Inconsistent classification of mild stroke and implications of health services delivery

 I have seen nothing that even remotely suggests that any stroke damage diagnosis is objective.  With nothing objective it is impossible to determine exactly what protocols worked and which ones to prescribe.  The prescription of E.T.(Evaluate and Treat) by the doctor to all therapists is completely showing that the doctor is taking no responsibility for survivor recovery.

Inconsistent classification of mild stroke and implications of health services delivery

Archives of Physical Medicine and Rehabilitation — Roberts PS, et al. | January 30, 2020

Researchers sought to perform a scoping review of mild stroke definitions based on stroke severity evaluations and/or clinical signs and symptoms reported in the literature. They searched PubMed, PsycINFO (Ovid), and CINAHL (EBSCO) databases added keyword combinations of a mild stroke, minor stroke, mini-stroke, mild cerebrovascular, minor cerebrovascular, transient ischemic attack, or TIA. For the final review, 62 studies were selected. Between January 2003 and February 2018, inclusion criteria were limited to articles published. It was noted that inequalities in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cut-off scores, imaging tools, and clinical or functional outcomes. Moreover, continued work is needed to establish a consensus definition of mild stroke, which directly influences treatment receipt, referral for services, and health service delivery.

Read the full article on Archives of Physical Medicine and Rehabilitation

Seven capital devices for the future of stroke rehabilitation

Not good enough, 'improve' is not what survivors want or need. They want 100% recovery. Will you stop with your TYRANNY OF LOW EXPECTATIONS? 

Seven capital devices for the future of stroke rehabilitation

  M. Iosa,
1
G.Morone,
1
 A.Fusco,
1
M.Bragoni,
2
P.Coiro,
2
M. Multari,
2
 V.Venturiero,
2
D.De Angelis,
2
L. Pratesi,
2
and S.Paolucci
1,2
1
Clinical Laboratory of Experimental Neurorehabilitation, Santa Lucia Foundation I.R.C.C.S., Via Ardeatina 306, 00179 Rome, Italy
 2
Operative Unit F, Santa Lucia Foundation I.R.C.C.S., Via Ardeatina 306, 00179 Rome, Italy
Correspondence should be addressed to M. Iosa, m.iosa@hsantalucia.itReceived 26 September 2012; Accepted 12 November 2012Academic Editor: Stefan Hesse Copyright © 2012 M. Iosa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Stroke is the leading cause of long-term disability for adults in industrialized societies. Rehabilitation’s efforts are tended to avoid long-term impairments, but, actually, the rehabilitative outcomes are still poor. Novel tools based on new technologies have been developed to improve the motor recovery. In this paper, we have taken into account seven promising technologies that can improve rehabilitation of patients with stroke in the early future: (1) robotic devices for lower and upper limb recovery, (2) brain computer interfaces,(3)noninvasive brain stimulators,(4)neuroprostheses,(5)wearable devices for quantitative human movement analysis,(6) virtual reality, and (7) tabletpc used for neurorehabilitation.

Flavonol may reduce Alzheimer’s dementia risk

With no amounts given and 'may', this is totally useless. 

Flavonol may reduce Alzheimer’s dementia risk

Holland TM, et al. Neurology. 2020;doi:10.1212/WNL.0000000000008981.

January 30, 2020

Thomas M. Holland

Eating more foods with flavonol, an antioxidant found in most fruits, vegetables and teas, could reduce the risk for developing Alzheimer’s dementia, according to research published in Neurology, the medical journal of the American Academy of Neurology.
“With this research, we are understanding that it’s the entire composition of the food, inclusive of bioactives, like flavonols, along with the vitamins and minerals that render these foods as beneficial,” Thomas M. Holland, MD, faculty member in the College of Health Sciences at Rush University, told Healio Primary Care. “As our knowledge of the disease process of Alzheimer’s dementia expands and we recognize that it is multifactorial, we should prepare ourselves as best we can with multiple, scientifically based tools to help stave off the progression with an eye toward the ultimate goal of prevention.”

See Also

• Most with preclinical Alzheimer’s disease will not develop dementia
• Frailty impacts susceptibility to dementia
• Exercise could ease Alzheimer’s disease complications

Researchers evaluated 921 participants (mean age, 81.2 years) from the Rush Memory and Aging Project, an ongoing community-based cohort of older adults living in the Chicago area who did not have dementia at enrollment. Each year, participants are asked to complete food frequency questionnaires that assess their past-year intake of 144 food items, according to the study authors. Participants were followed for an average of 6 years.
The researchers divided the participants into five groups based on their intake of flavonol. They said the average flavonol intake in the United States is 16 mg to 20 mg per day; in the study, the lowest intake group consumed an average of 5.3 mg per day, whereas the highest intake group consumed an average 15.3 mg per day.(How the hell do you know the amounts to take to get to this level?)

 

Eating more foods with flavonol, an antioxidant found in most fruits, vegetables and teas, could reduce the risk for developing Alzheimer’s dementia, according to research published in Neurology, the medical journal of the American Academy of Neurology.

Source: Adobe Stock

In their analysis, researchers examined Alzheimer’s risk with intake of four specific flavonols: kaempferol, which is found in kale, beans, tea, spinach and broccoli; myricetin, which is in tea, wine, kale, oranges and tomatoes; isorhamnetin, which is in pears, olive oil, wine and tomato sauce; and quercetin, which is found in tomatoes, kale, apples and tea.
According to Holland and colleagues, 220 participants developed Alzheimer’s dementia.
They found that after adjusting for genetic predisposition and lifestyle factors, those in the highest total flavonol intake group had a 48% lower risk of developing Alzheimer’s dementia compared with those in the first quintile (HR = 0.52; 95% CI, 0.33-0.84).
Alzheimer dementia risk was 51% lower in those with the highest kaempferol intake (HR = 0.49; 95% CI, 0.31-0.77), 38% lower in those with the highest myricetin intake (HR = 0.62; 95% CI, 0.4-0.97) and 38% lower in those with the highest isorhamnetin intake (HR = 0.62; 95% CI, 0.39-0.98) compared with the lowest consumers. Quercetin was not associated with a lower risk for developing Alzheimer’s dementia.

