More Evidence Ties Semaglutide to Reduced Alzheimer’s Risk

 With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING THIS!

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 

The latest here:

More Evidence Ties Semaglutide to Reduced Alzheimer’s Risk

A new study provides real-world evidence to support the potential repurposing of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), used to treat type 2 diabetes and obesity, for prevention of Alzheimer’s disease (AD). 

Adults with type 2 diabetes who were prescribed the GLP-1 RA semaglutide had a significantly lower risk for AD compared with their peers who were prescribed any of seven other antidiabetic medications, including other types of GLP-1 receptor–targeting medications. 

“These findings support further clinical trials to assess semaglutide’s potential in delaying or preventing AD,” the investigators, led by Rong Xu, PhD, with Case Western Reserve School of Medicine, Cleveland, Ohio, write. 

The study was published online on October 24 in Alzheimer’s & Dementia.

Real-World Data

Semaglutide has shown neuroprotective effects in animal models of neurodegenerative diseases, including AD and Parkinson’s disease. In animal models of AD, the drug reduced beta-amyloid deposition and improved spatial learning and memory, as well as glucose metabolism in the brain. 

In a real-world analysis, Xu and colleagues used electronic health record data to identify 17,104 new users of semaglutide and 1,077,657 new users of seven other antidiabetic medications, including other GLP-1 RAs, insulin, metformin, dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, sulfonylurea, and thiazolidinedione.

Over 3 years, treatment with semaglutide was associated with significantly reduced risk of developing AD, most strongly compared with insulin (hazard ratio [HR], 0.33) and most weakly compared with other GLP-1 RAs (HR, 0.59). 

Compared with the other medications, semaglutide was associated with a 40%-70% reduced risk for first-time diagnosis of AD in patients with type 2 diabetes, with similar reductions seen across obesity status and gender and age groups, the authors reported. 

The findings align with recent evidence suggesting GLP-1 RAs may protect cognitive function. 

For example, as previously reported by Medscape Medical News, in the phase 2b ELAD clinical trial, adults with early-stage AD taking the GLP-1 RA liraglutide exhibited slower decline in memory and thinking and experienced less brain atrophy over 12 months compared with placebo. 

Promising, but Preliminary 

Reached for comment, Courtney Kloske, PhD, Alzheimer’s Association director of scientific engagement, noted that diabetes is a known risk factor for AD and managing diabetes with drugs such as semaglutide “could benefit brain health simply by managing diabetes.”

“However, we still need large clinical trials in representative populations to determine if semaglutide specifically lowers the risk of Alzheimer’s, so it is too early to recommend it for prevention,” Kloske told Medscape Medical News. 

She noted that some research suggests that GLP-1 RAs “may help reduce inflammation and positively impact brain energy use. However, more research is needed to fully understand how these processes might contribute to preventing cognitive decline or Alzheimer’s,” Kloske cautioned. 

The Alzheimer’s Association’s “Part the Cloud” initiative has invested more than $68 million to advance 65 clinical trials targeting a variety of compounds, including repurposed drugs that may address known and potential new aspects of the disease, Kloske said. 

The study was supported by grants from the National Institute on Aging and the National Center for Advancing Translational Sciences. Xu and Kloske have no relevant conflicts.

Faster Brain Atrophy Linked to MCI

 You don't want this so DEMAND your competent? doctor have EXACT protocols to prevent MCI. Your doctor has known of this problem for years.

• brain atrophy (33 posts to July 2015)

• cerebral atrophy (2 posts to April 2016)

• Cortical atrophy (1 post to February 2019)
  

• Frontal Cortical Atrophy (1 post to June 2016)

• hippocampal atrophy (1 post to October 2019)

  The latest here: 

Faster Brain Atrophy Linked to MCI

A long-term brain imaging study in aging adults showed faster rates of atrophy in certain brain structures to be associated with the risk of developing mild cognitive impairment (MCI).

While some brain atrophy is expected in aging, high levels of atrophy in the white matter and high enlargement in the ventricles are associated with earlier progression from normal cognition to MCI, the study found. The researchers also identified diabetes and atypical levels of amyloid beta protein in the cerebrospinal fluid as risk factors for brain atrophy and MCI.

For their research, published online on October 30 in JAMA Network Open, Yuto Uchida, MD, PhD, and his colleagues at the Johns Hopkins University School of Medicine in Baltimore looked at data for 185 individuals (mean age, 55.4 years; 63% women) who were cognitively normal at baseline and followed for a median of 20 years.

All had been enrolled in a longitudinal cohort study on biomarkers of cognitive decline conducted at Johns Hopkins. Each participant underwent a median of five structural MRI studies during the follow-up period as well as annual cognitive testing. Altogether 60 individuals developed MCI, with eight of them progressing to dementia.

“We hypothesized that annual rates of change of segmental brain volumes would be associated with vascular risk factors among middle-aged and older adults and that these trends would be associated with the progression from normal cognition to MCI,” Uchida and his colleagues wrote.

