Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 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:

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.
My back ground story is here:

Saturday, December 15, 2018

Here’s why laughter is the best medicine—besides actual medicine

A highly effective stroke prevention tool. Is this too difficult for your doctor to understand?  Or too expensive to buy a few comedy DVDs and some DVD players?

Here’s why laughter is the best medicine—besides actual medicine

John Murphy, MDLinx | December 13, 2018
As the old saying goes, laughter is the best medicine—but for what? Can laughter cure cancer or defeat the common cold? Can laughing fix erectile dysfunction? Hmm, probably not.
Laughter really is good (if not the best) medicine for a range of ailments, from chronic pain to improved cardiovascular function.
We know that laughing has the intangible ability to make us feel better—it reduces tension and helps us cope. But laughter has also shown measurable clinical effects in the body: It releases endogenous opioids and endorphins in the brain, increases the activity of natural killer cells to strengthen the immune system, and lowers cortisol levels in blood circulation for stress reduction. Moreover, laughter is known to increase tolerance to pain and improve vascular function.
All in all, that’s pretty good medicine. Here are a few more examples of how laughter can be effective (if not the best) medicine.

Improv improves ADLs in Parkinson’s patients

There’s nothing funny about Parkinson’s disease—but maybe there should be.
After performing in an improv comedy course, people with Parkinson’s disease showed significant improvement in activities of daily living, reported researchers at Northwestern University Feinberg School of Medicine, Chicago, IL, in Parkinsonism & Related Disorders.
For this study, the researchers recruited patients with Parkinson’s disease to participate in a 12-week course operated by The Second City®, an improvisational comedy group known for launching the careers of professional funny people like John Belushi, Bill Murray, Steve Carrell, Tina Fey, and many others. At the end of the course—in which all but one participant attended at least 80% of the once-weekly classes—patients showed significantly improved scores on a ratings scale of activities of daily living (ADLs).
For people with Parkinson’s disease, “as mobility becomes limited, spontaneity of thought and action also becomes impaired,” the researchers wrote. “Because the success of an improv scene requires an element of risk-taking, playfulness, and support, the personal development benefits of practicing may include a greater ability to ‘live in the moment’ and focus.”

A laugh a day keeps the cardiologist away

Can laughter prevent cardiovascular disease? Researchers in Japan have found that people who said they never or almost never laugh had 1.21 times higher prevalence of heart disease compared with people who reported laughing every day, even after adjustment for confounding risk factors. The prevalence ratio for stroke was even greater: 1.60 times higher among never-laughers compared with daily laughers, the researchers reported in the Journal of Epidemiology.
For this study, the researchers analyzed cross-sectional data of 20,934 men and women aged 65 years or older from the Japan Gerontological Evaluation Study. After adjusting for hyperlipidemia, hypertension, depression, body mass index, and other risk factors, the researchers determined that daily laughter is associated with lower prevalence of cardiovascular diseases.
“Although our study could not clearly show any preventive effect of laughter on cardiovascular diseases due to its cross-sectional nature, the present findings are consistent with such an effect, since those who reported having been diagnosed with stroke or heart disease were found not to laugh as often as those who did not have a history of stroke or heart disease,” the amusing authors hilariously concluded.
They acknowledged that their study did have limitations. For one, they couldn’t rule out “reverse causality”—meaning that people with serious illnesses, such as stroke and heart disease, may have less frequent occasions to feel cheerful. Another limitation: Laughter itself may be a sign of having a physically and/or mentally positive lifestyle.
“People who have a more positive outlook on life may be more motivated to engage in healthy behaviors, such as exercise, healthy diet, and moderation in alcohol consumption,” the authors wrote. “Although we controlled for many of these behaviors, the possibility of residual confounding cannot be ruled out.”

