58, p<0.001) was lower. Multivariable logistic regression showed that atrial fibrillation (OR 1.651, p=0.049), higher Rankin score on admission (OR 1.689, p<0.001), hemianopia (OR 2.422, p=0.003) and PWR <20.22 (OR 2.197, p=0.002) were independently associated with delirium. Kaplan-Meier curves indicated that mortality increased for patients with delirium at 3 months (p<0.001) and 1 year (p<0.001) after AIS. Conclusion: Atrial fibrillation, higher Rankin score, hemianopia and lower PWR were independently associated with early onset delirium in patients with first ever AIS. This confirms that deprivation of senses and early generalized inflammatory response are critical for delirium development.


Assuntos
Fibrilação Atrial/epidemiologia , Delírio/epidemiologia , Hemianopsia/epidemiologia , Neutrófilos , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/complicações , Delírio/sangue , Delírio/etiologia , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
13.
Niger J Clin Pract ; 22(11): 1583-1589, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719281

RESUMO

Objective: To investigate the effect of emotional distress on functional outcomes in acute stroke patients. Materials and Methods: The study included 91 patients (51 females and 40 males) who were followed up with a diagnosis of acute stroke in the Neurology Department of Suleyman Demirel University Training and Research Hospital. The treatment programs of patients progressed in accordance with the functional level. Demographic data of age, gender, and educational level of the patients were recorded. The outcomes were evaluated with application of the patient distress scale (PDS), the functional independence measure (FIM), and the physiotherapy functional mobility profile (PFMP) before starting the rehabilitation program and on discharge from the clinic. The Montebello Rehabilitation Factor Score (MRFS) was used to evaluate the rehabilitation outcomes. Results: Mean age of the cases was 68.08 ± 12.66 years. The difference points were calculated for the total scores of the result measurements as Δ PDS 3.72 ± 7.18, ΔFIM 8.74 ± 15.15, and Δ PFMP 4.96 ± 8.82. The MRFS effect points were determined as 0.19 ± 0.31, and the MRFS performance points as 0.03 ± 0.07. A statistically significant negative correlation was determined between Δ FIM, ΔPFMP, MRFS effect points, MRFS performance points, and Δ PDS points (P < 0.01). Conclusion: The results of the study showed that acute stroke patients with a good emotional state had better functional outcomes. It can be concluded that evaluating the emotional state and existing problems while planning of rehabilitation programs will make a positive contribution to both the functional and emotional states of acute stroke patients.


Assuntos
Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
14.
J Stroke Cerebrovasc Dis ; 28(12): 104447, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31624035

RESUMO

BACKGROUND: We assessed the occurrence of neurological deficits that may impede the capacity to provide consent for trial participation in patients with an acute stroke, who are eligible for endovascular treatment (EVT). METHODS: We used data from the Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective observational cohort study. We included 1526 patients with an anterior large vessel occlusion, undergoing EVT between March 2014 and June 2016. We based our assessment of decision-making capacity for trial participation on neurological symptoms influencing conditions concerning informed consent as stated in the declaration of Helsinki. We formulated a strict and a mild capacity assessment rule, using 2 different cut points in item scores on the National Institutes of Health Stroke Scale (NIHSS). RESULTS: Applying the strict and mild rule, respectively 1469 (96%) and 1220 (80%) patients deemed not capable of decision-making for trial participation on admission, and 1077 (79%) and 825 (60%) patients at 24-48 hours after admission. Highest frequencies of predefined scores suggesting incapacity based on the strict rule were on the NIHSS items "Level of Consciousness Questions" (59%), "Best Gaze" (68%), and "Best Language" (58%). Patients who were considered incapable were older (median 71 versus 66 years, P = .043), had higher NIHSS scores (median 16 versus 8, P < .001), and had more often left hemisphere strokes (55% versus 28%, P < .001) than patients who were presumably capable. CONCLUSIONS: In the majority of patients with an anterior circulation stroke who are eligible for EVT, neurological deficits are present that may impede the capacity to provide informed consent for trial participation.