Spatio-temporal gait variables predicted incident disability

Could your doctor use this to objectively determine what protocols to use to prevent such disability?

Spatio-temporal gait variables predicted incident disability

• Takehiko Doi,
• Sho Nakakubo,
• Kota Tsutsumimoto,
• Min-Ji Kim,
• Satoshi Kurita,
• Hideaki Ishii &
• Hiroyuki Shimada 

Journal of NeuroEngineering and Rehabilitation volume 17, Article number: 11 (2020) Cite this article

Abstract

Background

Assessing the risk of disability in older adults is important for developing prevention and intervention strategies to decrease potential disability and dependency. The aim of this study was to examine the association between spatio-temporal gait variables and disability among older adults.

Methods

We conducted a prospective study in a community setting. We collected data from 4121 subjects (≥ 65 years, mean age: 71.9 years). Gait speed, cadence, stride length, and stride length variability were measured at baseline. Participants were instructed to walk at their usual pace along a 6.4 m straight and flat path on which an electronic gait measuring device was mounted at mid 2.4 m. Subsequent disability was confirmed from long-term care insurance records.

Results

During follow-up duration (mean: 49.6 months), 425 participants had incident disability. The cut-off value to detect high or low function in each gait variable was determined using the Youden index. Cox proportional hazard analysis adjusted for covariates showed that disability was significantly predicted by low function in each gait variable using the cut-off values: gait speed (hazard ratio [95% confidential intervals]: 2.06 [1.65–2.57]), stride length (2.17 [1.72–2.73]), cadence (1.49 [1.20–1.86], and stride length variability (1.46 [1.19–1.80]). The number of gait variables that scored in the low function category were also cumulatively related to subsequent disability (p < .001).

Conclusions

This study revealed that spatio-temporal gait variables had a significant predictive value for incident disability. Multifaceted and quantitative gait analysis can contribute to disability risk assessment.

NEUROMUSCULAR ELECTRICAL STIMULATION IN NEUROREHABILITATION

I see nothing in these 29 pages that suggests protocols were created, just a lazy review with guidelines. So useless. 

NEUROMUSCULAR ELECTRICAL STIMULATION IN NEUROREHABILITATION

 LYNNE R. SHEFFLER, MD, and JOHN CHAE, MD
Cleveland Functional Electrical Stimulation Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, Ohio 44109, USA

 ABSTRACT: 

This review provides a comprehensive overview of the clinical uses of neuromuscular electrical stimulation (NMES) for functional and therapeutic applications in subjects with spinal cord injury or stroke. Functional applications refer to the use of NMES to activate paralyzed muscles in precise sequence and magnitude to directly accomplish functional tasks. In therapeutic applications, NMES may lead to a specific effect that enhances function, but does not directly provide function. The specific neuroprosthetic or “functional” applications reviewed in this article include upper- and lowerlimb motor movement for self-care tasks and mobility, respectively, bladder function, and respiratory control. Specific therapeutic applications include motor relearning, reduction of hemiplegic shoulder pain, muscle strengthening, prevention of muscle atrophy, prophylaxis of deep venous thrombosis, improvement of tissue oxygenation and peripheral hemodynamic functioning, and cardiopulmonary conditioning. Perspectives on future developments and clinical applications of NMES are presented. Muscle Nerve 35: 562–590, 2007

Challenging access to seats in basketball stadium

MSU won vs. Northwestern 79-50.  I have to grab my left arm with my right to prevent it from hitting people on the way in. And hopefully I don't topple over or step on toes. Then when I sit I have to put my left hand on my right leg to keep my left elbow from attacking my neighbor.

Absolutely no training on any of this. How to walk past standing patrons  on the way to my seat, you've got maybe 6 inches to walk on.

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility

Did your stroke hospital know about this one from April 2019?

A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study (HAL-Exoskeleton STROke Study)

The latest here:

Gait training early after stroke with a new exoskeleton--the hybrid assistive limb: a study of safety and feasibility

 Anneli Nilsson
1*
, Katarina Skough Vreede
1,2
, Vera Häglund
1
, Hiroaki Kawamoto
3
, Yoshiyuki Sankai
3
and Jörgen Borg
1,2

Abstract

Background:
 Intensive task specific training early after stroke may enhance beneficial neuroplasticity and functional recovery. Impaired gait after hemiparetic stroke remains a challenge that may be approached early after stroke by use of novel technology. The aim of the study was to investigate the safety and feasibility of the exoskeleton Hybrid Assistive Limb (HAL) for intensive gait training as part of a regular inpatient rehabilitation program for hemiparetic patients with severely impaired gait early after stroke.
Methods:
 Eligible were patients until 7 weeks after hemiparetic stroke. Training with HAL was performed 5 days per week by the autonomous and/or the voluntary control mode offered by the system. The study protocol covered safety and feasibility issues and aspects on motor function, gait performance according to the 10 Meter Walking Test (10MWT) and Functional Ambulation Categories (FAC), and activity performance.
Results:
 Eight patients completed the study. Median time from stroke to inclusion was 35 days (range 6 to 46). Training started by use of the autonomous HAL mode in all and later switched to the voluntary mode in all but one and required one or two physiotherapists. Number of training sessions ranged from 6 to 31 (median 17) and walking time per session was around 25 minutes. The training was well tolerated and no serious adverse events occurred. All patients improved their walking ability during the training period, as reflected by the 10MWT (from 111.5 to 40 seconds in median) and the FAC (from 0 to 1.5 score in median).
Conclusions:
 The HAL system enables intensive training of gait in hemiparetic patients with severely impaired gait function early after stroke. The system is safe when used as part of an inpatient rehabilitation program for these patients by experienced physiotherapists.
Keywords:
 Gait, Stroke, Rehabilitation, Robotics

Movement therapy induced neural reorganization and motor recovery in stroke: A review

I have to say this is a failure. I see nothing that suggests they wrote protocols and distributed them worldwide to all stroke groups. OR the 10 million yearly stroke survivors. 

