Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 27,749 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
So you really think predicting failure to recover is what you need to tell your patients? Have you ever heard of the term; 'Blithering idiot'? Nothing on what to do to address the problem of structural integrity, so useless.
Objective: Motor impairment after
stroke has been related to infarct size, infarct location, and integrity
of motor tracts. To determine the value of diffusion tensor imaging
(DTI) as a predictor of motor outcome and its role as a structural
surrogate marker of impairment in chronic stroke, we tested correlations
between motor impairment and DTI-derived measures of motor tract
integrity.
Methods: Thirty-five chronic stroke
patients with varying degrees of recovery underwent DTI and motor
impairment assessments. Fibers originating from the precentral gyrus
were traced and separated into pyramidal tract (PT) and alternate motor
fibers (aMF). Asymmetry indices of fiber number and regional fractional
anisotropy (FA) values comparing lesional with nonlesional hemispheres
were correlated with motor impairment scores and compared to an
age-matched control group.
Results: Fiber number and regional FA
value asymmetry significantly differed between the groups with lower
values in the patients' lesional hemispheres. Both measures
significantly predicted motor impairment with stronger predictions when
all motor tracts were combined as compared to predictions using only the
PT. The pattern of motor tract damage (PT only vs PT and aMF) led to a
classification of mild, moderate, or severe impairment with significant
between-group differences in motor impairment scores.
Conclusions: Diffusion tensor
imaging-derived measures are valid structural markers of motor
impairment. The integrity of all descending motor tracts, not merely the
pyramidal tract, appears to account for stroke recovery. A 3-tier,
hierarchical classification of impairment categories based on the
pattern of motor tract damage is proposed that might be helpful in
predicting recovery potential.
The only valid outcome measure is one question: 'Are you 100% recovered?' If your stroke hospital is not measuring that they are completely incompetent.
2011, Neurorehabilitation and Neural Repair Ching-yi Wu, ScD 1,
Tiffany Fu, PhD 2,
Keh-chung Lin, ScD 2,3,
Chi-tzu Feng 4,
Kuang-ping Hsieh 5,
Hung-wen Yu 6,
Chia-huang Lin 7,
Ching-ju Hsieh, MD 8,
and Hisaaki Ota, PhD 9
Abstract
Objective This study investigates the clinimetric properties of the streamlined Wolf Motor Function Test (WMFT), a 6-item version of the performance time scale of the WMFT. Methods The streamlined WMFT, along with 2 criterion measures, the Fugl-Meyer Assessment (FMA) and the Stroke Impact Scale (SIS), were administered to 64 stroke patients before and after a 3-week intervention. Responsiveness was examined using the Wilcoxon signed rank test and standardized response mean (SRM). Criterion-related validity was investigated using the Spearman correlation coefficient (ρ).
Results. The mean score on the baseline FMA upper extremity of the patients was 44.84 (standard deviation = 12.77). The streamlined WMFT and the original performance time scale showed comparable responsiveness (SRM= 0.29 and 0.37, respectively). The concurrent validity of the streamlined WMFT was good (ρ= 0.57-0.69). For predictive validity, the streamlined WMFT showed slightly better association with the criterion measures (ρ= 0.60-0.68) than did the original scale (ρ= 0.56-0.64). Conclusions Compared with the original scale, the streamlined WMFT showed improved clinical utility.
Considerable
evidence indicates that the functional connectome of the healthy human
brain is highly stable, analogous to a fingerprint.
Objective
We
investigated the stability of functional connectivity across tasks and
sessions in a cohort of individuals with chronic stroke using a
supervised machine learning approach.
Methods
Twelve
individuals with chronic stroke underwent functional magnetic resonance
imaging (fMRI) seven times over 18 weeks. The middle 6 weeks consisted
of intensive aphasia therapy. We collected fMRI data during rest and
performance of 2 tasks. We calculated functional connectivity metrics
for each imaging run, then applied a support vector machine to classify
data on the basis of participant, task, and time point (pre- or
post therapy). Permutation testing established statistical significance.
