Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 28,987 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.
Samar M. Hatem 1, 2, 3 *, Geoffroy Saussez 2 , Margaux della Faille 2 , Vincent Prist 4 , Xue Zhang 5 , Delphine Dispa 2, 6 and Yannick Bleyenheuft 2 1 Physical and Rehabilitation Medicine, Brugmann University Hospital, Brussels, Belgium, 2 Systems and Cognitive Neuroscience, Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium, 3 Faculty of Medicine and Pharmacy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium, 4 Physical and Rehabilitation Medicine, Centre Hospitalier de l’Ardenne, Libramont, Belgium, 5 Movement Control and Neuroplasticity Research Group, Motor Control Laboratory, Department of Kinesiology, Katholieke Universiteit Leuven, Leuven, Belgium, 6 Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
Stroke is one of the leading causes for disability worldwide. Motor function deficits due to stroke affect the patients’ mobility, their limitation in daily life activities, their participation in society and their odds of returning to professional activities. All of these factors contribute to a low overall quality of life. Rehabilitation training is the most effective way to reduce motor impairments in stroke patients. This multiple systematic review focuses both on standard treatment methods and on innovating rehabilitation techniques used to promote upper extremity motor function in stroke patients. A total number of 5712 publications on stroke rehabilitation was systematically reviewed for relevance and quality with regards to upper extremity motor outcome. This procedure yielded 270 publications corresponding to the inclusion criteria of the systematic review. Recent technology-based interventions in stroke rehabilitation including non-invasive brain stimulation, robot-assisted training, and virtual reality immersion are addressed. Finally, a decisional tree based on evidence from the literature and characteristics of stroke patients is proposed. At present, the stroke rehabilitation field faces the challenge to tailor evidence-based treatment strategies to the needs of the individual stroke patient. Interventions can be combined in order to achieve the maximal motor function recovery for each patient. Though the efficacy of some interventions may be under debate, motor skill learning, and some new technological approaches give promising outcome prognosis in stroke motor rehabilitation.(I see NO PROGRESS in stroke rehab, so I have no clue what the fuck you're looking at!)
My doctor did nothing to get me 100%
recovered so I could stay active. Also didn't inform me that after age
50 my metabolism slows down and I should cut back on calories, gained 40
extra pounds, still have ways to go to get to a good weight.
Slightly overweight stroke survivors have a lower
risk of sustaining disabilities. New research adds another aspect to the
obesity paradox but also highlights the importance of considering the
population's normal when recommending best practices.
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FULL STORY
Slightly overweight stroke survivors
have a lower risk of sustaining disabilities. The Kobe University
finding adds another aspect to the obesity paradox but also highlights
the importance of considering the population's normal when recommending
best practices.
The obesity paradox is the well documented observation that amongst
people who suffered a stroke, those who are moderately overweight have
lower rates of mortality, recurrence and readmission compared to
patients of "normal" weight. Recently, survival rates have improved and
attention has shifted to the subsequent lives of the patients. The Kobe
University health scientist IZAWA Kazuhiro says: "In my clinical
practice I have experienced that patients with a thin physique often
have difficulties in recovering function whereas relatively overweight
people usually fare better. This motivated me to study whether there is a
demonstrable relationship between body size and functional disability
after a stroke."
Using a Japanese national database containing anonymized data on
diagnosis-procedure combinations for all vascular and cardiac disease
cases in hospitals across Japan, Izawa, postdoctoral researcher KANEJIMA
Yuji and their team evaluated the size of different factors on over
half a million patients' disability at the time of discharge from
hospital. The factors they looked at were the body mass index (BMI),
which is a person's weight relative to their height, the patients' age,
gender, their disability score at the time of hospitalization, and
others.
In the journal Topics in Stroke Rehabilitation, the Kobe
University team now published their results. They found that, indeed,
the risk of being discharged from hospital with a poor disability score
was observed to be relatively low in people with a BMI between 22.1 and
27.5 kg/m2, and was lowest at a BMI of 24.7 kg/m2. Given that the WHO classifies Asians with a BMI between 23 and 25 kg/m2
as overweight and above that as obese, a slightly higher-than-normal
BMI seems to be beneficial to the odds of recovering from a stroke with
less disability. First author Kanejima offers an explanation: "The
median age in this study was 77 and people in this age group and beyond
lose weight more easily. However, people having certain reserves may be
better able to withstand the nutritional challenge a stroke and the
following hospitalization pose, which effectively protects their nervous
system."
