Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective 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.

Tuesday, August 22, 2023

The Obesity Paradox: Effect of Body Mass Index and Waist Circumference on Post-Stroke Cognitive Impairment

 FYI.

The Obesity Paradox: Effect of Body Mass Index and Waist Circumference on Post-Stroke Cognitive Impairment

Received 20 June 2023

Accepted for publication 2 August 2023

Published 16 August 2023 Volume 2023:16 Pages 2457—2467

DOI https://doi.org/10.2147/DMSO.S420824

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Konstantinos Tziomalos



Qi Liu,1 Xiaoling Liao,1,2 Yuesong Pan,2 Xianglong Xiang,2 Yumei Zhang2,3

1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China

Correspondence: Yumei Zhang, Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, No. 119 South 4th Ring West Road, Fengtai District, Beijing, 100070, People’s Republic of China, Tel +86-10-59975531, Email zhangyumei95@aliyun.com

Background: Obesity is a risk factor for dementia within the old population however not within the middle-aged population, that is referred to the “obesity paradox”. This study explored the association of body mass index (BMI) and waist circumference (WC) with post-stroke cognitive impairment (PSCI) in middle-aged (40– 65 years) versus old population (≥ 65 years).
Methods: The current study enrolled 1735 individuals over the age of 40 who had their first ischemic stroke from the Impairment of Cognition and Sleep (ICONS) subgroup of the China National Stroke Registry-3 (CNSR-3). BMI and WC were used for the diagnosis of obesity and central obesity, respectively. PSCI was diagnosed according to the Montreal Cognitive Assessment (MoCA). The main clinical outcome was the incidence of PSCI assessed at three months after stroke. Multivariable regression analysis was performed to evaluate the association between obesity and three-month PSCI. Stratified analysis was also performed to explore the effect of age on the relationship between obesity and PSCI.
Results: In the general population, multivariable logistic regression found that the adjusted odds ratio (OR) with 95% confidence interval (CI) of general obesity was 1.45 (1.06– 1.98) and that of central obesity was 1.54 (1.24– 1.91) for the three-month incidence of PSCI. Stratified analysis by age showed that the adjusted OR with a 95% CI of general obesity was 1.84 (1.24– 2.72) in middle-aged patients and 0.89 (0.52– 1.54) in elderly patients (p-value for interaction = 0.05). Central obesity was associated with PSCI in all age groups: 1.57 (1.18– 2.09) in middle-aged patients and 1.52 (1.08– 2.15) in elderly patients (p-value for interaction= 0.93).
Conclusion: General obesity was related to an increased risk of PSCI in middle-aged but not elderly patients, whereas central obesity was associated with an increased risk of PSCI in all age groups, suggesting that the obesity paradox arises only obesity is outlined by BMI.

Keywords: post-stroke cognitive impairment, obesity paradox, ischemic stroke, middle-aged and elderly population, follow-up study

Introduction

Post-stroke cognitive impairment (PSCI) is a serious disability experienced by stroke survivors, and approximately one-third of stroke survivors develop cognitive impairment.1,2 Identifying and controlling risk factors for PSCI would play a pivotal role in prevention and intervention. The prevalence of obesity has risen rapidly in the past four decades and has been demonstrated to increase the risk of cognitive decline.3–5 However, some studies indicated that the impact of obesity on cognition varies by age6 In the middle-aged population, but not in the elderly population, overweight or obesity has been found to have a significant correlation with the heightened risk of experiencing cognitive decline.7,8 Contrary to common knowledge, some studies even found a positive effect of a higher body mass index (BMI) on cognition among elderly individuals.9–12 The unexpected phenomenon of improved cognitive function in individuals with obesity has been referred to as the “obesity paradox”, creating uncertainty regarding the impact of obesity on cognitive abilities.

Recently, several studies have explored whether stroke patients with obesity have impaired cognitive performance than normal weight patients.13,14 However, there is a lack of research on whether this relationship varies depending on age and whether the obesity paradox persists in patients with stroke. Additionally, previous studies have not explored the effects of central obesity on cognitive function. To investigate the impact of aging on fat distribution, previous studies have suggested that waist circumference (WC) is a more effective marker of adiposity than BMI in the elderly population.15 Thus, this study evaluated general obesity and central obesity using BMI and WC as adiposity markers, respectively. We hypothesized that the effect of obesity on PSCI may differ based on age. This study aimed to investigate the association between high BMI and large WC with PSCI in middle-aged (40–65) versus elderly patients (≥ 65 years) with minor stroke or transient ischemic attack (TIA). The meaning of this study lies in its provision of evidence for obesity management in stroke patients of different ages to prevent the occurrence of PSCI.

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