Movement therapy induced neural reorganization and motor recovery in stroke: A review

 Kamal Narayan Arya, MOT, PhD Scholar (Neurology), Sr. OccupationalTherapist
a,b,
*,ShantaPandian,MOT(Neurology),SuperintendentOT(OPD)
b
,Rajesh Verma, DM (Neurology), DNB (Neurology), Professor
a
,R.K. Garg, DM (Neurology), Professor & HOD
a
a
Department of Neurology, CSM Medical University (KGMU), Lucknow, UP 226003, India
b
Pt. Deendayal Upadhyaya Institute for the Physically Handicapped, University of Delhi,Ministry of Social Justice & Empowerment, Govt. of India, New Delhi 110002, India
Received 7 October 2010; received in revised form 22 January 2011; accepted 29 January 2011
KEYWORDS
Stroke;Neurorehabilitation;Cortical reorganization;Neuroplasticity
Summary
 This paper is a review conducted to provide an overview of accumulated evidence on contemporary rehabilitation methods for stroke survivors. Loss of functional movement is a common consequence of stroke for which a wide range of interventions has been developed.Traditional therapeutic approaches have shown limited results for motor deficits as well as lack evidence for their effectiveness. Stroke rehabilitation is now based on the evidence of neuroplasticity, which is responsible for recovery following stroke. The neuroplastic changes in the structure and function of relevant brain areas are induced primarily by specific rehabilitation methods. The therapeutic method which induces neuroplastic changes, leads to greater motor and functional recovery than traditional methods. Further, the recovery is permanent in nature. During the last decade various novel stroke rehabilitative methods for motor recovery have been developed. This review focuses on the methods that have evidence of associated cortical level reorganization, namely task specific training, constraint-induced movement therapy,robotic training, mental imaging,and virtual training. All of these methods utilize principles of motor learning. The findings from this review demonstrated convincing evidence both at the neural and functional level in response to such therapies. The main aim of the review was to determine the evidence for these methods and their application into clinical practice.
ª
2011 Elsevier Ltd. All rights reserved.

Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study

So failed research. 

Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study

Sheehy Lisa PhD

Taillon‐Hobson Anne MSc

Sveistrup Heidi PhD

Bilodeau Martin PhD

Yang Christine MD

Finestone Hillel MD

First published: 22 January 2020

https://doi.org/10.1002/pmrj.12331

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/pmrj.12331.

Abstract

Introduction

Virtual reality training (VRT) is engaging and may enhance rehabilitation intensity. Only one previous study has looked at its use to improve sitting balance after stroke.

Objective

To determine if supplemental sitting balance exercises, administered via VRT, improve control of sitting balance and upper extremity function in stroke rehabilitation inpatients.

Design

Assessor‐blinded, placebo‐controlled randomized controlled trial.

Setting

Stroke inpatient rehabilitation unit.

Participants

Seventy‐six participants (out of 130 approached) with sub‐acute stroke who could not stand independently were randomized to experimental and control groups. Sixty‐nine completed the study.

Interventions

The experimental group did VRT that required leaning and reaching, while the control group had their trunk restrained and performed VRT which only involved small upper extremity movements, to minimize trunk movement. Both groups performed 10‐12 sessions of 30‐45 minutes. Participants were assessed pre‐, post and one‐month post the sessions by a blinded examiner.

Outcome Measures

Function in Sitting Test (FIST, primary outcome measure); Ottawa Sitting Scale; Reaching Performance Scale; Wolf Motor Function Test (WMFT).

Results

Thirty‐three participants completed the experimental intervention and 36 the control. Pre/post differences for FIST were 3.4 [confidence interval (CI) 0.5;6.3] for the experimental group and 5.3 (2.9;7.7) for the control group. There was a significant improvement over time (adjusted for multiple comparisons, p<0.006) on most outcome measures excepting the WMFT Performance Time Scale (control group; p=0.007) and grip strength (p=0.008); there were no differences between groups (p>0.006).

Conclusions

Siting balance outcomes were similar for both groups; therefore this study does not support the use of sitting balance exercises provided via VRT for the rehabilitation of sitting balance after stroke. However, because it is only the second study to investigate VRT for sitting balance and upper extremity function, more research, using more challenging exercises and a greater treatment intensity, is required before definitive conclusions are made.
This article is protected by copyright. All rights reserved.

BRILINTA met primary endpoint in Phase III THALES trial in stroke

HOW LONG BEFORE THIS GETS TO A REHAB PROTOCOL IN YOUR HOSPITAL? I'm guessing decades, maybe in time for your children's and grandchildren's strokes. 

BRILINTA met primary endpoint in Phase III THALES trial in stroke

BRILINTA reduced the risk of the composite of stroke and
death after an acute ischemic stroke or transient ischemic attack

High-level results from the Phase III THALES trial showed AstraZeneca’s BRILINTA (ticagrelor) 90 mg used twice daily and taken with aspirin for 30 days, reached a statistically significant and clinically meaningful reduction in the risk of the primary composite endpoint of stroke and death, compared to aspirin alone.
THALES was conducted in over 11,000 patients who had a minor acute ischemic stroke or high-risk transient ischemic attack (TIA) in the 24 hours prior to treatment initiation. The preliminary safety findings in the THALES trial were consistent with the known profile of BRILINTA, with an increased bleeding rate in the treatment arm.
Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said: “Results of the Phase III THALES trial showed BRILINTA, in combination with aspirin, improved outcomes in patients who had experienced a minor acute ischemic stroke or high-risk transient ischemic attack. We look forward to sharing the detailed results with health authorities.”
Dr. Clay Johnston, lead investigator for the THALES trial and Dean of the Dell Medical School at The University of Texas at Austin, said: “The risk of having a subsequent stroke is highest in the first few days and weeks after a minor acute ischemic stroke or high-risk transient ischemic attack. While an expected increase in bleeding was observed, the findings from THALES showed that BRILINTA, in combination with aspirin, reduced the risk of potentially devastating events in this crucial time.”
The full THALES trial results will be presented at a forthcoming medical meeting.
BRILINTA is not indicated in patients with minor acute ischemic stroke or high-risk transient ischemic attack.
BRILINTA is indicated to reduce the rate of CV death, myocardial infarction (MI), and stroke in patients with ACS or a history of MI. For at least the first 12 months following ACS, it is superior to clopidogrel.
BRILINTA also reduces the rate of stent thrombosis in patients who have been stented for treatment of ACS.
Dosing: In the management of ACS, initiate BRILINTA treatment with a 180-mg loading dose. Administer 90 mg twice daily during the first year after an ACS event. After one year administer 60 mg twice daily. Use BRILINTA with a daily maintenance dose of aspirin of 75-100 mg.
IMPORTANT SAFETY INFORMATION FOR BRILINTA^® (ticagrelor) 60-MG AND 90-MG TABLETS
WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS
A.  BLEEDING RISK

• BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal bleeding
• Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
• Do not start BRILINTA in patients undergoing urgent coronary artery bypass graft surgery
• If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

B.  ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

• Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided

CONTRAINDICATIONS

• BRILINTA is contraindicated in patients with a history of intracranial hemorrhage or active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

WARNINGS AND PRECAUTIONS

• Dyspnea was reported in about 14% of patients treated with BRILINTA, more frequently than in patients treated with control agents. Dyspnea resulting from BRILINTA is often self-limiting
• Discontinuation of BRILINTA will increase the risk of MI, stroke, and death. When possible, interrupt therapy with BRILINTA for 5 days prior to surgery that has a major risk of bleeding. If BRILINTA must be temporarily discontinued, restart as soon as possible
• Ticagrelor can cause ventricular pauses. Bradyarrhythmias including AV block have been reported in the post-marketing setting. PLATO and PEGASUS excluded patients at increased risk of bradyarrhythmias not protected by a pacemaker, and they may be at increased risk of developing bradyarrhythmias with ticagrelor
• Avoid use of BRILINTA in patients with severe hepatic impairment. Severe hepatic impairment is likely to increase serum concentration of ticagrelor and there are no studies of BRILINTA in these patients
• In patients with Heparin Induced Thrombocytopenia (HIT): False negative results for HIT-related platelet functional tests, including the heparin-induced platelet aggregation (HIPA) assay, have been reported with BRILINTA. BRILINTA is not expected to impact PF4 antibody testing for HIT

ADVERSE REACTIONS

• The most common adverse reactions associated with the use of BRILINTA included bleeding and dyspnea: In PLATO, for BRILINTA vs clopidogrel, non-CABG    PLATO-defined major bleeding (3.9% vs 3.3%) and dyspnea (14% vs 8%); in PEGASUS, BRILINTA vs aspirin alone, TIMI Total Major bleeding (1.7% vs 0.8%) and dyspnea (14% vs 6%)

DRUG INTERACTIONS

• Avoid use with strong CYP3A inhibitors and strong CYP3A inducers. BRILINTA is metabolized by CYP3A4/5. Strong inhibitors substantially increase ticagrelor exposure and so increase the risk of adverse events. Strong inducers substantially reduce ticagrelor exposure and so decrease the efficacy of ticagrelor
• As with other oral P2Y₁₂ inhibitors, co-administration of opioid agonists delay and reduce the absorption of ticagrelor. Consider use of a parenteral anti-platelet in ACS patients requiring co-administration
• Patients receiving more than 40 mg per day of simvastatin or lovastatin may be at increased risk of statin-related adverse events
• Monitor digoxin levels with initiation of, or change in, BRILINTA therapy

SPECIAL POPULATIONS

• Lactation: Breastfeeding not recommended

Please read full Prescribing Information, including Boxed WARNINGS, and Medication Guide.

Diversified Innovation Strategies for an Early Limb Rehabilitation Program in Patients With Stroke

So instead of having an objective of delivering limb rehab results they lazily went for increasing the percentage of patients getting early rehab.  To me this is a complete failure in stroke research.

Diversified Innovation Strategies for an Early Limb Rehabilitation Program in Patients With Stroke

 

[Article in Chinese; Abstract available in Chinese from the publisher]

Hsu CW¹, Lin YH², Chang SY³, Tsai PJ⁴, Shen TC⁴, Lin YL⁵.

Author information

Abstract

in English, Chinese

BACKGROUND & PROBLEMS:

Early rehabilitation after stroke is important for the recovery of bodily functions in stroke patients. However, the percentage of completion of early limb rehabilitation among stroke patients is only 16%.

PURPOSE:

Raise the early rehabilitation intervention rate to 88% for patients with stroke within 24 hours of hospitalization.

RESOLUTION:

We developed an education course on post-stroke rehabilitation and a related e-Learning course as well as organized an 'alliance for recovery' team. In addition, we established a standard for post-stroke relay rehabilitation and designed rehabilitation relay cards, Xbox rehabilitation games, and nine squares challenge for brain stroke care.

RESULTS:

The accuracy of the knowledge of nursing staff related to physical rehabilitation improved from 72.4% to 100%; the accuracy of their perceptions regarding early limb rehabilitation increased from 16% to 100%; and patient satisfaction increased from 68% to 98%.

CONCLUSIONS:

We deployed diverse and innovative strategies to assist limb rehabilitation in patients with stroke. Patients and caregivers should be encouraged to participate in early rehabilitation and related programs and should apply the skills and rehabilitation activities learned to daily life.

KEYWORDS:

brain stroke; early rehabilitation; rehabilitation strategy; somatosensory game

PMID:

31960399

DOI:

10.6224/JN.202002_67(1).10

Walnuts may slow cognitive decline in at-risk elderly

You may need this, has your doctor had the nutritionist create a diet protocol on this for hospital food and then at discharge?

Your chances of getting dementia.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

5. Parkinson’s Disease May Have Link to Stroke March 2017

The latest here:

 

Walnuts may slow cognitive decline in at-risk elderly

MedicalXpress Breaking News-and-Events | January 28, 2020

Eating walnuts may help slow cognitive decline in at-risk groups of the elderly population, according to a study conducted by researchers in California and Spain.

The Walnuts and Healthy Aging Study, published this month in The American Journal of Clinical Nutrition, found that walnut consumption by healthy, elderly adults had little effect on cognitive function over 2 years, but it had greater effect on elderly adults who had smoked more and had a lower baseline neuropsychological test scores.