A similar study conducted in the United States a few years ago found the same basic effect, but with an optimal BMI of 30.0 kg/m2
for that population. "Asians tent to have a slimmer physique compared
to Americans and this is also reflected in the lower optimal BMI for a
lower probability of disability at discharge," says Kanejima. This
underscores that caution is needed when adapting BMI-based
recommendations for different populations around the world.
There is concrete advice gleaned for current health care practice
from the results of the present study. Izawa says: "For the public, this
serves as a reminder that losing weight at a high age is a
disadvantage. For health care providers, the study suggests that they
need to closely monitor weight loss during hospitalization to prevent
functional impairment." To understand more about the mechanism at work,
the Kobe University researchers next aim to study how the change in body
weight during hospitalization is related to functional disability.
This research was funded by the Japanese Circulation Society and the
Japan Society for the Promotion of Science (grants JP22K11392 and
JP22K19708). It was conducted in collaboration with researchers from the
National Cerebral and Cardiovascular Center.
Yuji Kanejima, Masato Ogawa, Kodai Ishihara, Naofumi Yoshida,
Michikazu Nakai, Koshiro Kanaoka, Yoko Sumita, Takuo Emoto, Yoshitada
Sakai, Yoshitaka Iwanaga, Yoshihiro Miyamoto, Tomoya Yamashita, Kenichi
Hirata, Kazuhiro P. Izawa. Body mass index is associated with
disability at discharge as indicated by the modified Rankin Scale in
patients with ischemic stroke: a JROAD-DPC study. Topics in Stroke Rehabilitation, 2024; 1 DOI: 10.1080/10749357.2024.2417644
Objectives To investigate associations of the ‘weekend warrior’ physical activity pattern with mild dementia.
Methods
Participants in the Mexico City Prospective Study were surveyed from
1998 to 2004 and re-surveyed from 2015 to 2019. Participants were asked
about leisure time physical activity at baseline. Those who exercised up
to once or twice per week were termed ‘weekend warriors’ and those who
exercised more often were termed ‘regularly active’. A Mini Mental State
Examination (MMSE) was used to assess mild dementia at re-survey. Cox
models were adjusted for age, sex, education, income, blood pressure,
smoking, body mass index, civil status, sleep, diet and alcohol at
baseline. The attributable fraction was defined as the proportion of
cases that would not exist if all adults were to exercise once or twice
per week or more often.
Results
The analysis included 10 033 adults of mean (SD) age 51 (10) years
followed for 16 (2) years. There were 2400 cases when mild dementia was
defined as a score of ≤22 on the MMSE. Compared with the group that
reported no sport or exercise, the hazard ratio was 0.75 (95% CI 0.61 to
0.91) in the weekend warrior group, 0.89 (95% CI 0.78 to 1.02) in the
regularly active group and 0.84 (95% CI 0.75 to 0.95) in the combined
group. The attributable fraction was 13% (95% CI 5% to 21%). Similar
results were observed when mild dementia was defined as a score of ≤23
on the MMSE.
Conclusions
This longitudinal analysis suggests that the weekend warrior physical
activity pattern is associated with a reduced risk of mild dementia.
Data availability statement
Data
are available upon reasonable request. Mexico City Prospective Study
data are available for open-access data requests. The data access policy
is described online: http://www.ctsu.ox.ac.uk/research/mcps.
Since there is no specific factual basis for what exactly a Mediterranean diet is, maybe you want your doctor to give you a transfusion of young blood or bone marrow or brain fluid!
Summary: The Green Mediterranean diet may help slow
brain aging by controlling blood sugar levels, benefiting cognitive
health in older adults. The study found that lower blood sugar levels
were linked to a younger brain age, particularly in regions critical for
memory and sensory processing.