Laughter lightens chronic pain in seniors

“Humor therapy” is an effective nonpharmacological intervention for chronic pain in nursing home residents, according to researchers in a study published in the Journal of Aging Research.
Because many older people simply accept pain as a part of aging, they don’t seek help until their pain becomes severe and unbearable. To add insult to injury, chronic pain not only impairs functional mobility and increases health-care costs, but also often results in social isolation, loneliness, and depression in older folks, the researchers observed.
To that end, they recruited two groups of similar residents in similar nursing homes to find out if humor therapy could reduce chronic pain and loneliness, and improve happiness. In one nursing home, 36 residents participated in an 8-week humor program, while 34 residents in another nursing home were evaluated but not offered the program. About two-thirds of all residents reported chronic pain.
During the humor program, participants made a “happy” scrapbook, heard and told jokes, had laughing exercises, and participated in other funny activities and games. Researchers found that at the end of the program, participants had significant reductions in pain scores and loneliness measures, as well as significant increases in happiness and life satisfaction scores. Sadly, those in the control group had no such improvements. (But don’t worry—the team visited these folks after the study and provided humor activities for them, too.)
The researchers concluded that humor therapy is an effective—and appealing—intervention for reducing pain and loneliness, and increasing happiness and life satisfaction.
“Nurses and other healthcare professionals can incorporate humor in caring for their patients. Telling a joke and encouraging clients to tell a funny story may have a therapeutic effect,” the authors suggested. “Regardless of their physical condition, patients need to allow themselves to be happy, to let humor play a greater role in their lives, and to enjoy life.”

Red meat raises heart disease risk through gut bacteria

Be careful out there. Maybe 50 years from now your doctor will have copied someone else's diet protocol.  Paleo diet?

Red meat raises heart disease risk through gut bacteria

Healthline/Medical News Today | December 13, 2018
Scientists have uncovered further evidence of how a diet rich in red meat interacts with gut bacteria to raise the risk of heart disease.
They found that people who ate red meat as their main source of protein for 1 month had levels of trimethylamine N-oxide (TMAO) that were two to three times higher than those in people who got their protein primarily from white meat or non-meat sources.
Gut bacteria produce TMAO as a byproduct when they feed on certain nutrients during digestion.
Previous studies have implicated high circulating levels of TMAO in the development of artery-blocking plaques and raised risk of heart-related conditions.
In the recent research, scientists at the Cleveland Clinic in Ohio uncovered two mechanisms through which a diet rich in red meat raises TMAO levels.

It appears that not only does frequent consumption of red meat enhance gut bacteria production of TMAO, but it also reduces elimination of the compound through the kidneys.

The European Heart Journal has published a report on the study and its findings.
"This is the first study of our knowledge," says senior study author Dr. Stanley L. Hazen, who chairs the Department of Cellular and Molecular Medicine in the Cleveland Clinic's Lerner Research Institute, "to show that the kidneys can change how effectively they expel different compounds depending on the diet that one eats—other than salts and water."

TMAO as a predictor of heart disease risk

In previous work, Dr. Hazen and his team had found that TMAO alters blood platelets to raise the risk of thrombosis, or blood clots.
Their work revealed that TMAO modifies calcium signaling in blood platelets. In addition, it showed that platelets respond differently to blood-clotting triggers when blood levels of TMAO are high.

The team proposed that the compound could be a powerful predictor of the risk of heart attack, stroke, and death—even when cholesterol and blood pressure levels are healthy.

Others have since replicated the findings and, like Dr. Hazen and his team, have continued to investigate TMAO and its impact on health.
Research from the University of Leicester in the UK, for example, demonstrated that people with acute heart failure fared worse if they had higher circulating levels of TMAO.
Clinical trials are also underway to test TMAO as a predictive marker of heart disease risk.

Red meat diet compared with other diets

The recent study assigned 113 individuals to follow three tightly controlled diets in a random order for 4 weeks each with a "washout diet" preceding the changeover.
The diets differed according to their main source of protein. In the red meat diet, 12% of the daily calories came from lean red meat in the form of pork or beef, while in the white meat diet, these calories came from lean white poultry meat.
In the non-meat diet, 12% of the daily calorie intake came from "legumes, nuts, grains, [and] isoflavone-free soy products."
In all three diets, protein accounted for 25% of the daily calories, and the remaining 13% of this protein came from "eggs, dairy, and vegetable sources."

After 4 weeks on the red meat diet, "the majority of" the individuals had raised levels of TMAO in their blood and urine.

On average, compared with levels during the white meat and non-meat diets, blood levels of TMAO during the red meat diet were up to three times higher. For some individuals, the levels were 10 times higher. Urine samples revealed a similar pattern.