Uniquely Long Follow-Up

Most longitudinal studies using structural MRI count a decade or less of follow-up, the study authors noted. This makes it difficult to discern whether the annual rates of change of brain volumes are affected by vascular risk factors or are useful in predicting MCI, they said. Individual differences in brain aging make population-based studies less informative.

This study’s long timeframe allowed for tracking of brain changes “on an individual basis, which facilitates the differentiation between interindividual and intraindividual variations and leads to more accurate estimations of rates of brain atrophy,” Uchida and his colleagues wrote.

People with high levels of atrophy in the white matter and enlargement in the ventricles saw earlier progression to MCI (hazard ratio [HR], 1.86; 95% CI, 1.24-2.49; P = .001). Diabetes mellitus was associated with progression to MCI (HR, 1.41; 95% CI, 1.06-1.76; P = .04), as was a low CSF Abeta42:Abeta40 ratio (HR, 1.48; 95% CI, 1.09-1.88; P = .04).

People with both diabetes and an abnormal amyloid profile were even more vulnerable to developing MCI (HR, 1.55; 95% CI, 1.13-1.98; P = .03). This indicated “a synergic association of diabetes and amyloid pathology with MCI progression,” Uchida and colleagues wrote, noting that insulin resistance has been shown to promote the formation of amyloid plaques, a hallmark of Alzheimer’s disease.

The findings also underscore that “white matter volume changes are closely associated with cognitive function in aging, suggesting that white matter degeneration may play a crucial role in cognitive decline,” the authors noted.

Uchida and colleagues acknowledged the modest size and imbalanced sex ratio of their study cohort as potential weaknesses, as well as the fact that the imaging technologies had changed over the course of the study. Most of the participants were White with family histories of dementia.

Findings May Lead to Targeted Interventions

In an editorial comment accompanying Uchida and colleagues’ study, Shohei Fujita, MD, PhD, of Massachusetts General Hospital in Boston, said that while a more diverse population sample would be desirable and should be sought for future studies, the results nonetheless highlight “the potential of long-term longitudinal brain MRI datasets in elucidating the interplay of risk factors underlying cognitive decline and the potential benefits of controlling diabetes to reduce the risk of progression” along the Alzheimer’s disease continuum.

The findings may prove informative, Fujita said, in developing “targeted interventions for those most susceptible to progressive brain changes, potentially combining lifestyle modifications and pharmacological treatments.”

Uchida and colleagues’ study was funded by the Alzheimer’s Association, the National Alzheimer’s Coordinating Center, and the National Institutes of Health. The study’s corresponding author, Kenichi Oishi, disclosed funding from the Richman Family Foundation, Richman, the Sharp Family Foundation, and others. Uchida and Fujita reported no relevant financial conflicts of interest.

Novel Intervention Slows Cognitive Decline in At-Risk Adults

 

With your lost 5 cognitive years from your stroke why isn't your competent? doctor using this to recover your cognition?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

Novel Intervention Slows Cognitive Decline in At-Risk Adults

Combining cognitive remediation (CR) with transcranial direct current stimulation (tDCS) was associated with slower cognitive decline for up to 6 years in older adults with major depressive disorder that is in remission (rMDD), mild cognitive impairment (MCI), or both, new research suggests.

The CR intervention included a series of progressively difficult computer-based and facilitator-monitored mental exercises designed to sharpen cognitive function. 

Researchers found that using CR with tDCS slowed decline in executive function and verbal memory more than other cognitive functions. The effect was stronger among people with rMDD vs those with MCI and in those at low genetic risk for Alzheimer’s disease. 

Benoit H. Mulsant, MD

“We have developed a novel intervention, combining two interventions that if used separately have a weak effect but together have substantial and clinically meaningful effect of slowing the progression of cognitive decline,” study author Benoit H. Mulsant, MD, chair of the Department of Psychiatry, University of Toronto, and senior scientist at the Center for Addiction and Mental Health, Toronto, told Medscape Medical News. 

The findings were published online October 30 in JAMA Psychiatry. 

High-Risk Group

Research shows that older adults with MDD or MCI are at high risk for cognitive decline and dementia. Evidence also suggests that depression in early or mid-life significantly increases the risk for dementia in late life, even if the depression has been in remission for decades.

A potential mechanism underlying this increased risk for dementia could be impaired cortical plasticity, or the ability of the brain to compensate for damage.

The PACt-MD trial included 375 older adults with rMDD, MCI, or both (mean age, 72 years; 62% women) at five academic hospitals in Toronto, Canada.

Participants received either CR plus tDCS or sham intervention 5 days per week for 8 weeks (acute phase), followed by 5-day “boosters” every 6 months.

tDCS was administered by trained personnel and involved active stimulation for 30 minutes at the beginning of each CR group session. The intervention targets the prefrontal cortex, a critical region for cognitive compensation in normal cognitive aging.