Using advanced MRI scans,
researchers observed that participants on the Green-Med diet exhibited a
slower rate of brain atrophy over 18 months. Components of this diet,
rich in polyphenols from plants like Mankai and green tea, may support
brain structure and function.
This dietary approach provides a
potential pathway to reducing age-related cognitive decline. The
findings offer promising insights into dietary and lifestyle changes as
practical strategies to protect brain health.
Key Facts:
Lower blood sugar levels were associated with a younger brain age, delaying brain atrophy.
Green-Med diet, rich in polyphenols from plants, slowed brain aging in study participants.
The DIRECT PLUS trial used MRI scans to show reduced brain tissue loss in those with improved glycemic control.
Source: Ben-Gurion University
Age-related
brain atrophy, the gradual loss of neurons and shrinkage of brain
tissue, is a natural part of aging, which can lead to cognitive decline
and other neurological issues.
While so far aging cannot
be prevented, recent research from an 18-month dietary intervention
offers hope that lifestyle and dietary changes can slow brain aging.
A
new international study, led by Ben-Gurion University of the Negev as
part of the DIRECT PLUS Brain MRI trial, has brought to light how blood
sugar control can significantly impact brain health.
This
study is one of the first large-scale trials to directly link dietary
changes, particularly those associated with the Green-Med diet, to
improved glycemic control and slower brain aging. Credit: Neuroscience
News
Brain age, as evaluated by MRI measurements of the hippocampus and
lateral ventricles, reflects the biological aging of the brain, which
can differ from a person’s chronological age. Chronological age is the
number of years lived, while brain age indicates the brain’s actual
health.
Typically, as we age, the hippocampus shrinks and the
lateral ventricles expand, serving as markers of brain aging. Some
individuals have a brain age younger or older than their chronological
age.
A younger brain age suggests better cognitive health, while
an older brain age may indicate accelerated aging and increased risk of
cognitive decline.
The study, which was published recently in The American Journal of Clinical Nutrition 2024,
was conducted by an international team of brain and nutrition experts,
including researchers from Ben-Gurion University, Harvard University,
Leipzig University, and more.
The research was primarily carried
out by Ph.D. student Dafna Pachter and overseen by Prof. Iris Shai,
along with several international collaborators.
A
previous study published two years ago, reported that Mediterranean
(MED) and green-MED diets significantly attenuated age-related brain
atrophy by ∼50% within 18 months.
In the current study, the researchers aimed to understand the mechanism by which the slowing of brain atrophy occurs.
The
study found that a decline in HbA1c, and key markers of long-term blood
sugar levels, are associated with significant positive changes in
specific brain regions commonly affected by age-related atrophy.
Brain
MRI results showed that lower HbA1c levels corresponded to greater
deviations in the thalamus, caudate nucleus, and cerebellum – areas
crucial for cognitive function, motor control, and sensory processing.
The
study suggests that improved blood sugar control could be one of the
most important factors in slowing down age-related brain changes.
The Green Mediterranean Diet Shows Promise
Earlier
research has highlighted the benefits of the Green Mediterranean
(Green-Med) diet, including better blood sugar control. The Green-Med
diet is rich in polyphenols from plant-based sources like Mankai (a
high-protein aquatic plant) and green tea, while being low in red and
processed meats.
The current study further strengthens this
connection by suggesting that the Green-Med diet may not only support
metabolic health but also exert protective effects on brain structure
and function.
DIRECT PLUS Trial – One of the Largest Brain MRI intervention Studies in the World
The DIRECT PLUS trial, one of the longest and largest brain MRI
studies conducted to date, involved approximately 300 participants who
were divided into three dietary groups. Whole-brain MRI measurements
were taken before and after the 18-month trial to track changes in brain
health.
The researchers used Hippocampal Occupancy (HOC), as a
proxy for brain age which predicts future risk of dementia. HOC
typically decreases with age. Interestingly, some participants exhibited
a brain age either younger or older than their chronological age.
Using
NeuroQuant, an FDA-authorized fully automated tool, the research team
quantified and segmented the brain MRI-derived data. The study aimed to
examine whether improved glycemic control and specific dietary
components could slow down brain aging.