Reduced kidney efficiency

The study also yielded an unexpected result. While on the red meat diet, the study participants' kidneys were less efficient at expelling TMAO.
However, in the 4 weeks after ceasing the red meat diet, their blood and urine levels of TMAO fell.
Dr. Hazen says that the findings show that people can reduce their risk of heart-related problems by changing what they eat.
Gut production of TMAO was lower and kidney elimination was higher when the individuals followed the white meat or non-meat protein diet.
This suggests, says Dr. Hazen, that these types of diet are more healthful for the heart and body.
"We know lifestyle factors are critical for cardiovascular health, and these findings build upon our previous research on TMAO's link with heart disease."
—Dr. Stanley L. Hazen
To read more, click here.

Sex and race differences in the association of incident ischemic stroke with risk factors

You mean your mentors and senior researchers don't know that race as you are using it doesn't exist? Send everyone back to the drawing board to find out the real reason for the differences. Incompetence in stroke reigns supreme. 

Genetically Speaking, Race Doesn't Exist In Humans.

Sex and race differences in the association of incident ischemic stroke with risk factors

JAMA NeurologyHoward VJ, et al. | December 12, 2018
In this prospective cohort study, researchers investigated the incidence and risk factors for ischemic stroke by sex for black and white individuals. They found that, for both races, women were at lower risk of stroke at 45-64 years of age vs men, and there was no sexual difference at age ≥ 75 years. However, the pattern of sexual difference may vary by race from age 65-74 years. The risk factors associated with stroke risk varied by race-sex groups. The association of hypertension, diabetes, and heart disease with stroke risk varied by sex for white individuals but not black individuals. Some demographic subgroups might require earlier and more aggressive strategies while the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups.

  • Study participants included individuals aged ≥ 45 years who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental US 2003-2007 with follow-up through October 2016.
  • From March 2018 to September 2018, data were analyzed.
  • Exposures included sex and race.
  • Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors were included main outcomes and measures.


  • There were a total of 25,789 participants (14,170 women [54.9%]; 10,301 black individuals [39.9%]).
  • Over 222,120 person-years of follow-up, there were 939 ischemic strokes: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%).
  • White women aged 45-64 years had a 32% lower risk of stroke vs white men, and black women had a 28% lower risk than black men.
  • They observed that lower risk of stroke in women than men persisted in white individuals at ages 65-74 but not in black individuals.
  • However, the race-sex interaction was not significant.
  • There was no sex difference in stroke risk for either race at age ≥ 75 years.
  • Associations of systolic blood pressure, diabetes, and heart disease with stroke risk were greater for women than men for white individuals.
  • On the other hand, the association of antihypertensive medication use was greater among men vs women.
  • There was no evidence of a sex difference for any risk factors in black people.
Read the full article on JAMA Neurology

Less Than Ideal Trends in Cardiovascular Health Among US Stroke Survivors

You can COMPLETELY BLAME your doctors and stroke hospital. You are not gotten to 100% recovery thus not being able to do enough physical activity.   You have NO diet protocol, so no healthy diet.  NO diet protocol for natural blood pressure  and cholesterol control.  This is all your doctors responsibility, don't let them deflect responsibility by quoting this asinine response; 'All strokes are different, all stroke recoveries are different'.

Less Than Ideal - Trends in Cardiovascular Health Among US Stroke Survivors

Originally publishedStroke. 2018;0:STROKEAHA.118.022644

Background and Purpose—

The American Heart Association’s Life’s Simple 7 (LS7) defines ideal cardiovascular health by 7 metrics: not smoking, regular physical activity, normal body mass index, blood pressure, plasma glucose, and total cholesterol levels, and a healthy diet. We assessed prevalence and predictors of ideal LS7 among US stroke survivors.


Among 67 514 participants in the National Health and Nutrition Examination Surveys from 1988 to 1994 and 1999 to 2014, 1597 adults (≥18 years) had self-reported history of stroke. LS7 metrics were categorized as poor, intermediate, and ideal; ideal LS7 scores were calculated (1 point for each ideal metric met). Trends in poor, intermediate, and ideal cardiovascular health were assessed. Odds of low (0–1) versus high (≥4) ideal LS7 scores were assessed according to sex, race, poverty income ratio, and education level, before and after adjusting for covariates.