Results
Whole
brain functional connectivity matrices could be classified at levels
significantly greater than chance on the basis of participant (87.1%
accuracy; P < .0001), task (68.1% accuracy; P = .002), and time point (72.1% accuracy; P
= .015). All significant effects were reproduced using only the
contralesional right hemisphere; the left hemisphere revealed
significant effects for participant and task, but not time point.
Resting state data could also be used to classify task-based data
according to subject (66.0%; P < .0001). While the strongest
post therapy changes occurred among regions outside putative language
networks, connections with traditional language-associated regions were
significantly more positively correlated with behavioral outcome
measures, and other regions had more negative correlations and
intrahemispheric connections.
Conclusions
Findings
suggest the profound importance of considering interindividual
variability when interpreting mechanisms of recovery in studies of
functional connectivity in stroke.
For all the backslapping this still did not measure 100% recovery. Please talk to survivors sometime, your ideas on what survivors want and the research you do does not help us get to 100% recovery.
Severity-based
assessment tools may assist in prehospital triage of patients to
comprehensive stroke centers (CSCs) for endovascular thrombectomy (EVT),
but criticisms regarding diagnostic inaccuracy have not been adequately
addressed. This study aimed to quantify the benefits and disadvantages
of severity-based triage in a large real-world paramedic validation of
the Ambulance Clinical Triage for Acute Stroke Treatment (ACT-FAST)
algorithm.
Methods:
Ambulance
Victoria paramedics assessed the prehospital ACT-FAST algorithm in
patients with suspected stroke from November 2017 to July 2019 following
an 8-minute training video. All patients were transported to the
nearest stroke center as per current guidelines. ACT-FAST diagnostic
accuracy was compared with hospital imaging for the presence of large
vessel occlusion (LVO) and need for CSC-level care (LVO, intracranial
hemorrhage, and tumor). Patient-level time saving to EVT was modeled
using a validated Google Maps algorithm. Disadvantages of CSC bypass
examined potential thrombolysis delays in non-LVO infarcts, proportion
of patients with false-negative EVT, and CSC overburdening.
Results:
Of
517 prehospital assessments, 168/517 (32.5%) were ACT-FAST positive and
132/517 (25.5%) had LVO. ACT-FAST sensitivity and specificity for LVO
was 75.8% and 81.8%, respectively. Positive predictive value was 58.8%
for LVO and 80.0% when intracranial hemorrhage and tumor (CSC-level
care) were included. Within the metropolitan region, 29/55 (52.7%) of
ACT-FAST-positive patients requiring EVT underwent a secondary
interhospital transfer. Prehospital bypass with avoidance of secondary
transfers was modeled to save 52 minutes (95% CI, 40.0–61.5) to EVT
commencement. ACT-FAST was false-positive in 8 patients receiving
thrombolysis (8.1% of 99 non-LVO infarcts) and false-negative in 4
patients with EVT requiring secondary transfer (5.4% of 74 EVT cases).
CSC bypass was estimated to over-triage 1.1 patients-per-CSC-per-week in
our region.
Conclusions:
The
overall benefits of an ACT-FAST algorithm bypass strategy in expediting
EVT and avoiding secondary transfers are estimated to substantially
outweigh the disadvantages of potentially delayed thrombolysis and
over-triage, with only a small proportion of EVT patients missed.
Anne
Abbott is a scientist on a mission. She believes large numbers of
debilitating strokes can be prevented without surgical interventions.
Lifestyle changes and medication alone can make massive improvements to
people at risk from the thickening of their arteries.
It
is not an attitude that has endeared her to the medical establishment,
however. For years, it has attempted to block her work while instead
pressing for increasing use of carotid surgery and stents, she told the Observer last week.
“I
was told not to publish my research findings,” said Abbott, associate
professor of neuroscience at Monash University in Melbourne. “I was
shocked. Then it became hard to submit grant applications to continue my
research. People would say ‘yes’ to my proposals, then at the last
minute, they would back out. If you can’t put a grant in, it could be
the end of your research career.”