The results indicated that
participants who managed to improve their blood sugar levels and
achieve normal glucose status experienced a more pronounced attenuation
of brain aging.
Notably, those who consumed higher amounts of
green tea and Mankai duckweed shakes demonstrated the most significant
improvements in both blood sugar levels and brain health.
Glycemic Control and Polyphenols: The Key to a Younger Brain Age?
The
study’s lead researcher, Prof. Iris Shai, from Ben-Gurion University,
an adjunct professor at Harvard University, and an Honorary Professor at
Leipzig University, explains, “Maintaining low blood sugar levels, even
within the normal range, shows promise for preserving a younger brain,
especially when combined with a healthy diet and regular physical
activity.
“Specifically, polyphenols found in plant-based foods may cross the
blood-brain barrier and help reduce brain inflammation, which is crucial
for memory”.
Dafna Pachter, a Ph.D. student and the first author
of the paper, adds, “This trial offers a safe approach to potentially
slow down our brain aging—by adopting the components of a
green-Mediterranean diet.”
A Pathway to Reducing Age-Related Cognitive Decline
This
study is one of the first large-scale trials to directly link dietary
changes, particularly those associated with the Green-Med diet, to
improved glycemic control and slower brain aging.
While further
research is needed to fully understand the mechanisms at play, these
results suggest a potential avenue for reducing the risk of age-related
cognitive decline through relatively simple dietary adjustments.
Funding: The
DIRECT PLUS trial was funded by grants from the German Research
Foundation (DFG), Israel Ministry of Health, Israel Ministry of Science
and Technology, and the California Walnuts Commission.
None of the funding providers were involved in any stage of the
design, conduct, or analysis of the study, nor did they have access to
the study results before publication.
The researchers:
Dafna Pachter, Alon Kaplan, Gal Tsaban, Hila Zelicha, Anat
Yaskolka Meir, Ehud Rinott, Gidon Levakov, Moti Salti, Yoram Yovell, Sebastian Huhn, Frauke Beyer, Veronica Witte, Peter Kovacs, Martin von
Bergen, Uta Ceglarek, Matthias Blüher, Michael Stumvoll, Frank
B. Hu, Meir J. Stampfer, Alon Friedman, Ilan Shelef, Galia Avidan, and
Iris Shai.
About this brain aging and diet research news
Author: Ehud Zion Waldoks Source: Ben-Gurion University Contact: Ehud Zion Waldoks – Ben-Gurion University Image: The image is credited to Neuroscience News
You'll be interested that there is NO discussion of 100% recovery which means they are NEVER going to do anything towards that! The takeaway is don't have a stroke because your stroke medical 'professionals' aren't really professional in my opinion!
Send
me hate mail on this: oc1dean@gmail.com. I'll print your complete
statement with your name and my response in my blog. Or are you afraid
to engage with my stroke-addled mind? I would like to know what your definition of professionalism in stroke is.
Dr Ray O’Connor takes a look at the
latest clinical papers on the treatment of stroke, and how high-quality
rehabilitation can minimize(NOT RECOVER!) the impact of the condition
Globally, stroke is the second leading cause
of death, and the third leading cause of death and disability combined.
Around 100,000 people have strokes each year, and around 1.3 million
people in the UK have survived a stroke. High-quality rehabilitation can
minimise the physical, emotional, cognitive, and social impacts for
people who have had a stroke, and their carers. It can also yield
substantial cost savings to society.
The National Institute for Health and Care Excellence (NICE) guidance
on stroke rehabilitation in adults was updated in October 2023.1 The guideline summary published in the BMJ earlier this year2
covers selected new and updated recommendations and focuses on those
most relevant to primary care and community rehabilitation settings.
Dr Ray O’Connor
The main recommendations are as follows. Stroke
rehabilitation total therapy time should be based on the person’s needs,
with the amount increasing to at least three hours a day, on at least
five days a week. Fatigue is common; use a validated scale for early
assessment. Offer vision and hearing assessment. Consider referral to
community participation programmes suited to the person’s rehabilitation goals.