Advertisement

The study examined nearly 640 free-living elders in Loma Linda, CA, and in Barcelona, Catalonia, Spain. For 2 years, the test group included walnuts in their daily diet, and the control group abstained from walnuts.
Walnuts contain omega-3 fatty acids and polyphenols, which have previously been found to counteract oxidative stress and inflammation, both of which are drivers of cognitive decline.
Joan Sabaté, MD, DrPH, professor of nutrition and epidemiology at Loma Linda University School of Public Health and the study's principal investigator, said this was the largest and most well-controlled trial ever conducted on the effects of nuts on cognition.

• See Also: New year, new FDA food labels

"While this was a minor result, it could lead to better outcomes when conducted over longer periods of time," Sabaté said. "Further investigation is definitely warranted based on our findings, especially for disadvantaged populations, who may have the most to gain from incorporating walnuts and other nuts into their diet."
Sabaté and his research team at Loma Linda University were the first to discover the cholesterol-lowering effect of nut consumption—specifically walnuts—with lowering blood cholesterol. Findings were first published in the New England Journal of Medicine in 1993.
Subsequently, findings from Loma Linda University researchers have linked nut consumption to lower risk of cardiovascular diseases.

—Ansel Oliver, Loma Linda University Adventist Health Sciences Center

• See Also: Drinking 1% rather than 2% milk accounts for 4.5 years of less aging in adults

To read more, click here.

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

This is why I think you really need to have a discussion with your doctor as to why this needs to be done. If your Circle of Willis is complete it would seem to make more sense to just close up the artery completely rather than risk more brain damage. My right carotid artery was completely closed for at least 10 years before collaterals appeared and I suffered no cognitive impairment from that lack of blood source.  Push your doctor hard on that question. Will they guarantee no adverse events from the procedure they do? 

Silent Cerebral Infarctions During Revascularisation Procedures Associated With Worse Cognitive Impairment

By Eric Ramos

BARCELONA, Spain -- January 26, 2020 -- Patients with new silent cerebral infarctions during revascularisation procedures for carotid artery disease appear to have worse cognitive impairment than patients who do not develop new lesions, according to a study presented here at The International Conference of the European Society of Cardiology (ESC) Council on Stroke.

Patients who developed new ischaemic lesions scored significantly worse on the Mini Mental State Examination (MMSE) at their follow-up visit, compared with MMSE scores taken right before and after the procedure.

“Patients undergoing carotid artery angioplasty and stenting have high risk of stroke or transient ischaemic attack intra-procedurally,” explained Alexandros Evangeliou, MD, Hippokration General Hospital, Thessaloniki, Greece. “Even though ischaemic brain lesions are detected on post-procedural imaging, most of these patients do not have neurological deficits.”

To clarify the association between intra-procedural ischaemic lesions and cognitive impairment, the researchers examined the neurological outcomes of 31 patients aged 56 to 78 years who successfully underwent carotid artery angioplasty and stenting for carotid artery disease.

All patients underwent a neurological clinical examination, and Mini-Mental-State-Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS) questionnaires were administered before and after surgery, and at the follow-up visit. Cerebral diffusion-weighted MRI was performed before and after revascularisation.

After a median follow-up time of 9 months, 8 (25.8%) patients showed new ischaemic lesions on MRI.

There were no differences in NIHSS scores before and after the procedure or at the follow-up visit. The authors noted that this was expected because the NIHSS score is used to quantify stroke severity in clinically evident strokes, not silent ones.

However, the MMSE score at the follow-up visit (24.7 ± 5) was significantly lower than scores recorded before the revascularisation procedure (27.2 ± 2.7; P = .049) and after (28.3 ± 1.53; P = .029).

“The MMSE score correlated with MRI imaging and can be used in this setting to assess prognosis,” said Dr. Evangeliou.

[Presentation title: Evaluation of Silent Cerebral Infarction Prognosis in Patients With Carotid Artery Disease Undergoing Carotid Artery Revascularization Procedure]

Brain iron levels may have a drastic impact on improving cognitive function

WHOM do we go to to ask the simple questions? 

1. What measurement needs to be done post stroke? 

2. What intervention needs to be done post stroke?  

WITH NO STROKE LEADERSHIP AND NO STROKE STRATEGY nothing will be done. 

Brain iron levels may have a drastic impact on improving cognitive function

Brain tissue iron could be more vital to a healthy brain function than previously thought, possibly improving cognition in adolescents and young adults with neurodegenerative diseases, a new study suggests. The results were published in the Journal of Neuroscience.
The study, funded by the National Institute of Health, analyzed the magnetic resonance imaging (MRI) scans of more than 1,500 adolescents and young adults as part of the Philadelphia Neurodevelopment Cohort. The participants, ranging from 8 to 24 years of age, had their brain iron levels examined through the brain scans, concentrating in the basal ganglia.
“Atypical iron concentration in the basal ganglia is associated with neurodegenerative disorders in aging and cognitive deficits,” the findings stated. “However, the normative development of brain iron concentration in adolescence and its relationship to cognition are less well understood.”
“We assessed the longitudinal developmental trajectories of tissue iron in the basal ganglia. We quantified tissue iron concentration using R2* relaxometry within four basal ganglia regions, including the caudate, putamen, nucleus accumbens, and globus pallidus.”
According to the findings, researchers determined that iron levels in the basal ganglia progressively increases throughout development,. Higher levels of brain iron in the putamen region was linked to greater cognitive abilities, in which decreased levels was correlated with weaker performance on cognitive tests.
“These results highlight the transition from adolescence to adulthood as a period of dynamic maturation of tissue iron concentration in the basal ganglia,” researchers proclaimed.
“Together, our results suggest a prolonged period of basal ganglia iron enrichment that extends into the mid-twenties, with diminished iron concentration associated with poorer cognitive ability during late adolescence.”

FDA clears algorithms that detect heart murmurs and AFib

You may want your doctor to have this in a testing protocol prior to hospital discharge.  Does your hospital have a way for patients to suggest improvements? If not you need new hospital leadership, starting with the board of directors. 