But now
Abbott’s efforts have received global recognition – thanks to the judges
of the John Maddox prize. Named after the former editor of Nature,
and organised by the journal and the charity Sense About Science, the
international awards are given to researchers who stand up for sound
science. Past winners have included scientists who have been persecuted
for speaking out about the dangers of rainforest destruction, the
bleaching of coral reefs and the misuse of vitamin C supplements as
“treatments” for cancer.
Anthony Fauci, left, and Salim Abdool Karim: joint winners of this year’s John Maddox prize. Photograph: Rajesh Jantilal/AFP/Getty Images
This year, US health chief Anthony Fauci and his South African counterpart Salim Abdool Karim were jointly awarded the main John Maddox prize for “communicating the complex science of Covid-19
in the midst of international uncertainty and anxiety”. However, the
judges also gave an early career award to Abbott for her perseverance in
challenging traditional surgical and stenting procedures as the main
way to treat patients at risk of strokes. (A stent is a tiny tube that
can be placed into an artery or vein.)
Advertisement
The
carotid arteries run from the heart to the brain on each side of the
neck. In older people, these key blood vessels can thicken, a condition
known as carotid stenosis; if left untreated, this can lead to blockages
and trigger a stroke.
“For decades, it was
standard practice to operate on people who have carotid stenosis – by
cutting open an artery and removing the narrowing,” added Abbott. “More
recently, carotid stenting was introduced, and this is even more
dangerous than surgery. But my research a decade ago showed, in many
cases, these procedures are unnecessary or cause net harm,” added
Abbott.
“Major improvements can simply be made
by medical – as opposed to procedural – interventions, such as the
adoption of healthier lifestyles, anti-cholesterol drugs, taking blood
pressure and cutting out smoking.”
But despite
publication of papers on the effectiveness of these measures, major
programmes to use surgical interventions were being introduced across
the world, and Abbott came under considerable pressure to stop her
attempts to improve stroke prevention. “To get all this resistance from
multiple people, multiple institutions, was shocking and tiring,” she
added. “It became terribly difficult to keep going.”
But
she persisted and her work is now being accepted by growing numbers of
doctors. She is working on producing what she calls the first
“evidence-true” guidelines for carotid artery disease in collaboration
with an international group of doctors.
“It takes great courage and determination to go against established practices,” said one Maddox prize judge, Magdalena Skipper, Nature’s
editor-in-chief. “Anne Abbott’s efforts to move away from unnecessary
clinical interventions and procedures have shifted stroke prevention
methods and improved stroke prevention worldwide – despite coming up
against resistance from her academic seniors.”
The objective of this study was to investigate current international
research which identifies the effect of dual-task training on stroke
with hemiplegia. To this end, journals published from 2007 to 2015 and
searched in PubMed were systematically examined. A total of 5 articles
were selected for the analysis. The selected studies were all in
international journals, using two-group experimental design. In
addition, all the papers got PEDro scores above 6. The studies conducted
gait task as the motor task, at the same time using various domains of
cognitive task such as sustained attention and working memory. The
outcome measure tools used, for evaluation by the standardized
assessment tool and operational definition, also included assessment
tools designed for dual-task training, such as a variety of tools to
assess various aspects of effect. Dual-task training in this study was
found to have a positive effect on dual-task performance, as well as
improving the motor and cognitive functions in patients with stroke.
However, there were also limitations to the studies conducted so far.
These results suggest complementary points for application in the field
of occupational therapy, which may help inform the role of basic data
and effective treatment of stroke with hemiplegia. Descriptor Terms: Literature reviews, Measurements, Stroke, Therapeutic training.
Language: Korean Geographic Location(s): Republic of Korea, East & Southeast Asia.
Citation: Lee, Yei-Jin, Jung, Min-Ye. (2016). A Systematic Review of the Dual-Task Training for Stroke With Hemiplegia.
뇌졸중 환자에게 적용한 이중과제 훈련이 미치는 효과에 대한 체계적 고찰. Therapeutic Science for Neurorehabilitation, 5(1), Pgs. 23-32. Retrieved 12/27/2020, from REHABDATA database.