The sham group received a weakened version of CR, with exercises that did not get progressively more difficult. For the sham stimulation, the current flowed at full intensity for only 54 seconds before and after 30-second ramp-up and ramp-down phases, to create a blinding effect, the authors noted. 

A geriatric psychiatrist followed all participants throughout the study, conducting assessments at baseline, month 2, and yearly for 3-7 years (mean follow-up, 48.3 months). 

Participants’ depressive symptoms were evaluated at baseline and at all follow-ups and underwent neuropsychological testing to assess six cognitive domains: processing speed, working memory, executive functioning, verbal memory, visual memory, and language.

To get a norm for the cognitive tests, researchers recruited a comparator group of 75 subjects similar in age, gender, and years of education, with no neuropsychiatric disorder or cognitive impairment. They completed the same assessments but not the intervention.

Study participants and assessors were blinded to treatment assignment.

Slower Cognitive Decline

Participants in the intervention group had a significantly slower decline in cognitive function compared with those n the sham group (adjusted z score difference [active − sham] at month 60, 0.21; P = .006). This is equivalent to slowing cognitive decline by about 4 years, researchers reported. The intervention also showed a positive effect on executive function and verbal memory. 

“If I can push dementia from 85 to 89 years and you die at 86, in practice, I have prevented you from ever developing dementia,” Mulsant said.

The efficacy of CR plus tDCS in rMDD could be tied to enhanced neuroplasticity, said Mulsant. 

The treatment worked well in people with a history of depression, regardless of MCI status, but was not as effective for people with just MCI, researchers noted. The intervention also did not work as well among people at genetic risk for Alzheimer’s disease.

“We don’t believe we have discovered an intervention to prevent dementia in people who are at high risk for Alzheimer disease, but we have discovered an intervention that could prevent dementia in people who have an history of depression,” said Mulsant. 

These results suggest the pathways to dementia among people with MCI and rMDD are different, he added. 

Because previous research showed either treatment alone demonstrated little efficacy, researchers said the new results indicate that there may be a synergistic effect of combining the two. 

The ideal amount of treatment and optimal age for initiation still need to be determined, said Mulsant. The study did not include a comparator group without rMDD or MCI, so the observed cognitive benefits might be specific to people with these high-risk conditions. Another study limitation is lack ofdiversity in terms of ethnicity, race, and education. 

Promising, Important Findings

Commenting for Medscape Medical News, Badr Ratnakaran, MD, assistant professor and division director of geriatric psychiatry at Carilion Clinic-Virginia Tech Carilion School of Medicine, Roanoke, Virginia, said the results are promising and important because there are so few treatment options for the increasing number of older patients with depression and dementia.

The side-effect profile of the combined treatment is better than that of many pharmacologic treatments, Ratnakaran noted. As more research like this comes out, Ratnakaran predicts that CR and tCDS will become more readily available.

“This is telling us that the field of psychiatry, and also dementia, is progressing beyond your usual pharmacotherapy treatments,” said Ratnakaran, who also is chair of the American Psychiatric Association’s Council on Geriatric Psychiatry. 

The study received support from the Canada Brain Research Fund of Brain Canada, Health Canada, the Chagnon Family, and the Centre for Addiction and Mental Health Discovery Fund. Mulsant reported holding and receiving support from the Labatt Family Chair in Biology of Depression in Late-Life Adults at the University of Toronto; being a member of the Center for Addiction and Mental Health Board of Trustees; research support from Brain Canada, Canadian Institutes of Health Research, Center for Addiction and Mental Health Foundation, Patient-Centered Outcomes Research Institute, and National Institutes of Health; and nonfinancial support from Capital Solution Design (software used in this study) and HappyNeuron (software used in this study). Ratnakaran reported no relevant conflicts.

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review

 You blithering idiots need to create a protocol based on all previous music research, rather than this useless crapola review. I'd have you all fired!

• music (94 posts back to March 2011)

• music therapy (53 posts back to October 2014)

• musical training (13 posts back to June 2014)

• singing (12 posts to July 2013)

Exploring Music-Based Interventions for Executive Functioning and Emotional Well-Being in Stroke Rehabilitation: A Scoping Review 

                                 by

Camila F. Pfeiffer

^1,2,*,

Wendy L. Magee

³,

Rebecca Fülöp

³,

Travis C. Nace

³,

Candela Castro

⁴,

Agustina Iturri

⁵,

Jimena Franceschi

⁶,

Gabriela Echauri

⁷,

Liliana Gassull

⁸ and

María Julieta Russo

⁹

¹

Music Therapy Department, ArtEZ Academy of Music, ArtEZ University of the Arts, PN7511 Enschede, The Netherlands

²

Facultad de Humanidades, Ciencias Sociales y Empresariales, Universidad Maimónides, Buenos Aires C1405, Argentina

³

Music Therapy, Boyer College of Music and Dance, Temple University, Philadelphia, PA 19122, USA