Interestingly the American Heart Association and the American Stroke
Association also jointly published stroke prevention guidelines this
year3 It is an extensive document covering over 80 pages with 735 references.
The ‘Top Ten Take-home Messages’ for busy clinicians are listed. A brief summary is as follows.
Everyone should have access to and regular visits with a primary care
health professional to identify and achieve opportunities to promote
brain health.Screening for and addressing adverse
social determinants of health is important in the approach to prevention
of incident stroke.
The Mediterranean diet is a dietary pattern that has been shown to
reduce the risk of stroke. Physical activity is essential for
cardiovascular health and stroke risk reduction. Glucagon-like protein-1
receptor agonists have been shown to be effective not only for
improving management of type 2 diabetes but also for weight loss and
lowering the risk of cardiovascular disease and stroke.
Blood
pressure management is critical for stroke prevention. Antiplatelet
therapy is recommended for patients with antiphospholipid syndrome or
systemic lupus erythematosus without a history of stroke or unprovoked
venous thromboembolism to prevent stroke. Prevention of pregnancy-related stroke can be achieved primarily through management of hypertension.
Treatment of verified systolic blood pressure ≥160 mm Hg or diastolic
blood pressure ≥110 mm Hg during pregnancy and within six weeks
postpartum is recommended. Endometriosis, premature ovarian failure (before 40 years of age),and early-onset menopause (before 45 years of age) are all associated with an increased risk for stroke.
Therefore, screening for all three of these conditions is a
reasonable step in the evaluation and management of vascular risk
factors in these individuals to reduce stroke risk. Finally, the authors
recommend that understanding transgender health is essential to truly
inclusive clinical practice.
Treatment of acute stroke, before a distinction can be made between
ischemic and haemorrhagic types, is challenging. This randomised
controlled trial4
studied whether very early blood-pressure control in the ambulance
improves outcomes among patients with undifferentiated acute stroke.
The subjects were 2404 Chinese patients with mean age of 70 years
with stroke that caused a motor deficit and with elevated systolic blood
pressure (≥150 mm Hg). The authors randomly assigned patients who were
assessed in the ambulance within two hours after the onset of symptoms,
to receive immediate treatment to lower the systolic blood pressure
(target range, 130 to 140 mm Hg) (intervention group) or usual
blood-pressure management (usual-care group).
The results were that prehospital BP reduction did not
improve functional outcomes. Interestingly, 46.5 per cent subsequently
received a diagnosis of haemorrhagic stroke.
Inflammation has been associated with incidence and recurrence of
stroke, and risk of stroke was reduced in patients who have coronary
artery disease and who were treated with colchicine. This multicentre,
double blind, randomised, placebo controlled trial from China5
looked to assess the efficacy and safety of colchicine versus placebo
on reducing the risk of subsequent stroke after high risk
non-cardioembolic ischaemic stroke or transient ischaemic attack within
the first three months of symptom onset.
The participants were 8,343 patients aged 40 years of age or older.
Patients were randomly assigned 1:1 within 24h of symptom onset to
receive colchicine (0.5 mg twice daily on days 1-3, followed by 0.5 mg
daily thereafter) or placebo for 90 days. Unfortunately, no differences were noted in treatment effects on subsequent stroke between the low dose colchicine and the placebo groups.
Increasingly, the effects of global warming are resulting in extremes of heat. This ecological study6 considered
what is the burden of stroke worldwide associated with extremes in
temperature. The authors collected data from the Global Burden of
Diseases Study 2019, the Climate Research Unit Gridded Time Series, and
the World Bank database to estimate stroke burden attributable to
nonoptimal temperature and its distributional characteristics at the
global, regional, and national levels. The conclusion was that
the burden of stroke attributable to nonoptimal temperature conditions
continued to increase, and aging was a key factor in this increase.
In 2019, 521,031 deaths and 9,423,649 disability adjusted life years
(DALYs) were attributable to stroke due to nonoptimal temperature
globally.
Anecdotally I know two persons with Ph.Ds; one which got full blown Alzheimers and the other now having MCI. I don't even have a masters, so this is concerning to me.