The objective of this study was to identify and synthesize studies
delineating the relationship between quality of life and other factors
in stroke patients in South Korea. To this end, electronic databases
were searched, including KISS, NDSL, National Assembly Library, and
KmBase. The search terms included stroke, quality of life, and
relationship. The search was limited to papers published in Korean.
Twelve studies, from 256 references screened, were included. All studies
were non-experimental using correlational analysis. A correlation
coefficient between Quality of Life and ADL .293~.622, Depression
-.804~-.533, Cognition .090~.610, Quality of Sleep .107, Quality of
Satisfaction .367, Fatigue -.260, MAL (Quality of Movement .208, Amount
of Use .364), Family Support .824, Pain -.306, Motivation for
Rehabilitation .51~.86, Balance .740, Self-efficacy .388 were analyzed
respectively. Results revealed that the quality of life of stroke
patients was influenced by multiple factors. Occupational therapists
need to consider upper extremity functions and activities of daily
living as well as depression, cognition, sleep, family support, pain,
and self-efficacy to improve the quality of life of stroke patients. Descriptor Terms: Literature reviews, Quality of life, Stroke.
Language: Korean Geographic Location(s): Republic of Korea, East & Southeast Asia.
Citation: Jung, Jun-Sik. (2015). Factors Influencing the Quality of Life of Stroke Patients : A Systematic Review.
뇌졸중 환자의 삶의 질에 영향을 끼치는 요인: 체계적 문헌고찰. Therapeutic Science for Neurorehabilitation, 4(1), Pgs. 39-51. Retrieved 12/27/2020, from REHABDATA database.
So we have NO OBJECTIVE DAMAGE DIAGNOSIS FOR WALKING. Without that we can never get to stroke protocols that will recover from that damage; NOT JUST COMPENSATE. This is all because our stroke medical world still believes in this crapola statement; 'All strokes are different, all stroke recoveries are different' Whomever spouts that at you needs to be keel-hauled.
Article discusses recent advances in the understanding of post-stroke
propulsion deficits, reviews emerging approaches to systematically
diagnose and treat the underlying impairment, and highlights the
substantial research and development effort that is required before
these approaches can alter clinical practice. Advances in medical
diagnosis and treatment have facilitated the emergence of precision
medicine. In contrast, locomotor rehabilitation for individuals with
acquired neuromotor injuries remains limited by the dearth of (1)
diagnostic approaches that can identify the specific neuromuscular,
biomechanical, and clinical deficits underlying impaired locomotion and
(2) evidence-based, targeted treatments. In particular, impaired
propulsion by the paretic limb is a major contributor to walking-related
disability after stroke; however, few interventions have been able to
target deficits in propulsion effectively and in a manner that reduces
walking disability. Current rehabilitation paradigms emphasize the rapid
attainment of walking independence, not the restoration of normal
propulsion function. Although walking independence is an important goal
for stroke survivors, independence achieved via compensatory strategies
may prevent the recovery of propulsion needed for the fast, economical,
and stable gait that is characteristic of healthy bipedal locomotion.
The authors suggest that post-stroke rehabilitation should aim to
promote independent walking, in part, through the acquisition of
enhanced propulsion. They present the biomechanical and functional
consequences of post-stroke propulsion deficits, review advances in
understanding the nature of post-stroke propulsion impairment, and
discuss emerging diagnostic and treatment approaches that have the
potential to facilitate new rehabilitation paradigms targeting
propulsion restoration. Descriptor Terms: AMBULATION, DIAGNOSIS, EVALUATION, INTERVENTION, LIMBS, MOBILITY IMPAIRMENTS, MOTOR SKILLS, STROKE.
Citation: Awad, Louis N. , Lewek, Michael D. , Kesar, Trisha M. , Franz, Jason R. , Bowden, Mark G.. (2020). These legs were made for propulsion: Advancing the diagnosis and treatment of post-stroke propulsion deficits.
Journal of NeuroEngineering and Rehabilitation, 17(139) Retrieved 12/27/2020, from REHABDATA database.
Useless because it is using the current failures to recover as the status quo. CHANGE THAT TO 100% RECOVERY and survivors will gladly accept those predictions.