Assuntos
Comportamento de Escolha , Procedimentos Endovasculares , Consentimento Livre e Esclarecido , Competência Mental , Seleção de Pacientes , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Sujeitos da Pesquisa/psicologia , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia
15.
Medicine (Baltimore) ; 98(42): e17235, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626084

RESUMO

BACKGROUND: Conflicting results have been reported on the association of poststroke depression with recurrent stroke events. This meta-analysis of prospective studies aims to evaluate whether poststroke depression is an independent predictor of stroke recurrence among stroke patients. METHODS: A systematic search of articles in PubMed and Embase databases from their inception to October 2018 was conducted. Prospective studies reporting risk estimates of stroke recurrence by depression status in stroke patients were included and pooled risk ratio (RR) with 95% confidence intervals (CIs) of stroke recurrence was calculated for patients with or without poststroke depression. RESULTS: Six studies with 4648 stroke patients were finally included, and the prevalence of poststroke depression was found to from 15.9% to 40.5%. The pooled adjusted RR for stroke recurrence in patients suffering from poststroke depression was 1.48 (1.22-1.79) in a fixed-effect model. Subgroup analyses indicated that poststroke depression significantly increased stroke recurrence (RR 1.64; 95% CI, 1.28-2.10) among ischemic stroke patients but not in total stroke patients (RR 1.28; 95% CI, 0.96-1.73). CONCLUSIONS: This meta-analysis suggests that poststroke depression may be an independent predictor of stroke recurrence among ischemic stroke patients. Further studies are required to investigate whether treatment of poststroke depression can reduce the risk of stroke recurrence.


Assuntos
Depressão/epidemiologia , Acidente Vascular Cerebral/psicologia , Idoso , Idoso de 80 Anos ou mais , Depressão/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Recidiva , Fatores de Risco , Sobreviventes/estatística & dados numéricos
16.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(9): 1168-1172, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31594167

RESUMO

Stroke has caused a heavy disease burden across the world, and it has become a worldwide public health problem. Several studies have assessed the relationship between psychological and social factors and risk of stroke so far. This paper summarizes the progress in epidemiological research on the relationship between psychological and social factors (depression, psycho-social stress, anxiety, loneliness, psychological distress, social support, social isolation, and social network) and the risk for stroke, the results of these studies were inconsistent. Most studies showed an association between these factors and the incidence of stroke, but there were still some studies showing no such association.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Ansiedade , Depressão , Humanos , Apoio Social , Estresse Psicológico , Acidente Vascular Cerebral/psicologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-31569534

RESUMO

OBJECTIVES: Adequate awareness of cardiovascular disease (CVD) may help in its prevention and control. Therefore, we evaluated knowledge among the general population of stroke and heart attack symptoms and determined the factors associated with poor understanding of CVD. METHODS: This cross-sectional study included 228,240 adults (102,408 males, 125,832 females) who participated in the 2017 Korean Community Health Survey. Data on sociodemographic characteristics and cognizance of the warning signs of CVD events (stroke and heart attack) were examined. Logistic regression analysis was used to investigate factors associated with poor understanding of CVD. RESULTS: The stroke and heart attack warning signs that were identified least often by respondents were "sudden poor vision in one or both eyes" (66.1%) and "pain or discomfort in the arm or shoulder" (53.8%). Of the subjects, 19.0% had low CVD knowledge scores (less than 4 out of 10) with males having lower scores than females. In the multivariate analysis, poor understanding of CVD warning signs was significantly associated with older age, male gender, lower education level, lack of regular exercise, unmarried status, unemployment, poor economic status, poor health behaviors (high salt diet, no health screening), poor psychological status (high stress, self-perceived poor health status), and the presence of hypertension or dyslipidemia. CONCLUSIONS: Specialized interventions, including those based on public education, should focus on groups with less knowledge of CVD.