Only 1 participant met all ideal LS7 metrics. The proportion with low LS7 score increased from 17.9% in 1988 to 1994 to 35.4% in 2011 to 2014 (P<0.001). Over that time frame, prevalence of poor blood pressure (≥140/90 mm Hg) and poor cholesterol (≥240 mg/dL) decreased (45.2%–26.5% and 37.2%–10.3%), whereas prevalence of poor body mass index (≥30 kg/m2), poor diet (healthy eating index score <50), and poor physical activity (0 minutes moderate/vigorous activity per week) increased (26.9%–39.0%; 14.2%–50.6%; 44.6%–70.9%; all P<0.05). After adjustment, black race (odds ratio, 2.29; 95% CI, 1.17–4.48), poverty income ratio ≤200% (odds ratio, 2.20, 95% CI, 1.11–4.36), and ≤12th grade education (odds ratio, 4.50; 95% CI, 2.27–8.92) were associated with low ideal LS7 scores.


Over the past 3 decades, blood pressure and cholesterol control among stroke survivors improved, but rates of obesity, poor diet, and physical inactivity increased. Stroke survivors who are black, poor, or less educated are less likely to have ideal cardiovascular health.

Association between vitamin D status and cognitive impairment in acute ischemic stroke patients: a prospective cohort study

I see nothing here that suggests that this is being written up as a stroke protocol and distributed worldwide to all stroke hospitals and doctors. Isn't that the minimum needed to 'do no harm'? 

Is this just Vitamin D or D3? Inquiring minds want to know.  Does low vitamin D cause this problem or the underlying reason that initially caused the low levels the real problem? Have you actually identified the root cause?

Vitamin D3 Could Help Prevent, Repair Cardiovascular System Damage

The latest here:

Association between vitamin D status and cognitive impairment in acute ischemic stroke patients: a prospective cohort study

Authors Chen H, Liu Y, Huang G, Zhu J, Feng W, He J
Received 11 September 2018
Accepted for publication 18 November 2018
Published 10 December 2018 Volume 2018:13 Pages 2503—2509
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Andrew Yee
Peer reviewer comments 3
Editor who approved publication: Dr Wu

Huijun Chen,1,* Yuntao Liu,1,* Guiqian Huang,1,* Jie Zhu,2 Wenqian Feng,2 Jincai He1

1Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; 2Department of Mental Health, Mental Health School, Wenzhou Medical University, Wenzhou 325000, China

*These authors contributed equally to this work

Objective: Previous studies found that low vitamin D levels were modestly associated with risk of stroke and poor functional outcome after stroke. In addition, vitamin D deficiency has been linked with cognitive decline. Our study aimed to explore the potential relationship between vitamin D levels in the short-term acute phase of ischemic stroke and cognitive impairment at 1 month.
Methods: In total, 354 ischemic stroke patients were consecutively enrolled in the study and received 1-month follow-up. The serum levels of vitamin D were measured within 24 hours after admission. Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) at 1 month after acute ischemic stroke. Cognitive impairment was defined according to different education levels.
Results: According to MMSE scores, 114 participants (32.2%) had cognitive impairment at 1 month. Patients with vitamin D deficiency were more likely to have cognitive impairment than those with vitamin D insufficiency and vitamin D sufficiency (P<0.001). After adjusting for potential confounders in our Cox proportional hazards model, vitamin D deficiency was independently associated with the development of cognitive impairment in acute ischemic stroke patients.
Conclusion: Independent of established risk factors, vitamin D deficiency in the short-term phase of ischemic stroke was associated with a higher incidence of 1-month cognitive impairment.

Keywords: vitamin D, cognitive impairment, ischemic stroke, Mini-Mental State Examination
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
Download Article [PDF]  View Full Text [HTML][Machine readable]

Effects of Light Treatment on Sleep, Cognition, Mood, and Behavior in Alzheimer’s Disease: A Systematic Review

Does your doctor have the ability to recognize and implement this for stroke patients as a possible prevention for dementia? Or will incompetence reign again waiting for SOMEONE ELSE TO SOLVE THE PROBLEM?

I shouldn't ask such simple questions, I'm not medically trained and thus have no right to question the medical gods. 