Rehabilitation
following traumatic brain injury (TBI) significantly improves outcomes;
yet TBI heterogeneity raises the need for molecular evidence of brain
recovery processes to better track patient progress, evaluate
therapeutic efficacy, and provide prognostication.
Objective
Here,
we assessed whether the trajectory of TBI-responsive peptides secreted
into urine can produce a predictive model of functional recovery during
TBI rehabilitation.
Methods
The
multivariate urinary peptidome of 12 individuals with TBI was examined
using quantitative peptidomics. Measures were assessed upon admission
and discharge from inpatient rehabilitation. A combination of Pavlidis
template matching and partial least-squares discriminant analysis was
used to build models on Disability Rating Scale (DRS) and Functional
Independence Measure (FIM) scores, with participants bifurcated into
more or less functional improvement groups.
Results
The
produced models exhibited high sensitivity and specificity with the
area under the receiver operator curve being 0.99 for DRS- and 0.95 for
FIM-based models using the top 20 discriminant peptides. Predictive
ability for each model was assessed using robust leave-one-out
cross-validation with Q2 statistics of 0.64 (P = .00012) and 0.62 (P
= .011) for DRS- and FIM-based models, respectively, both with a high
predictive accuracy of 0.875. Identified peptides that discriminated
improved functional recovery reflected heightened neuroplasticity and
synaptic refinement and diminished cell death and neuroinflammation,
consistent with postacute TBI pathobiology.
Conclusions
Produced
models of urine-based peptide measures reflective of ongoing recovery
pathobiology can inform on rehabilitation progress after TBI, warranting
further study to assess refined stratification across a larger
population and efficacy in assessing therapeutic interventions.
J.J. Heit, H. Coelho, F.O. Lima, M. Granja, A. Aghaebrahim, R. Hanel, K. Kwok, H. Haerian, C.W. Cereda, C. Venkatasubramanian, S. Dehkharghani, L.A. Carbonera, J. Wiener, K. Copeland and F. Mont’Alverne
American Journal of Neuroradiology December 2020, DOI: https://doi.org/10.3174/ajnr.A6926
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Abstract
BACKGROUND AND PURPOSE:
Intracranial hemorrhage (ICH) is an important event that is diagnosed
on head NCCT. Increased NCCT utilization in busy hospitals may limit
timely identification of ICH. RAPID ICH is an automated hybrid 2D–3D
convolutional neural network application designed to detect ICH that may
allow for expedited ICH diagnosis. We determined the accuracy of RAPID
ICH for ICH detection and ICH volumetric quantification on NCCT.
MATERIALS AND METHODS:
NCCT scans were evaluated for ICH by RAPID ICH. Consensus detection of
ICH by 3 neuroradiology experts was used as the criterion standard for
RAPID ICH comparison. ICH volume was also automatically determined by
RAPID ICH in patients with intraparenchymal or intraventricular
hemorrhage and compared with manually segmented ICH volumes by a single
neuroradiology expert. ICH detection accuracy, sensitivity, specificity,
positive predictive value, negative predictive value, and positive and
negative likelihood ratios by RAPID ICH were determined.
RESULTS:
We included 308 studies. RAPID ICH correctly identified 151/158 ICH
cases and 143/150 ICH-negative cases, which resulted in high sensitivity
(0.956, CI: 0.911–0.978), specificity (0.953, CI: 0.907–0.977),
positive predictive value (0.956, CI: 0.911-0.978), and negative
predictive value (0.953, CI: 0.907–0.977) for ICH detection. The
positive likelihood ratio (20.479, CI 9.928–42.245) and negative
likelihood ratio (0.046, CI 0.023–0.096) for ICH detection were
similarly favorable. RAPID ICH volumetric quantification for
intraparenchymal and intraventricular hemorrhages strongly correlated
with expert manual segmentation (correlation coefficient r = 0.983); the median absolute error was 3 mL.
CONCLUSIONS:
RAPID ICH is highly accurate in the detection of ICH and in the
volumetric quantification of intraparenchymal and intraventricular
hemorrhages.