FDA clears algorithms that detect heart murmurs and AFib

 

Christine Fisher

Contributing Writer

,

Engadget•January 28, 2020

Eko
The FDA just granted clearance to a suite of algorithms that could help healthcare providers in the US more accurately screen for heart conditions during routine physical exams. The algorithms, developed by Eko, can help detect both heart murmurs, indicative of valvular or structural heart disease, and atrial fibrillation, or AFib, which can lead to blood clots, strokes, heart failure and other complications.
According to the company, the AI can identify heart murmurs with 87 percent sensitivity and 87 percent specificity. In comparison, primary care physicians unaided by AI had a 43 percent sensitivity and 69 percent specificity, according to a study in European Heart Journal. When used with the Eko DUO stethoscope, the AI reportedly detected AFib with 99 percent sensitivity and 97 percent specificity.
"Two centuries after its invention, the stethoscope is still the front line tool to detect cardiovascular disease," says Dr. Patrick McCarthy, Executive Director of the Bluhm Cardiovascular Institute at Northwestern Medicine and member of Eko's Scientific Advisory Board. "Eko's development of artificial intelligence algorithms to help clinicians better interpret sounds, identify arrhythmias and detect heart murmurs during a physical exam is going to make a huge difference in our ability to care for patients."
The AI is meant to be used with Eko's digital stethoscopes, which are already on the market. This FDA clearance gives the company the greenlight to deploy its murmur- and AFib-detection algorithms. In December, the FDA granted another Eko algorithm "breakthrough status," fast-tracking it for approval. That algorithm uses ECG data to identify Left Ventricular Ejection Fraction (LVEF), a measure commonly used to diagnose heart failure. If and when that algorithm is cleared, Eko's digital stethoscopes will be able to use AI to screen for heart failure, valve disease and AFib, and all of that will be possible during routine physical exams.

Alzheimer’s disease may be combated by improving blood vessel health in the brain

If there was anything useful in here that I could take to my doctor I couldn't find it.  And what is visually evoked vascular responses?

Alzheimer’s disease may be combated by improving blood vessel health in the brain

A build-up of amyloid-beta in the brain is, by theory, a possible cause of Alzheimer’s disease among older adults. In a recent study, a team of researchers determined how such accumulation could be prevented and even treated.
According to the study, published in the peer-reviewed journal Neuron, improving blood vessel health in the brain may be a new route for combating the neurodegenerative disease.
The study focused on vasomotion, slow vessel pulsations associated with the clearance of substances from the brain, possibly affecting the accumulation of amyloid-beta. Such protein fragments are considered a hallmark sign for Alzheimer’s disease, based on countless studies targeting neurodegeneration.
For the study, researchers administered to rodents dextran, a fluorescently labeled carbohydrate, initiating imaging tests thereafter.
Upon evaluating the findings, researchers quickly noticed something aberrant: Vasomotion was detrimental in clearing dextran from the brain. Also, vessel pulsations were inhibited and clearance rates abated in rodents with cerebral amyloid angiopathy.
“Vasomotion correlated with paravascular clearance of fluorescent dextran from the interstitial fluid,” Susanne van Veluw, co-author of the study, explained.
“Increasing the amplitude of vasomotion by means of visually evoked vascular responses resulted in increased clearance rates in the visual cortex of awake mice. Evoked vascular reactivity was impaired in mice with CAA, which corresponded to slower clearance rates.”
Overall, the findings bring new light on how maintaining healthy vasculature may be beneficial for patients with Alzheimer’s disease.
“Our findings highlight the importance of the vasculature in the pathophysiology of Alzheimer’s disease.”
“If we direct therapeutic strategies towards promoting healthy vasculature and therefore improve clearance of amyloid-beta from the brain, we may be able to prevent or delay the onset of Alzheimer’s disease in the future.”

Better primary care needed to help young stroke survivors return to work

You got it wrong right from the start in your title. 'Care' NOT RESULTS. Does no one have two functioning neurons anywhere in stroke? The stupid, it burns.

Better primary care needed to help young stroke survivors return to work 

Queen Mary University of London

The role of primary care needs to be improved to help young stroke survivors return to work, according to a new study from Queen Mary University of London and the University of Cambridge.
Many people of working age who have a stroke want to return to work, but encounter difficulties.
In the study, published in the British Journal of General Practice (BJGP), the researchers describe a number of causes behind this. To do this, they took the results of a previous study looking at issues with returning to work after stroke at UK level to all stakeholders from a local community.
They found there was a mismatch between patient and carer needs and what is provided by primary care. This included lack of GP awareness of invisible impairments, uncertainty how primary care could help in time-limited consultations and complexity of return-to-work issues.
Primary care physicians were also not aware of relevant services they could refer patients to, such as occupational therapy support.
In addition, there was an overall lack of coordination between different stakeholders in the returning to work process. Linking with other services was considered important but challenging due to ongoing changes in service structure and the commissioning model.
A quarter of all strokes happen in working age, with a general practice of around 6,000 patients containing on average 15 stroke survivors aged between 18 and 65 years. Stroke rates are increasing in people aged under 55 while it is known that enabling people with stroke to work has positive effects on health.
Dr Anna De Simoni, lead author of the study from Queen Mary University of London's Institute of Population Health Sciences said: "Primary care is in a crucial position to support stroke survivors successfully returning to work and address inequalities in access to vocational rehabilitation support.
"Through group discussions with stakeholders from a local community, patients, carers, GPs, occupational therapists, employer representative and clinical commissioners we are able to put forward concrete proposals to address the barriers identified. "
Suggestions for improvement include a central contact in primary care for signposting to available services, a rehabilitation assessment integrated with the electronic record, and a patient-held share-care plan at discharge from stroke wards.
The Equality Act 2010 obliges employers to consider whether 'reasonable adjustments' could help stroke survivors return to work, provided there is an assessment of their impairments/disabilities.
However, the researchers found evidence of employers asking clinicians for sick notes rather than undertaking work adaptations.
Dr De Simoni added: "This is more straightforward for physical impairments. Primary care might be the only source of help for patients whose invisible impairments have not been highlighted and are exacerbated by return to employment and for self-employed or business owners."
The researchers say that more work is needed to develop the three suggestions emerged from this study into interventions, addressing potential problems together with their evaluation in terms of cost-benefit.
Georgina Hill, Research Communications Manager at the Stroke Association, said: "Stroke can strike at any age, and about a quarter of stroke survivors are of working age. This study highlights the unique challenges that stroke survivors may face in getting the support they need when returning to work. While this study looked at a small number of people in the UK, it builds on existing evidence that too often, stroke survivors and those close to them, can't get the support they need to rebuild their lives.
"Last year, our largest ever survey of people affected by stroke was published as the Lived Experience of Stroke report, which also showed that many stroke survivors experience fatigue and problems with memory and concentration which need consideration when stroke survivors return to work.