⁴

Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON M5S 1K6, Canada

⁵

Hospital Universitario Austral, Pilar B1629, Buenos Aires, Argentina

⁶

Servicio Neurología Cognitiva, Neuropsicología y Neuropsiquiatría, Centro de Rehabilitación, CR, Departamento de Rehabilitación, Fleni, Buenos Aires C1428AQK, Argentina

⁷

Servicio de Rehabilitación y Cuidados Continuos, Centro Hirsch, Buenos Aires B1663FDC, Argentina

⁸

Independent Researcher, Buenos Aires C1428, Argentina

⁹

Instituto de Neurociencias (INEU) Fleni Consejo Nacional de Investigaciones en Científicas y Técnicas (CONICET), Buenos Aires C1060AAF, Argentina

^*

Author to whom correspondence should be addressed.

NeuroSci 2024, 5(4), 565-599; https://doi.org/10.3390/neurosci5040041

Submission received: 16 October 2024 / Revised: 8 November 2024 / Accepted: 13 November 2024 / Published: 27 November 2024

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Review Reports Versions Notes

Abstract

Purpose: 

Stroke is one of the leading causes of disability with life-long implications requiring assessment and treatment of several functional domains. This review identifies the results from research into music-based interventions (MBIs), including music therapy (MT), for executive functions (EFs) and emotional well-being (EWB) in adults with stroke and highlights opportunities for clinical practice and future research. Methods: APA PsycInfo (EBSCOhost), and CINAHL (EBSCOhost) were searched, in addition to grey literature. 

Results: 

A total of 49 studies were included and encompassed experimental, analytic, and descriptive observational studies, and case reports, involving a total of 1663 participants. In total, 32 studies included MT interventions, and 17 were MBIs. EFs were an outcome in 20.41%, and EWB in 61.22% of studies, for which active interventions were the most utilized. Overall, 73.47% of the studies reported positive results. 

Conclusions: 

This scoping review indicates that music interventions can be beneficial for the improvement of different aspects of EFs and EWB at different stages of stroke recovery. Further research may benefit clinical practice by including standardized protocols,(AND WHY THE FUCK DIDN'T YOU CREATE THESE PROTOCOLS? LAZINESS? NOT MY JOB?) outcome and self-reported measures, and brain imaging data to determine the effects of interventions and support evidence-based decisions for treatment policies for stroke survivors.

Keywords:

stroke; music therapy; music-based interventions; executive functioning; emotional well-being; cognitive rehabilitation

1. Introduction

Stroke is a major health concern with a high incidence worldwide, affecting millions of people annually [1]. Stroke is clinically defined as a vascular injury of the central nervous system that can be caused by a wide range of risk factors and disease processes. It can impact any brain region to different extents and its sequelae will depend, among other factors, on the size and location of the vascular lesion [2]. As one of the leading causes of death and disability around the world, it commonly causes cognitive, motor, sensory, and mood dysfunctions that can be either transient or permanent [2,3]. Current evidence suggests that cognitive impairments are prevalent after stroke and often remain present over time [4,5]. Specifically, executive functions (EFs) play an important role in functional recovery as they encompass a set of interrelated cognitive processes of learning and applying knowledge to behavior, which involve attention control, planning, working memory, cognitive flexibility, problem-solving, decision-making, and goal-oriented behavior. These processes often work interdependently with one another to accomplish goal-driven tasks, concentrate, or solve unexpected challenges [6,7,8]. Behaviors characterized as “dysexecutive” are common to stroke and can entail diminished mental flexibility, speed of processing, attention control, and a lack of inhibition control that can potentially lead to risky decisions in harmful situations [4,9]. Early treatment is necessary to prevent these behaviors from becoming chronic [3,10]. Together with post-stroke depression, executive functioning is a strong predictor of a person’s functional status after rehabilitation [11] and can seriously compromise their return to independent work and social life. As executive and emotional disorders frequently co-occur in stroke survivors [12,13], there are some indications that cognitive functioning is influenced by the person’s emotional state [14].

Emotional well-being (EWB) encompasses a variety of components and is broader than the relative absence of negative emotional states such as depressive or anxious feelings. EWB entails the perception of positive functioning, life satisfaction, positive social relationships, a feeling of life balance, and a sense of purpose [15]. According to the working definition developed by the National Institute of Health (NIH), EWB is a multidimensional construct that describes “how positive an individual feels generally and about life overall. It includes both experiential features (emotional quality …) and reflective features (judgments about life satisfaction, sense of meaning, and ability to pursue goals …). These features occur in the context of culture, life circumstances, resources, and life course” [16], p. 16. EWB is also linked to psychopathology and health outcomes with a consensus that they are on a continuum; a positive perception of EWB has been shown to reduce the risk of death by nearly 20% [17]. Stroke survivors commonly face some type of emotional and mood disorders (e.g., fatigue, depression, lack of initiative, emotional incontinence, anxiety, feelings of loneliness, apathy) and experience a diminished quality of life [18,19,20,21,22,23]. This implies that after a stroke, people may have limited opportunities for experiencing EWB. Consequently, rehabilitation treatment continues seeking effective and meaningful interventions that contribute to functional and emotional recovery.