The
purpose of this study was to determine the outcomes after mechanical
thrombectomy (MT) versus medical management in patients with minor
stroke symptomatology.
Methods
A
meta-analysis was performed for studies reporting outcomes after
mechanical thrombectomy, either as stand-alone therapy or with
intravenous thrombolysis (IVT) in patients with minor stroke with LVO.
Results
Fourteen
studies with 2,134 patients met the selection criteria and were
included. Two studies compared immediate thrombectomy (IMT) versus best
medical management (with rescue thrombectomy) and the ORs of excellent
outcomes, good outcomes, mortality and incidence of sICH after IMT vs
BMM were 1.07 (95% CI: 0.93 – 1.22%),1.15 (95% CI 1.05 – 1.25), 0.65
(95% CI 0.30 – 1.38), and 2.89 (95% CI: 0.82 – 10.13) respectively.
Among the 8 studies that compared mechanical thrombectomy (MT) outcomes
versus medical management (without thrombectomy), ORs of excellent
outcomes, good outcomes, mortality and incidence of sICH after MT vs MM
were 0.98 (95% CI: 0.89 – 1.07), 0.94 (95% CI: 0.89 – 1.00), 1.61 (95%
CI: 1.08 – 2.41), and 2.59 (95% CI: 1.35 – 4.96) respectively. Among all
14 studies, pooled proportions of excellent outcomes, good outcomes,
mortality and sICH after thrombectomy were 58.7%, 76.2%, 6.82%, and
3.23% respectively.
Conclusion
Our
study shows significant selection bias and heterogeneity in the
literature with differences in baseline characteristics (age, stroke
severity, pre-stroke mRS, side of infarct, vessel and site of occlusion,
use of IVT, criteria for clinical deterioration and selection bias for
rescue MT and rates of reperfusion), emphasizing the need for a
randomized controlled trial.
The
ANA™ thrombectomy system is a novel stroke thrombectomy device
comprising a self-expanding funnel designed to reduce clot fragmentation
by locally restricting flow while becoming as wide as the lodging
artery.
•
In in vitro phantom and swine models ANA™ device showed high recanalization rates with no safety concerns.
•
In
this first-in-human study, the ANA™ device achieved a high rate of
complete reperfusion, sudden recanalization, and a good safety profile.
Abstract
Introduction
The
ANA™ (Anaconda Biomed) thrombectomy system is a novel stroke
thrombectomy device comprising a self-expanding funnel designed to
reduce clot fragmentation by locally restricting flow while becoming as
wide as the lodging artery. Once deployed, ANA allows distal aspiration
in combination with a stentretriever (SR) to mobilize the clot into the
funnel where it remains copped during extraction. We investigate safety
and efficacy of ANA™ in a first-in-man study.
Methods
Prospective
data was collected on 35 consecutive patients treated as first line
with ANA™ at a single centre. Outcome measures included per-pass
reperfusion scores, symptomatic intracerebral hemorrhage (sICH), NIHSS
at day 5, and mRS at 90 days.
Results
Median
NIHSS was 12(9-18). Sites of primary occlusion were: 5 ICA, 15 M1-MCA,
15 M2-MCA. Primary performance endpoint, mTICI 2b-3 within 3 passes
without rescue therapy was achieved in 91.4% (n = 32) of patients; rate
of complete recanalization (mTICI 2c-3) was 65.7%. First pass complete
recanalization rate was 42.9%, and median number of ANA passes 1(IQR:
1-2). In 17.1% (n = 6) rescue treatment was used; median number of
rescue passes was 2(1-7), leading to a final mTICI2b-3rate of 94.3%
(n = 33). There were no device related serious adverse events, and rate
of sICH was 5.7% (n = 2). At 5 days median NIHSS was 1 (IQR 1-6) and 90
days mRS 0-2 was achieved in 60% of patients.
Conclusions
In
this initial clinical experience, the ANA™ device achieved a high rate
of complete recanalization with a good safety profile and favourable 90
days clinical outcomes.
Cocoa flavanols may help adults’ brains recover from mild vascular
challenges quicker and help them perform better on cognitive tests,
according to research published in Scientific Reports.