Summary: A recent study explored whether additional
years of education lead to long-term changes in brain structure,
especially in protecting against brain aging. Analyzing data from a
unique natural experiment involving nearly 30,000 individuals,
researchers found no detectable impact on brain structure from an
additional year of education.
Although education is linked to
better cognitive skills and health, it does not appear to alter the
brain’s physical structure in the long run. Researchers suggest that any
initial structural impact may be temporary or too small to detect with
MRI technology. These findings highlight the need for caution when
linking education directly to brain structure based on correlations
alone.
Key Facts:
Education correlates with cognitive and health benefits but shows no lasting effect on brain structure.
The study used a natural experiment, comparing brain scans from individuals with and without an additional year of school.
The impact of education on brain structure may be temporary or microscopic, evading MRI detection.
Source: Radboud University
It is
well-known that education has many positive effects. People who spend
more time in school are generally healthier, smarter, and have better
jobs and higher incomes than those with less education.
However,
whether prolonged education actually causes changes in brain structure
over the long term and protects against brain aging, was still unknown.
The
researchers examined the MRI scans for the structure of various brain
regions, but they found no differences between those who attended school
longer and those who did not. Credit: Neuroscience News
It
is challenging to study this, because alongside education, many other
factors influence brain structure, such as the conditions under which
someone grows up, DNA traits, and environmental pollution.
Nonetheless, researchers Rogier Kievit (PI of the Lifespan Cognitive
Dynamics lab) and Nicholas Judd from Radboudumc and the Donders
Institute found a unique opportunity to very precisely examine the
effects of an extra year of education.
Aging
In
1972, a change in the law in the United Kingdom raised the number of
mandatory school years from fifteen to sixteen, while all other
circumstances remained constant. This created an interesting ‘natural
experiment’, an event not under the control of researchers which divides
people into an exposed and unexposed group.
Data from
approximately 30,000 people who attended school around that time,
including MRI scans taken much later (46 years after), is available.
This dataset is the world’s largest collection of brain imaging data.
The
researchers examined the MRI scans for the structure of various brain
regions, but they found no differences between those who attended school
longer and those who did not.
‘This surprised us’, says Judd.
‘We
know that education is beneficial, and we had expected education to
provide protection against brain aging. Aging shows up in all of our MRI
measures, for instance we see a decline in total volume, surface area,
cortical thickness, and worse water diffusion in the brain. However, the
extra year of education appears to have no effect here.’
Brain structure
It’s possible that the brain looked different immediately after the extra year of education, but that wasn’t measured.
‘Maybe
education temporarily increases brain size, but it returns to normal
later. After all, it has to fit in your head’, explains Kievit.
‘It
could be like sports: if you train hard for a year at sixteen, you’ll
see a positive effect on your muscles, but fifty years later, that
effect is gone.’
It’s also possible that extra education only produces microscopic changes in the brain, which are not visible with MRI.
Both
in this study and in other, smaller studies, links have been found
between more education and brain benefits. For example, people who
receive more education have stronger cognitive abilities, better health,
and a higher likelihood of employment. However, this is not visible in
brain structure via MRI.
Kievit notes: ‘Our study shows that one
should be cautious about assigning causation when only a correlation is
observed. Although we also see correlations between education and the
brain, we see no evidence of this in brain structure.’
About this brain aging and cognition research news
Author: Pauline Dekhuijzen Source: Radboud University Contact: Pauline Dekhuijzen – Radboud University Image: The image is credited to Neuroscience News
With your elevated chances of dementia
post stroke, your competent? doctor and hospital are responsible for preventing that!
Have they taken on that responsibility to check if this would help diagnose dementia post stroke? Or are they DOING NOTHING?
With your chances of getting dementia post stroke, you need prevention solutions. YOUR DOCTOR IS RESPONSIBLE FOR PREVENTING THIS!
A consortium of 46 international Alzheimer’s disease experts issued revised guidelines for disease diagnosis.Image: Adobe Stock
“These recommendations are the collaborative effort of 46
international experts who emphasize that diagnosing Alzheimer’s disease
should primarily rely on clinical evaluation supported by biomarkers,” Bruno Dubois, MD, MSc,
of the Institute of Memory and Alzheimer’s disease in the department of
neurology at Salpetriere Hospital in Paris, said in a release related
to the guidelines, which were published in JAMA Neurology.