Music has long been applied in different forms to treat stroke sequelae, for instance, through music listening, group singing, exercising with pre-recorded music, or longer music therapeutic processes [24,25,26]. Overall, music holds a high potential for promoting health [27,28]. MT utilizes evidence-based interventions that aim to accomplish personalized goals and are carried out by credentialed music therapy professionals [29]. MT is usually a process that includes assessment, treatment, and evaluation of the client’s progress over time [30]. Other MBIs are protocols that study the therapeutic effects of music, which can be delivered by other caregivers, do not take place in a therapeutic relationship typical for MT, and may be prescribed or delivered in a single contact without evaluation or follow-up [30,31]. Accordingly, this review utilized the term music therapy for studies in which music therapists were involved in the delivery of the intervention, and music-based interventions for those in which no music therapists were involved. The latest Cochrane review on MBIs for persons with acquired brain injuries found that music interventions are beneficial to motor recovery, communication, and quality of life in stroke survivors. However, no strong evidence could be found on the benefits of music on cognitive and emotional outcomes and further research was recommended [27]. A growing body of studies investigated the effects of music interventions on cognitive and emotional rehabilitation after stroke and reported positive results specifically on mood, depressive syndromes, and quality of life [26,32].

Despite the rapid advances in the field, there remain, however, some limitations in the literature that this scoping review seeks to address. Our objective is to synthesize comprehensive knowledge of the current literature available on MBIs, including MT, in stroke rehabilitation targeting EF and EWB. The review seeks to identify the types of interventions used to address these domains, the outcome measures utilized, and how gained data can be translated into opportunities that will guide clinical practice and future research. Given the specificity of the topic, a limited number of sources was expected; therefore, a broader scope on the two main outcomes was taken by considering factors that influence EWB and EFs, such as mood disorders, quality of life, and cognitive functions interdependent with EFs, such as attention and memory. A scoping review was considered the most accurate approach to obtaining a comprehensive understanding of the applications of music-based and music therapy interventions in stroke rehabilitation [33,34].

More at link.

Stroke patients test new nerve stimulation therapy

 Why is there a trial for this? You incompetently don't know of this earlier research? 

Dorset Embarks on Revolutionary Stroke Recovery Trial Utilizing Earpiece Technology February 2024

 

Non-invasive VNS approach could enhance post-stroke recovery outcomes August 2023

The latest here: 

Stroke patients test new nerve stimulation therapy

Two years ago Michael Koers was a fit and healthy 62-year-old - a courier who liked to keep busy at the family allotment.

But things changed one night when he suffered a stroke that's left him with issues down his left side.

We're with him at King's College Hospital in Camberwell, south London, as he comes in to see if he'll be accepted for a new trial.

If he is, medics will aim to help give him more movement in his arm and hand.

Patients on the trial receive this small earpiece which is designed to stimulate the vagus nerve, along with a portable device worn on the wrist

There are plenty of tests here at the hospital to see how much he can move his left arm and hand.

"It's not like I was an inactive person. I just woke up in the middle of the night having a stroke, simple as that," Michael says.

"It's been a total disruption. There's no way I can continue with the role I was doing. I've always been a very hands-on person, an outdoors type, but the stroke's limited that completely," he adds.

Ava Coughlan, an occupational therapist, is here to test Michael to see if he is a good fit for the trial.

"Lift you arm," she tells him. "Turn your wrist. Try and hold on to the piece of paper while I try to take it."

If he's accepted on the trial, he will be given a device that's a little bit like a hearing aid.

It would be placed in his ear and attached to a device that would send electrical signals to his vagus nerve, which carries signals between the brain, heart and digestive system.

The hope is that the device would help him move his arm and hand more easily.

Michael Koers was very active before he had a stroke

On a similar type of programme in the United States, patients had a similar device that was surgically implanted.

The therapy then had to be administered under hospital supervision by a therapist, who triggered the stimulation.

This new technique needs only a portable device, with patients wearing a watch-like monitor linked to a mobile phone to gather the results.

It's used while patients do rehabilitation exercises. The trial here in the UK is to see if it works as well as the US scheme - and could mean patients not having to undergo surgery.

"This is a very interesting trial," Michael says. "Even if I don't make it on to it I think it's something that other people that have strokes could benefit from.

"If I'm accepted, hopefully they can use what they learn for other people in the future."

'It's exciting'

The trial at King College Hospital is part of a wider project being run by Sheffield Teaching Hospitals and the University of Sheffield.

Here in London, it's led by consultant occupational therapist Bill Tahtis. He tells me that initial studies have shown that when people receive stimulation from the device, it can speed up the rehabilitation process.