###

If you're looking for information and support, visit the Stroke Association website at stroke.org.uk."
The study was funded by the Evelyn Trust and NIHR.

• Research paper: 'How primary care can help survivors of transient ischaemic attack and stroke return to work: focus groups with stakeholders from a UK community'. Chantal Balasooriya-Smeekens, Andrew Bateman, Jonathan Mant, Anna De Simoni. British Journal of General Practice.
• For a copy of the paper please contact below.

Contact:
Rupert Marquand
PR Officer
Queen Mary University of London
r.marquand@qmul.ac.uk
Tel: 020 7882 3004

 

Treating depression important after stroke, but caution may be needed

Solve the primary problem of 100% recovery and this secondary problem goes away. Solve the correct problem rather than wasting effort on these secondary issues. Does your stroke hospital even understand what the only goal in stroke is? 100% RECOVERY FOR ALL!  When the fuck will you even try to get there? How fucking stupid is your stroke hospital?
Treating depression important after stroke, but caution may be needed

by George Institute for Global Health

Recognising and managing depression is an important part of post-stroke treatment, but some treatments should be used with caution until more is known about the risks, according to new evidence published in the Cochrane Library today.

The George Institute for Global Health researchers analyzed the results of 49 trials involving over 3,000 people with depression following a stroke and found that while psychological therapy or medication could be useful, the latter may come with some potentially harmful side effects.
Senior author Professor Maree Hackett, Program Head, Mental Health at The George Institute said that while depression is an important consequence of stroke that impacts on recovery, it is often not detected or is inadequately treated.
"Management of people who have experienced a stroke tends to focus on the physical effects of the stroke and the psychological effects may be overlooked. Having depression after stroke can hamper recovery by reducing a person's motivation or making them unable to keep up with the recommended rehabilitation," she said.
"People with depression may feel very alone and stop talking to family and friends, and also may stop taking the medications they have been given to prevent another stroke."
"That's why it's important to alleviate depression, but our review on the best way to do this hadn't been updated for over ten years,(And in those 10 years you haven't moved an inch closer to 100% recovery.) during which time new trials have been published and different combinations of treatments have been used," Prof Hackett added.
Cochrane publishes systematic reviews, which summarize all of the available research evidence, that are used to inform treatment guidelines.
Lead author of the review and Research Fellow at The George, Dr. Sabine Allida, said the team had set out to determine which treatments or combinations of treatments would be most effective at treating depression and reducing depressive symptoms after a stroke, based on the best available evidence. (The best treatment is so fucking obvious. EXACT DEFINED STROKE PROTOCOLS LEADING TO 100% RECOVERY.  Knowing what is needed would alleviate the anxiety and depression that comes from not knowing what is ahead.)
"We found a small benefit of antidepressants and talking therapies (like cognitive behavioral therapy) in treating depression. Studies of repetitive Transcranial Magnetic Stimulation (rTMS—a mild form of brain stimulation applied through the scalp and skull) and combined antidepressant and talking therapy, or antidepressant and rTMS interventions reduced the number and severity of depressive symptoms people experienced," she said.
"Our results suggested an increase in side effects for antidepressant medications such as confusion, sedation and gastrointestinal problems. Also, the individual trials often included only a small number of people—we are generally more confident of results when trials include a lot of people and are well conducted. So more research is need before recommendations can be made about the routine use of such treatments," she added.
While some mood changes can be caused by the effects of a stroke on the brain, they can also be a reaction to a life changing event and later on, the realization that there may be things a person is no longer able to do.
Stroke Foundation Chief Executive Officer Sharon McGowan said that as many as one in three people experience depression at some point during the five years after their stroke.
"It's important to recognize that depression and anxiety are common after a stroke, but they are also treatable. Recovery is possible and there are many things that can help. The sooner you get help, the sooner you will move towards recovery," she said.
"It is great to get updated Cochrane reviews that we can now rapidly integrate into our world-first "Living' Stroke guidelines which healthcare professionals refer to when caring for people with stroke," Ms McGowan added.
Prof Hackett said that future research needs to include a broader group of people with stroke to be able to draw more definite conclusions about the most effective treatments.
"In the meantime there are many options to manage depression and depressive symptoms—not just antidepressants. Speak with your GP or neurologist about what is the best option for you, how long you should be on treatment, and how you/they will know when to stop treatment," Prof Hackett added.

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Explore further

VA, DoD update guideline for rehabilitation after stroke

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More information: Sabine Allida et al. Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke, Cochrane Database of Systematic Reviews (2020). DOI: 10.1002/14651858.CD003437.pub4

Journal information: Cochrane Library

Provided by George Institute for Global Health

Factors associated with successful home discharge after inpatient rehabilitation in frail older stroke patients

I see absolutely nothing here that suggests  you got them 100% recovered and as such you completely failed them.  There are no excuses, you have had decades of failure and could have come up with solutions in those decades if you had acknowledged how fucking bad you were at stroke rehab.  But no; excuses abound. 

Excuse #1.  People with hemiparesis after stroke appear to recover 70 to 80 percent of the difference between their baseline and the maximum upper-extremity Fugl-Meyer (UEFM) score, a phenomenon called proportional recovery (PR). 

Excuse #2.  Have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise. So blame the patient rather than the doctor. 

Factors associated with successful home discharge after inpatient rehabilitation in frail older stroke patients

BMC Geriatrics — Vluggen TPMM, et al. | January 28, 2020

Researchers sought to determine the factors associated with home discharge after inpatient rehabilitation among frail and multimorbid older stroke patients. Ninety-two community-dwelling stroke patients (mean age: 79.0 years (SD 6.4); 51.1% females) were assessed in this longitudinal cohort study. Sixteen potentially relevant factors (age; gender; household situation before admission; stroke history; cardiovascular disorders; diabetes mellitus; multimorbidity; cognitive disability; neglect; apraxia; dysphagia; urinary and bowel incontinence; emotional problems; sitting balance; daily activity level; and independence in activities of daily living) (You are missing testing for 100% recovery, all the rest is not needed then) measured at admission were examined for their association with discharge to the former living situation. Within 6 months following the start of geriatric rehabilitation, discharge to the former living situation was reported for a total of 71 patients (77.1%). Findings suggest the significant correlation of only a higher level of independence in activities of daily living at admission with home discharge.