Effects of Light Treatment on Sleep, Cognition, Mood, and Behavior in Alzheimer’s Disease: A Systematic Review

Dement Geriatr Cogn Disord 2018;46:371–384


Background: Bright light treatment is a therapeutic intervention mainly used to treat sleep and circadian disturbances in Alzheimer’s disease (AD) patients. Recently, a handful of studies also focused on the effect on cognition and behavior. Conflicting findings are reported in the literature, and no definite conclusions have been drawn about its specific therapeutic effect.  
Summary: The aim of this review is to provide a critical evaluation of available evidence in this field, highlighting the specific characteristics of effective bright light treatment. Eligible studies were required to assess at least one of the following outcome measures: sleep, cognition, mood, and/or behavior (e.g., depression, agitation). A total of 32 articles were included in this systematic review and identified as research intervention studies about light treatment in AD. The quality of the papers was evaluated based on the US Preventive Service Task Force guidelines.  
Key Messages: Overall, the current literature suggests that the effects of light treatment in AD patients are mixed and may be influenced by several factors, but with a general trend toward a positive effect. Bright light seems to be a promising intervention treatment without significant adverse effects; therefore, further well-designed randomized controlled trials are needed taking into account the highlighted recommendations.
© 2018 S. Karger AG, Basel
Mitolo M.a · Tonon C.a,b · La Morgia C.c,d · Testa C.e · Carelli V.c,d · Lodi R.a,b
Author affiliations
Corresponding Author

Friday, December 14, 2018

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

You as a survivor will need to get involved. Otherwise it will never occur to them that they need to write protocols NOT guidelines.  

The real problem here is using recommendations and guidelines. If you were using protocols you would have a defined objective starting diagnosis, exact instructions on what to do and an efficacy rating. 


2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

and on behalf of the American Heart Association Stroke Council
Originally publishedStroke. 2018;49:e46–e99


Please see the following corrections to this publication:

Background and Purpose—

The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates.


Members of the writing group were appointed by the American Heart Association Stroke Council’s Scientific Statements Oversight Committee, representing various areas of medical expertise(Missing the most important people - survivors). Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council’s Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format.


These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings.


These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.


Thursday, December 13, 2018

Respect difficult problems, stroke is a difficult problem, leaders tackle difficult problems

Another great blog by Seth Godin. Until our leaders step up to the plate survivors will be screwed.  Prevention press releases are the pinnacle of laziness and incompetency.

Respect difficult problems 

They’re difficult because they resist simple solutions. Glib answers and over-simplication have been tried before, and failed.
People have tried all of the obvious solutions. They haven’t worked. That’s why we’ve resorted to calling them difficult problems.
Difficult problems require emotional labor, approaches that feel risky and methods that might not work. They reward patience, nuance and guts, and they will fight off brute force all day long.

Neuroprotective role of hypothermia in hypoxic-ischemic brain injury: combined therapies using estrogen

But is your doctor already treating you with testosterone? Would the combination of testosterone and estrogen cause problems?

Testosterone gel shown for first time to benefit men over 65


Testosterone Improves Woman’s Brain Functions


Low testosterone and the risk of dementia in elderly men



Neuroprotective role of hypothermia in hypoxic-ischemic brain injury: combined therapies using estrogen

Hypoxic-ischemic brain injury is a complex network of factors, which is mainly characterized by a decrease in levels of oxygen concentration and blood flow, which lead to an inefficient supply of nutrients to the brain. Hypoxic-ischemic brain injury can be found in perinatal asphyxia and ischemic-stroke, which represent one of the main causes of mortality and morbidity in children and adults worldwide. Therefore, knowledge on underlying mechanisms triggering these insults may help establish neuroprotective treatments. Selective Estrogen Receptor Modulators and Selective Tissue Estrogenic Activity Regulators exert several neuroprotective effects, including decrease of reactive oxygen species, maintenance of cell viability, mitochondrial survival, among others. However, these strategies represent a traditional approach of targeting a single factor of pathology without satisfactory results. Hence, combined therapies, such as the administration of therapeutic hypothermia with a complementary neuroprotective agent, constitute a promising alternative. In this sense, the present review summarizes the underlying mechanisms of hypoxic-ischemic brain injury and compiles several neuroprotective strategies, including Selective Estrogen Receptor Modulators and Selective Tissue Estrogenic Activity Regulators, which represent putative agents for combined therapies with therapeutic hypothermia.

Two Memory Tests Accurately Predict Brain Atrophy, Alzheimer’s Disease

How many decades before your stroke hospital gives these to every stroke patient? You have to look at the actual research to see that one of the tests is the Rey Auditory Verbal Learning Test. Then your doctor needs specific protocols that will reverse such brain atrophy and prevent Alzheimers. That is the minimum your doctor is responsible for.  DEMAND such competence.