Assuntos
Conscientização , Conhecimentos, Atitudes e Prática em Saúde , Infarto do Miocárdio/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/psicologia , República da Coreia/epidemiologia , Fatores de Risco , Acidente Vascular Cerebral/psicologia , Adulto Jovem
18.
J Stroke Cerebrovasc Dis ; 28(11): 104387, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542365

RESUMO

BACKGROUND: No study to date has focused on what combinations of motor functions are strongly associated with self-care independence in individuals with stroke. The purpose of this study is to clarify the impact of motor function interactions on self-care independence in individuals with stroke. METHODS: This retrospective observational study included 132 individuals with first stroke. We conducted a decision tree analysis to examine the impact on daily living skills of numerous key functions - the upper and lower limbs on the affected side, bilateral grip strength and lower limb muscle strength on the unaffected side, bilateral upper limb and trunk function, and balance. Further, we confirmed the interaction effects detected via the decision tree approach using logistic regression. RESULTS: As per the decision tree analysis, the interaction between balance and upper limb function of the affected side showed an association with self-care independence. The interaction terms of balance and upper limb function we analyzed were significantly associated with the ability to achieve self-care independence, after some adjustments to eliminate the influence of confounding factors. CONCLUSIONS: These results suggest that the combination of functional status of balance and upper limb function of the affected side are strongly associated with the independence of self-care. The decision tree created in this study could serve as an effective guide when implementing a remedial approach for individuals with stroke aiming to achieve self-care independence.


Assuntos
Atividade Motora , Equilíbrio Postural , Autocuidado , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Árvores de Decisões , Feminino , Nível de Saúde , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Força Muscular , Seleção de Pacientes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 28(11): 104341, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31542367

RESUMO

OBJECTIVE: To investigate the effects of water-based exercise on functioning and quality of life in poststroke persons. DATA SOURCES: We searched the following electronic database: MEDLINE, PeDro, Scielo, and the Cochrane Central Register of Controlled Trials up to September 2018 Study Selection: Only randomized controlled trials were included. Two review authors screened the titles and abstracts and selected the trials independently. DATA EXTRACTION: Two review authors independently extracted data of the included trials, using standard data-extraction model. We analyzed the pooled results using weighted mean differences, and standardized mean difference and 95% confidence intervals (CIs) were calculated. DATA SYNTHESIS: Twenty-four studies met the study criteria, but only 15 studies were included on meta-analyses. The studies presented moderate methodological quality, due to the lack of blinding of subjects and therapists and the nonperformance of the intention-to-treat analysis. Water-based exercise compared with land exercise had a positive impact on: muscle strength balance gait speed and mobility aerobic capacity and functional reach. Combined water-based exercise and land exercise was more effective than land exercise for improving balance, gait speed, and functional reach. The meta-analysis showed significant improvement in role limitations due to physical functioning and emotional problems, in vitality general mental health, social functioning, and bodily pain for participants in the water-based exercise and land exercise group versus land exercise group. CONCLUSIONS: Water-based exercise may improve muscle strength, balance, mobility, aerobic capacity, functional reach, joint position sense, and quality of life in poststroke persons and could be considered for inclusion in rehabilitation programs.


Assuntos
Terapia por Exercício/métodos , Hidroterapia/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Idoso , Avaliação da Deficiência , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Equilíbrio Postural , Qualidade de Vida , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Resultado do Tratamento , Velocidade de Caminhada
20.
J Rehabil Med ; 51(9): 660-664, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31478056

RESUMO

OBJECTIVE: To investigate different aspects of self-perceived impact of stroke 1 and 5 years after stroke onset, with a focus on self-perceived participation. DESIGN: Longitudinal cohort study. PARTICIPANTS: Forty-five persons diagnosed with first-time stroke included in the Stroke Arm Longitudinal study at University of Gothenburg (SALGOT). METHODS: Participants responded to the Stroke Impact Scale, the Impact on Participation and Autonomy and the European Quality of Life 5 dimensions at 1 year and 5 years post-stroke. Wilcoxon signed-rank test was used to check for differences in changes over time between groups. RESULTS: In general, the perceived consequences of stroke were more severe after 5 years compared with at 1 year. Strength, emotion and participation were the areas most affected, along with restrictions in social life and autonomy indoors. Global disability (mRS) was moderately correlated with quality of life. CONCLUSION: The perceived impact of stroke becomes more prominent with time, even for persons with mild-to-moderate stroke. This study highlights the need for long-term support for persons with stroke.


Assuntos
Qualidade de Vida/psicologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/psicologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Autoimagem , Fatores de Tempo
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