• See Also: Tea drinkers live longer

Read the full article on BMC Geriatrics

KineAssist: A Robotic Overground Gait and Balance Training Device

Did your stroke hospital do anything to follow the earlier research on this from October 2012? Or do they incompetently not even have an employee assigned to follow and  implement research into rehab protocols? You can blame the board of directors for not setting correct goals and objectives for the hospital.

Maximum walking speeds obtained using treadmill and overground robot system in persons with post-stroke hemiplegia

The latest here:

KineAssist: A Robotic Overground Gait and Balance Training Device

 Michael Peshkin, David A. Brown, Julio J. Santos-Munné, Alex Makhlin,Ela Lewis, J. Edward Colgate, James Patton, Doug Schwandt  — Chicago PT LLC, Evanston IL

  Abstract

 — The KineAssist is a robotic device for gait and balance training. A user-needs analysis led us to focus on increasing the level of challenge to a patient's ability to maintain balance during gait training, and also on maintaining direct involvement of a physical therapist (rather than attempting robotic replacement.) The KineAssist provides partial body weight support and postural torques on the torso; allows many axes of motion of the trunk as well as of the pelvis; leaves the patient's legs accessible to a physical therapist during walking; servo-follows a patient's walking motions overground in forward, rotation, and sidestepping directions; and catches a patient who begins to fall. Design and development of the KineAssist proceeded more rapidly in the context of a small company than would have been possible in most research contexts. A prototype KineAssist has been constructed, and has received FDA approval and IRB clearance for initial human studies. We describe the KineAssist's motivation, design, and use.

5 basic steps to add years to your life, according to researchers

I most assuredly am not doing #5, limit alcohol intake. That intake vastly increases my social connections and thus reduces my chances of dementia. 

The following two quotes are going to be my life: 

"Your body is not a temple: It's an amusement park. Enjoy the ride." Anthony Bourdain

 

Part of my Hunter S. Thompson journey;
“Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside in a cloud of smoke, thoroughly used up, totally worn out, and loudly proclaiming "Wow! What a Ride!”

5 basic steps to add years to your life, according to researchers

Naveed Saleh, MD, MS, for MDLinx | January 24, 2020

What would you do to prolong your life? Believe it or not, this doesn’t involve making a deal with the Devil himself like Oscar Wilde’s tragic character, Dorian Gray. According to results from a recent study published in the BMJ, this may be as simple as five healthy lifestyle factors, which, when maintained in middle age, may be linked to longer life expectancy devoid of chronic illnesses like diabetes, heart disease, and cancer.

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Fortunately, if the average American wants to live as long as those in other countries, there are 5 specific healthy lifestyle factors that, if followed, may help achieve this goal.

Lower life expectancy is currently a major concern in the US, and any strides made in that arena will likely be dwarfed by those in other industrialized nations, moving forward. In the United States, the average life expectancy is 78.6 years compared with 82.3 years in similar countries, according to the Peterson KFF Health System Tracker.
Fortunately, if the average American wants to live as long as those in other countries, there are 5 specific healthy lifestyle factors that, if followed, may help achieve this goal.
The five factors:

• Keeping a healthy diet
• Exercising regularly
• Maintaining a healthy body weight
• Not smoking
• Limiting alcohol intake

• See Also: Do you live in the unhealthiest state in the US?

Researchers mined 34 years of data from the Nurses’ Health Study and the Health Professionals Follow-Up Study in this high-powered, double-cohort study to pinpoint these factors. Specifically, these factors were defined as follows: higher diet quality scores, per the Alternate Healthy Eating Index; 30+ minutes of moderate-to-vigorous exercise each day; maintaining a BMI between 18.5 and 24.9 kg/m2; complete smoking cessation; and, at most, one serving of alcohol per day for women and up to two servings for men.
The researchers observed that life expectancy without chronic disease at age 50 years was 23.5 years in male participants who adhered to none of these low-risk lifestyle variables, which jumped to 31.1 years in those who adhered to four out of five. In women, these measures were 23.7 years for those who adhered to none of the low-risk lifestyle factors, compared with 34.4 years in those who adopted four or five of them.
Adherence to a low-risk lifestyle conferred a greater increase in life expectancy free of diabetes than one free of cancer and heart disease. Overall, 50% of cancer deaths, 70% of cardiovascular deaths, 80% of coronary heart disease diagnoses, and 90% of diabetes diagnoses occurred secondary to failed adherence to these low-risk factors.
Among the lifestyle changes, alcohol had the least effect on disease-free longevity.
“We observed a relatively small difference in life expectancies across different levels of alcohol consumption compared with other individual lifestyle factors,” the authors wrote. “The cardiovascular benefits of moderate alcohol consumption have been consistently observed in large cohort studies, but alcohol consumption and risk of cancer showed a dose-response relation. Thus, current guidelines do not encourage a non-alcohol drinker to start drinking just for the benefit of preventing cardiovascular disease.”
Smoking, poor diet quality, high levels of alcohol intake, and sedentary lifestyle combined to lead to up to between 7.4 and 17.9 years of lost life expectancy, and account for 60% of premature deaths, according to previous research. The current study is distinct in examining the effects of multiple low-risk lifestyle choices on healthy life expectancy.

• See Also: 5 simple dietary changes everyone should make

“Our findings suggest that promotion of a healthy lifestyle would help to reduce the healthcare burdens through lowering the risk of developing multiple chronic diseases, including cancer, cardiovascular disease, and diabetes, and extending disease-free life expectancy,” the authors noted.
“Public policies for improving food and the physical environment conducive to adopting a healthy diet and lifestyle, as well as relevant policies and regulations (for example, smoking ban in public places or trans-fat restrictions), are critical to improving life expectancy, especially life expectancy free of major chronic diseases,” they concluded.