Key takeaways:
The guidance outlines core biomarkers for Alzheimer’s, including cerebrospinal fluid, evidence of tau protein and amyloid-beta.
It also includes three new terms for stages of disease progression.
The International Working Group has updated diagnostic guidelines for
Alzheimer’s disease to include individuals with normal cognition who
test positive for core biomarkers indicative of disease pathology.
The recommendations, which revise the organization’s 2021 guidelines,
were presented at the 2024 Clinical Trials on Alzheimer’s Disease
(CTAD) conference in Madrid. They permit that biological evidence may
not be the sole manner in which AD can be defined,
with core biomarkers being cerebrospinal fluid (CSF), amyloid-beta and
tau, as well as plasma phosphorylated tau 217 (pTau-217) found via
positron emission tomography.
The revisions were also intended to separate patients into two
groups: individuals who display typical AD-related symptoms along with
evidence of disease-specific biomarkers who are diagnosed with AD vs.
those who have evidence of disease-specific biomarkers but no symptoms which predict eventual disease progression, Dubois added.
The guidelines additionally encourage clinicians to embrace three specific terms relating to disease pathology and progression.
Those deemed asymptomatic but at risk for AD:(We stroke survivors are at risk)
are cognitively normal but are at elevated risk for becoming cognitively impaired due to unknown risk from a biomarker profile;
are at increased risk for progression to cognitive impairment compared to those without biomarker presence; and
should not be defined as having the condition.
Individuals found to have presymptomatic AD:
are cognitively normal individuals who show a pattern of
biomarkers consistent with a very high risk for progression to cognitive
impairment;
possess dominant genetic variations associated with a 100% risk for development to clinical AD such as APP, PSEN1 and PSEN2; and
demonstrate biomarker changes, coupled with genetic risk
factors, associated with elevated risk for clinical AD development such
as those confirmed by PET.
Those with AD:
are cognitively impaired individuals with specific clinical
phenotypes including aphasia, cortical atrophy along with behavioral or
executive dysfunction;
test positive for AD-related pathology through analysis of plasma biomarkers, CSF or PET; and
show signs of the above in the prodromal and dementia stages of disease.
“Further developing brain health services for the prevention of
dementia could lead to better evaluation of risk, communication of risk
and risk reduction strategies targeting modifiable risk factors,” Giovanni B. Frisoni, MD, professor in the department of psychiatry at Geneva University Hospital in Switzerland, said in the release.
THIS is what's wrong with our stroke medical 'professionals'! They start out just improving recovery, RATHER THAN DELIVERING RECOVERY! Whomever approved that needs to be fired!
A new £1m stroke rehabilitation unit has been
officially opened at Frimley Park Hospital, while a national campaign
looks to shorten the time between a stroke and dialling 999.
Funded
by Frimley Health Charity and donations from the public, the new
extension to the hospital is designed to improve patient experience and
recovery times.
With a specially-designed
garden and dedicated therapy rooms, the new stroke rehab unit allows
medical staff to give the 'best care possible' to their patients.(NOT RECOVERY!)
Consultant
Dr Tom Pain said: "Before this ward open all the therapy was done in
ward bays and there is very little privacy so this allows the therapist
to take the patients out of the ward environment to deliver the therapy
sessions."
The stroke rehab unit includes a therapy garden for patients. Credit: ITV News Meridian
A common misconception about strokes is that they mainly affect older people, but they can happen to anyone.
The latest figures from Public Health England show the average age of stroke victims is getting younger.
Claire Woodward was admitted to Frimley Park Hospital after suffering a stroke on 14 October.
She
said: "I can come into the day room to see my children and
grandchildren and I use the therapy rooms with the occupational
therapist - so it's made a big difference."
Around 100,000 people have a stroke each year in the UK, which occurs when the blood supply to part of the brain is cut off.