Two Memory Tests Accurately Predict Brain Atrophy, Alzheimer’s Disease

The use of 2 memory tests assessing episodic memory made the diagnosing of mild cognitive impairment (MCI) due to Alzheimer’s disease more precise, and the tests helped identify those individuals with an increased risk of receiving an Alzheimer’s diagnosis within the next 3 years, according to a study published in Brain Imaging and Behavior.“The use of 2 memory tests markedly improved the accuracy of the prognosis for an Alzheimer’s disease diagnosis and brain atrophy in the medial temporal lobes during a 3-year follow-up period,” said Eero Vuoksimaa, MD, University of Helsinki, Helsinki, Finland. “The results highlight the importance of neuropsychological assessment as a cost-effective method of diagnosing mild cognitive impairment due to Alzheimer’s disease.”
The study utilised data collected in the United States under the Alzheimer’s Disease Neuroimaging Initiative (ADNI), comprising 230 cognitively normal individuals and 394 individuals with MCI on the basis of poor memory performance in 1 episodic memory measure, namely in story recall.
Those with MCI were further divided into 2 groups based on whether their memory performance was impaired only in 1 (story recall) or 2 (story recall and word list recall) tests.
The researchers investigated baseline differences between the groups in terms of Alzheimer’s disease cerebrospinal fluid biomarkers, finding that those who performed poorly in both episodic memory tests more closely resembled Alzheimer’s patients than those who only did poorly in the story recall test.
“During the follow-up stage, brain atrophy in the medial temporal lobes of those who only performed poorly in the story recall test did not differ from the cognitively healthy participants, whereas in those who had poor performance in both the story and word list recall tests, brain atrophy was faster,” said Dr. Vuoksimaa.
Alzheimer’s disease was diagnosed in approximately half of the participants who performed poorly in both episodic memory tests within the 3-year study period, whereas only 16% of those with a poor performance in only 1 memory test received diagnosis of Alzheimer’s Disease.
Several prior studies have shown that word list recall tests predict the risk of Alzheimer’s disease as well as or even better than brain imaging or cerebrospinal fluid biomarkers.
“In this study, we employed age adjusted cut-off points for memory, which produces a diagnostic method directly adaptable to clinical use,” said Dr. Vuoksimaa. “Indeed, more comprehensive neuropsychological assessment including at least 2 episodic memory tests could be introduced as part of the health evaluation of the ageing population, particularly in cases where memory impairment is suspected.”
“Our method could also be used when selecting participants for clinical drug trials,” he added. “When looking for preventive drug therapy for Alzheimer’s disease, it would be important to be able to identify those individuals whose early cognitive impairment is due to Alzheimer’s disease.”
SOURCE: University of Helsinki

Efficacy of Cognitive Rehabilitation in Alzheimer Disease: A 1-Year Follow-Up Study

Maybe you want to have your doctor give you this protocol as a preventative for your likely dementia. But I know nothing, demand your doctor give you effective dementia prevention protocols. Isn't that what doctors are for?

The reason you need dementia prevention: 

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.


Efficacy of Cognitive Rehabilitation in Alzheimer Disease: A 1-Year Follow-Up Study

First Published November 26, 2018 Research Article
The benefit of cognitive rehabilitation (CR) for patients with early-stage Alzheimer disease (AD) remains difficult to assess.
An observational, prospective study was conducted in a sample of 52 patients with AD included in a clinical, individualized CR program. Cognitive rehabilitation consisted of 1 weekly session during 3 months at home, followed by 1 monthly contact for 9 months. Rehabilitation techniques were used by experienced therapists to adapt activities important for the patient. Evaluation of patient’s dependence in activities and objective and subjective caregiver’s burden was performed with a research quantitative scale immediately after the intervention and at 6-month and 1-year follow-up.
Analyses with repeated measure analysis of variance showed decreased patient’s dependence for adapted activities at 3 months, 6 months, and 1 year. Objective and subjective percentage of caregiver’s burden was also decreased at all evaluations with our research functional scale, while there was no change on Zarit’s burden scale. Global cognition slightly decreased over 1 year.
This observational study in a clinical setting is in line with the benefit of CR for patients with mild AD reported in recent randomized controlled trials. The benefit obtained for adapted activities remained after 1 year, even if global cognition declined. Moreover caregiver’s burden related to all individually relevant daily activities (from a list of 98) evaluated within the CR program was decreased after 1 year. Those preliminary results emphasize the importance of choice for the measurement instrument to report CR efficacy and claim for further validation of such tools.