He says: "We think this is something on top of the therapy we provide that will be really beneficial to patients."

At the moment, Bill and his team are trying to recruit more people to the study, seeking patients who have had a stroke between six months and 10 years ago.

He says: "We don't know whether the treatment will be effective using this mechanism and we don't know which specific subgroups it will work for."

He adds: "It's exciting, we feel it's got great promise but we're testing to see if it does."

For Michael, it's good news.

After an hour or so of testing, he's been accepted on to the trial and given a lot of exercises to do every day when he gets home, using the new device.

He laughs as he leaves. "I don't know what I passed... But I passed something!"

7 Things Stroke Doctors Say You Should Never, Ever Do

 What these stroke doctors ARE COMPLETELY FAILING AT! 100% RECOVERY!

Why?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

7 Things Stroke Doctors Say You Should Never, Ever Do

Strokes are the fifth leading cause of death in the United States. But there are ways you can lower your risk.(But you won't recover 100% because your blithering idiots in the stroke medical world don't even have that as a goal!)

By Jillian Wilson

Nov 28, 2024, 03:00 AM EST

Halfpoint Images via Getty Images

It's important to lead an active lifestyle, eat nutritious foods and manage things like your blood pressure, doctors say.

In the United States, strokes are a top cause of death and a major cause of disability, according to the American Stroke Association. This is a scary reality, especially since many of the stroke risk factors are pretty silent (like high cholesterol and high blood pressure) ― until they’re not.

But just because some of the risk factors aren’t always obvious doesn’t mean strokes can’t be controlled. In fact, it’s estimated that 80% of strokes are preventable through lifestyle changes like exercise, diet and more, according to the Centers for Disease Control and Prevention.

No one knows that more than the experts who treat the issue. Stroke doctors say they think a lot about the key ways to lower their risk (and their patients’ risk) of stroke.

“I like to think of it more proactively — what I could do to prevent stroke,” said Dr. Anthony Kim, a vascular neurologist and medical director of the University of California at San Francisco Stroke Center.

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Below, stroke doctors share the habits they personally avoid ― and why you should avoid them, too.

Have A Sedentary Lifestyle

According to Dr. Arthur Wang, director of endovascular neurosurgery at Tulane University School of Medicine, one of the modifiable risk factors for stroke is having a sedentary lifestyle.

While there isn’t one across-the-board definition of a sedentary lifestyle, overall, it means spending too much time sitting or lying down and not enough time exercising or moving around.

“It’s been shown that regular physical activity helps keep your blood vessels clog-free. It stops the buildup of plaque in the arteries,” Wang said. “And so we generally recommend that people get probably 30 minutes of moderate exercise maybe five times a week.”

This could mean going for walks, runs, biking, gardening or joining a group workout class — there is no wrong way to get moving.

Ignore High Blood Pressure

“It turns out that a lot of the same things that we would recommend for a healthy lifestyle also reduce the risk of both heart disease and stroke,” Kim said. “But if there’s one factor that is the most impactful it would be blood pressure, blood pressure, blood pressure.”

Elevated blood pressure, particularly over time, can lead to problems, he said: High blood pressure is the biggest modifiable stroke risk factor.

“If you took a magic wand and waved it and suddenly eliminated high blood pressure from the U.S. population, there would be 60% fewer strokes,” Kim said. “It’s by far the leading risk factor for stroke and we call it the silent killer because oftentimes, patients don’t feel it; you have to have it checked and monitored and treated.”

“If you took a magic wand and waved it and suddenly eliminated high blood pressure from the U.S. population, there would be 60% fewer strokes.”

- Dr. Anthony Kim, University of California, San Francisco, Stroke Center

Skip Regular Check-Ups

“These risk factors oftentimes don’t have any real symptoms,” Wang said, which is a worrisome thing to think about. “A patient would never know that their blood pressure’s high, they wouldn’t know whether they have high cholesterol unless all of this is routinely tested or screened on a regular basis.”

This means it’s crucial that you visit your primary care doctor for the routine check-ups that they deem necessary. They’ll screen you for issues like high cholesterol and high blood pressure while checking other risk factors like your blood sugar and weight, too, he added.

“I think just being hyper-vigilant about those things, especially when these risk factors for stroke are very cryptic, meaning that they don’t manifest in any real symptoms, so it’s really important for patients to understand that so they take the actionable steps to see their doctor to get these routine screening tests,” Wang said.

Your doctor can also review any risk factors outside your control, like gender (strokes are more common in women, Wang said), race (they’re more common in Black people, he noted) and personal history.

“In terms of previous medical history, those who have had prior strokes in the past, or if one of their parents had a stroke in the past, are at a much higher risk of having a future stroke,” Wang said.

Smoke

According to both Kim and Wang, one of the habits that is high on a to-avoid list is smoking.

“That definitely increases the risk of stroke, and heart disease, for that matter,” Kim said.