The
current stroke service at the hospital looks after more than 100 people
every month, and it is hoped the bigger and better unit will become a
national centre of excellence for stroke care.
The new rehab unit hopes to improve care for patients by taking them out of a ward setting for therapy. Credit: ITV News Meridian
OT
Suzanne Barber said: "Some of our patients are on the stroke ward for
two to three months and being in that environment all the time is
really, really difficult.
"So it just allows
people to step off of the ward and not be stuck in that ward
environment. Psychologically it's good for people's wellbeing."
Without
fast treatment a stroke can result in death or long-term disabilities
such as paralysis, memory loss and communication problems.
The
new unit comes as the NHS launches a campaign which aims to improve the
time between the onset of a stroke and emergency services being called.
New
analysis of NHS data shows that for 2023-24, of 41,327 patients with a
recorded time of symptom onset, the average time between first symptom
and a 999 call being made was 88 minutes.
The FAST acronym (Face, Arms, Speech, Time) is a test to quickly identify if someone is having a stroke.
Face weakness: Can the person smile? Has their mouth or eye drooped?
Arm weakness: Can the person raise both arms?
Speech problems: Can the person speak clearly and understand what you say?
Time to call 999: if you see any of these signs.
Dr
David Hargroves, NHS national clinical director for stroke and
consultant stroke physician, said: “When someone has a stroke, it’s
estimated they may lose around two million brain cells a minute, which
is why rapid diagnosis and treatment is critical – the first sign of a
stroke might not seem like much, but face or arm or speech, at the first
sign it’s time to call 999.
Media medic and
GP, Dr Amir Khan said: “A stroke strikes every five minutes in the UK,
so it’s crucial everyone is aware of the most common symptoms of a
stroke and acts FAST by calling 999.
"The
first sign of a stroke actually might not seem like much, but every
minute is vital – getting quick access to specialist treatment can be
lifesaving and can reduce long-term disability. Whether someone is
unable to raise their arm, struggling to smile or slurring when they
speak – any sign is always an emergency and you need to call 999
immediately.”
I blame the supervisor for not instructing this person to map recovery protocols to each problem you have in the gait cycle. My problem really only shows up on a head on view; my left foot angles out 15% due to spasticity, causing no pushoff and heel to toe rolloff doesn't occur. My physical therapists never saw that and never worked on solving it.
3 1.Summary After a stroke,patientsusually struggle with physicaldeficitsthat havea directimpact on their quality of life.Strokes cause a lot of mortality and morbidity in thepopulation. The challenges existparticularlyforstrokessurvivors. Such an event in a person’s life often brings not only physical but also mental health issues.Good motivation is crucial in the process of rehabilitation to achieve good results. Therefore, itshouldbe essential to ensure accurate patient caretoofferindividualpatients specificprocedures. It isimportantto beable toreintegratepeople intotheirsurroundingsas well. In thatinstance,recovery of motor deficits or deficits during walkingshould be provided. A precise analysis of motor deficits is essential, which can beobtained in detail using differentassessmentmethods.Thisalso determinesthe further course of therapy options or effects of differenttherapyoptions on individual strokepatients. A basic understandingof normal gait physiology in humansshouldplayarole for every participating therapist. This isparticularlyusefultobe able to evaluate pathological gait patterns and to recommend appropriate therapy options. Furthermore, precise gait analyses should be carried out to record different gait parameters. Thedifferentproblems of patientsareoften very specific. Gait rehabilitationcan utilizemany different strategies today. It is helpful to ensure a basic need for different therapy options that positively influence differentfactors suchas gait cycle, stride length,step width,cadence, endurance, balance, motordeficits, step length, mobility, etc. Guidelines often give an approximate idea of what a therapy plan can look like. Inaddition, to classic physical therapy, therapies such as proprioceptiveneuromuscularfacilitation, differentmotor learning techniques and context-or task-specific training can be used. Functional electrical stimulation has been used for stroke patients for many years and has proven its effectiveness. Basic training of the complex gait cycle throughtreadmilltraining is a crucial step in gait rehabilitation. Inthe next fewyears developmentof new methods may find theirwayinto gaitrehabilitation.
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