Researchers conducted a randomized, double-blind, within-participant,
placebo-controlled study that included physiological and cognitive
challenges to evaluate whether the physiological effects of cocoa
flavanols impact cerebral and peripheral vascular function and cognition.
They measured cerebrovascular reactivity using a breathing challenge
before and after 18 participants received either the high- or
low-flavanol cocoa drinks at two visits that were at least 2 weeks
apart. Participants then had a third visit where they had structural MRI
brain scans. At the beginning of each visit, the researchers assessed
participants’ diastolic and systolic BP, brachial artery flow-mediated
dilation and frontal cortex oxygenation/deoxygenation at rest and during
the breathing challenge.
In the breathing challenge, which took place 2 hours after cocoa consumption, participants breathed in air containing 5% CO2, approximately 100 times more than normal air.
Researchers found that most participants had stronger, faster brain
oxygenation responses after consuming high-flavanol cocoa compared with
baseline or low-flavanol cocoa.
Additionally, researchers found that participants had better
performance on the most challenging cognitive tests and solved problems
11% quicker than they did at baseline or after low-flavanol cocoa. The
researchers did not identify a measurable difference on performance of
easier tasks.
Healio Primary Care spoke with study coauthor Catarina Rendeiro, PhD, MSC,
researcher and lecturer in nutritional sciences at the University of
Birmingham in the U.K., to learn more about the findings and what PCPs
should know about dietary flavanols.
Q: What led you to study the impact of cocoa flavanols specifically?
A: For the last 10 to 12 years, I have been interested in the health
benefits of plant-derived flavonoids, particularly their effects on
brain and cognitive function. We have known for many years that
flavanols from cocoa, in particular, can improve vascular function in
humans by improving vessel/arterial function. These benefits are
apparent even after one single dose. However, the extent to which some
of these benefits could translate into the brain vasculature were less
clear. The goal of this study was to investigate whether benefits of
cocoa flavanols could improve function of the cerebral vasculature and
cognitive function.
Q: How do these findings compare with other studies on dietary flavanols?
There are only a handful of studies that looked at the beneficial
effects of cocoa on brain function in humans by looking simultaneously
at cognitive function and the underlying vascular physiology. Some
previous studies show encouraging cognitive benefits, whilst others fail
to do so. This variability might be related to the level of the
difficulty of the cognitive test used. What we showed in our study is
that only when the levels of cognitive challenge are substantially high
do we see benefits of cocoa flavanols. This suggests that only when the
oxygenation demands in the brain are high enough, a young healthy brain
can actually benefit from the intake of flavanols. This is also the
first study to show clearly the hemodynamics of brain blood oxygenation
after intake of flavanols, leading us to find that flavanols help the
brain react more efficiently when challenged with a carbon dioxide
breathing test. Not only flavanols increase the total levels of blood
oxygenation, but they lead to faster (1 minute faster) oxygenation
compared to a low-flavanol placebo.
Q: Based on the findings, should physicians recommend increased
cocoa flavanol intake for certain patients to improve brain function?
A: Recommending a diet rich in flavanols would be advisable, eg
grapes, green tea, apples, berries, pulses and unprocessed cocoa
powders. Many people tend to associate the benefits of cocoa with
chocolate, but those are two very different things. The cocoas that
contain flavanols are normally unprocessed; however, when you process
cocoa beans to make chocolate (roasting, alkalization, etc.), the
flavanol content declines. Unfortunately, it is difficult to know what
the content of flavanols is in chocolate products as these are not
disclaimed in labels. Producing chocolate in ways that retain the
content of flavanols should be a goal, so we can obtain effective doses
of flavanols from small amounts of chocolate (1-2 squares).
Q: What additional research is needed to determine the role of cocoa flavanols in brain oxygenation and cognition in adults?
A: In order to extrapolate these results to the whole population, we
need to extend these studies to other portions of the population (other
than young men), including women, middle-aged and older adults. We also
only looked at levels of brain oxygenation in the frontal areas of the
brain, and although the effects seem to be similar across this area, we
do not know whether the same effects will be found in other areas of the
brain.