“And one of the ways that it does that is by causing the blood vessels to become narrowed over time, and that can ultimately lead to blockages in blood flow to part of the brain, which is essentially what a stroke is,” he explained.

Tom Werner via Getty Images

High blood pressure is a huge stroke risk, doctors say, but it can be managed through diet and medication.

Drink Too Much Alcohol

You’re probably aware that alcohol is not good for you. It’s linked to certain kinds of cancer, liver disease, and yes, stroke, too. Specifically, Kim said there is an “association between ... excessive alcohol use and heart disease and stroke risk.”

Alcohol recommendations vary by person, but, the CDC considers more than four drinks in one sitting for women or five drinks in one sitting for men to be excessive drinking. More than eight drinks per week for women and 15 drinks per week for men is also considered excessive drinking.

Generally, it’s accepted that women should not have more than one alcoholic drink a day and men should not have more than two, Kim said. These are also the recommendations put forth by the Dietary Guidelines for Americans.

Ignore Your Diet

A proper diet is important for managing stroke risk, too. This means moderating foods that are full of saturated fats, sugar and salt, Wang said. (Additionally, Kim pointed out that there is a relationship between salt intake and high blood pressure, which, as we now know, is another stroke risk factor.)

When it comes to what you should eat, Kim points to the work of author and journalist Michael Pollan. This advice is “eat food, mostly plants, not too much,” Wang said. This means having a diet that’s rich in fruits and veggies with some meat added in.

Dismiss Necessary Treatment

Since strokes are so common in this country (and this world), it’s important that you’re aware of the signs and get treated as soon as possible. Available stroke treatments work better the sooner they’re done, Kim said.

“Because many strokes aren’t painful, and the symptoms of stroke vary so much, it’s important to recognize symptoms of stroke,” he said.

And, there’s a useful acronym to help people remember the signs — and that acronym is FAST, Kim said. FAST stands for “facial drooping, arm weakness, speech difficulty and time to call 9-1-1,” according to the American Stroke Association website.

“These are not the list of all potential stroke symptoms, but any one of those [factors] raises the suspicion that it could be a stroke, especially if it happens suddenly,” Kim noted.

And, once again, it’s important to remember that getting treatment as fast as possible is vital, he said.

This Five-Second Test Can Tell If You’re Aging Well

 

I would require 2 knees and a hand to get up. Getting down to the floor might be even harder for me.  I must not be healthy at all, can't even get down to the floor. See what your doctor thinks. I think this is total bullshit for stroke survivors! If I'm not aging well, how the hell did I get to 10,200 feet to visit Tigers Nest in Bhutan last year? Here is the scoring:

This Five-Second Test Can Tell If You’re Aging Well

From fine wine to a pair of well-worn blue jeans, it’s said that things get better with age. But unlike a bottle of Cabernet Sauvignon that can improve just by sitting there, we humans need to stay active as we get older to stay fit and healthy. Even if you visit the gym regularly and follow a strict diet, it can be challenging to determine how well you’re aging. Thankfully, you can do a quick fitness test from the comfort of your home, and it only takes five seconds of your valuable time. This test requires no special equipment or anyone to guide you — just an open space and a few moments to spare.

The “sit-to-stand test” isn’t a panacea by any means, but rather an indirect measure of one’s personal fitness backed by a 2012 research study. To begin, stand upright in an open space. Then sit cross-legged on the floor before returning to a standing position. While this may sound easy, the trick is to avoid using your hands, forearms, or other parts of your upper body and torso to help you stand up. Your leg and core muscles are the only muscles you’re supposed to rely on.Give yourself 10 imaginary points at the start of the test. Then subtract one point every time you use your arms, torso, hips, or even your knees to help you get from a standing position to a sitting position and vice versa. If you can sit down and stand back up without assistance, then you score a perfect 10. If you’re unable to sit down or stand back up at all, then your score is zero. Dr. Natalie Azar — a medical contributor to NBC News — achieving a score of eight or higher is ideal. However, she acknowledges that some people may not be able to perform the test due to a recent injury or genetic musculoskeletal limitations, although those individuals may be extremely fit. All this is to say that there are flaws within the test that fail to account for certain circumstances, so your score shouldn’t be taken as gospel. Instead, look at your score as a potential indicator of personal fitness rather than an indisputable fact.The Science Behind This Test According to the aforementioned 2012 study, a successful sit-to-stand test may indicate stronger cardiovascular health, high-quality core strength, and more desirable levels of balance and flexibility. The study also determined that the test was a solid indicator of an increased risk of mortality for participants between the ages of 51 and 80. Again, it’s important to note that this test is far from a sure science but something that we can make reasonable assumptions about based on the results.

Direction-specifc Disruption of Paretic Arm Movement in Post-stroke Patients

Wow, they managed to cherry-pick patients that had no spasticity! There would have been no movement at all. Useless research, nothing here gets survivors recovered!

 Direction-specifc Disruption of Paretic Arm Movement in Post-stroke Patients

Kiyoshi Yoshioka, RPT, PhD a,* Tatsunori Watanabe, RPT, PhD b,* Mizuki Yoshioka, RPT a Keita Iino, RPT a Kimikazu Honda, RPT a Koshiro Hayashida, RPT a and Yuji Kuninaka, RPT a

Objective: 

This study aimed to characterize reaching movements of the paretic arm in diferent directions within the reachable workspace in post-stroke patients. 

Methods: 

A total of 12 post- stroke patients participated in this study. Each held a ball with a tracking marker and performed back-and-forth reaching movements from near the middle of the body to one of two targets in front of them located on the ipsilateral and contralateral sides of the arm performing the movement. We recorded and analyzed the trajectories of the tracking marker. The stability of arm movements was evaluated using areas and minimum Feret diameters to assess the trajectories of both the paretic and non-paretic arms. The speed of the arm movement was also calculated. 

Results: 

For the paretic arm, contralateral movement was more impaired than ipsilateral movement, whereas for the non-paretic arm, no diference was observed between the directions. The maximum speed of the contralateral movement was signifcantly slower than that of the ipsilateral movement in both the paretic and non-paretic arms. 

Conclusion: 

The paretic arm shows direction-specifc instability in movement toward the contralateral side of the arm. 

Is Post-Stroke Mortality Risk Predicted by LACE+ Scores at Admission, Discharge?

 Instead of this prediction crapola, why aren't you providing EXACT PROTOCOLS that prevent this mortality?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem?

When these persons become the 1 in 4 per WHO that has a stroke : they'll want 100% recovery and by then it will be too late.

Is Post-Stroke Mortality Risk Predicted by LACE+ Scores at Admission, Discharge?

References:

Jun-O’Connell A, Silver B, Grigoriciuc E, Gulati A, Kobayashi KJ, Henninger N. Association between LACE+ index risk category and 90-day mortality after stroke. Neurol Clin Pract. 2025;15(1):e200363. doi:10.1212/CPJ.0000000000200363        

LACE+ scores calculated at admission and discharge can be used to identify patients with stroke who are at a greater risk for 90-day mortality.

The LACE+ (hospital Length of stay, Admission acuity, Comorbid conditions, and Emergency department use within 6 months of admission, plus other relevant factors) calculated at both admission (aLACE+) and discharge (dLACE+) predicts mortality risk among patients with stroke, according to study findings published in Neurology Clinical Practice.

Researchers conducted a retrospective review of a prospectively accrued cohort to explore whether aLACE+ and dLACE+ indices were independently related to 90-day mortality following stroke. Adults who presented with ischemic or hemorrhagic strokes between January 2018 and December 2021 were eligible for inclusion and categorized as high (score, ≥78), medium to high (score, 59-77), or low to medium (score, 0-58) risk. The primary outcome was mortality at 90 days after the index hospitalization. Cox regression models were used in statistical analysis.

A total of 2729 patients (median age, 70; men, 51.9%) were included in the study, of whom 474 (17.3%) died in the hospital or were discharged to hospice. 

Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death,

According to the Kaplan-Meier analysis, cumulative 90-day survival was higher among patients in the low to medium vs medium to high or high aLACE+ risk categories (P <.001).

A higher aLACE+ risk category was independently associated with a higher mortality risk at 90 days (adjusted hazard ratio [aHR], 1.36; 95% CI, 1.13-1.64; P =.001), according to ordinal analysis. This association was sustained after excluding patients with withdrawal of life sustaining therapies (aHR, 1.57; 95% CI, 1.03-2.40; P =.035).

Overall, participants in the high vs low to medium aLACE+ risk category had a 62.9% higher risk for death within 90 days (aHR, 1.69; 95% CI, 1.06-2.69; P =.027) in categorical analysis. Participants in the medium to high vs low to medium aLACE+ risk category also had a 58.7% higher 90-day mortality risk (aHR, 1.42; 95% CI, 1.14-1.78; P =.002).

Similarly, cumulative 90-day survival in participants without withdrawal of life sustaining therapies was higher among patients in the low to medium vs medium to high or high aLACE+ risk categories (P <.001).

A higher dLACE+ risk category was independently associated with a higher mortality risk at 90 days (aHR, 1.82; 95% CI, 1.31-2.53).

Participants in the high vs low to medium LACE+ risk category had an 80.2% higher risk for death within 90 days. Compared with low to medium, high (aHR, 6.18; 95% CI, 1.90-20.13; P =.002) and medium to high (aHR, 4.04; 95% CI, 1.27-12.88; P =.018) dLACE+ risk categories were associated with greater mortality risk.

This study was limited by its retrospective, single-center design.

“Future studies are warranted to determine whether LACE+ score-based risk stratification can be used to devise early interventions to mitigate the risk for death,” the study authors concluded.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.