Spilling the beans: How much caffeine is too much?

I must metabolize it quickly since I do 8-10 cups daily.  I need all the other compounds in coffee for my dementia and Parkinson's prevention. Don't follow me, I'm not normal. 

Spilling the beans: How much caffeine is too much?

FDA Press Announcements | December 12, 2018
Do you drink just one cup of coffee or tea first thing in the morning, hoping the caffeine in it will jump-start your day? Do you follow it up with a caffeinated beverage or two and then drink several more cups of coffee throughout the day?
Does it matter?
According to scientists at the FDA, caffeine can be part of a healthy diet for most people, but too much caffeine may pose a danger to your health. Depending on factors such as body weight, medications you may take, and individual sensitivity, “too much” can vary from person to person.
Learn more about caffeine in the following questions and answers.

1. Which kinds of foods and beverages contain caffeine?

Caffeine can be found naturally in the plants we use to make coffee, tea and chocolate. It’s also found in some plants used as flavorings, such as guarana, or alternative teas popular in South American, such as yerba mate (Ilex paraguariensis) and Ilex guayusa.
Caffeine may also be added as an ingredient to foods and beverages.

2. How do you know how much caffeine a food or beverage contains?

Many packaged foods, including beverages and dietary supplements containing caffeine, voluntarily provide information on the label as to how much caffeine they contain. Consumers should take care when consuming for the first time a new packaged food containing added caffeine if the amount of caffeine in the food is not declared on the label.
There are several online databases that provide estimates of caffeine content of certain foods and beverages such as coffee and tea. However, the amount in these brewed beverages can vary depending on such factors as how and where the coffee beans and tea leaves were grown and processed and how the beverage product is prepared.
For reference, a 12 ounce can of a caffeinated soft drink typically contains 30 to 40 milligrams of caffeine, an 8-ounce cup of green or black tea 30-50 milligrams, and an 8-ounce cup of coffee closer to 80 to 100 milligrams. Caffeine in energy drinks can range from 40-250 mg per 8 fluid ounces.

3. If a coffee or tea says “decaffeinated,” does that mean it contains no caffeine?

No. Decaf coffees and teas have less caffeine than their regular counterparts, but they still contain some caffeine. For example, decaf coffee typically has 2-15 milligrams in an 8-ounce cup. If you react strongly to caffeine in a negative way, you may want to avoid these beverages altogether.

4. How much caffeine is too much?

For healthy adults, the FDA has cited 400 milligrams a day—that's about four or five cups of coffee—as an amount not generally associated with dangerous, negative effects. However, there is wide variation in both how sensitive people are to the effects of caffeine and how fast they metabolize it (break it down).
Certain conditions tend to make people more sensitive to caffeine’s effects, as can some medications. In addition, if you’re pregnant, trying to become pregnant, or breastfeeding, or are concerned about another condition or medication, we recommend talking to your health care provider about whether you need to limit caffeine consumption.
The FDA has not set a level for children, but the American Academy of Pediatrics discourages the consumption of caffeine and other stimulants by children and adolescents.

5. How do you know if you’ve consumed more caffeine than you can tolerate?

Over-consuming caffeine can cause:
  • insomnia
  • jitters
  • anxiousness
  • fast heart rate
  • upset stomach
  • nausea
  • headache
  • a feeling of unhappiness (dysphoria)

6. Does caffeine pose a danger to your health?

The FDA estimates toxic effects, like seizures, can be observed with rapid consumption of around 1,200 milligrams of caffeine, or 0.15 tablespoons of pure caffeine.
Pure and highly concentrated caffeine products present a significant public health threat and have contributed to at least two deaths in the US in the last few years. (In April, the FDA took action to protect consumers from these products.)
These products, often labeled as dietary supplements, consist of pure or highly concentrated caffeine in powder or liquid forms and are often marketed in bulk packaging with up to thousands of servings per container, requiring the consumer to measure out a safe serving from what can be a toxic or even lethal amount of bulk product.
The risk of caffeine overdose increases as the concentration of caffeine in the product increases, meaning even small dosages of a highly concentrated product could lead to dangerous effects. Just one teaspoon of pure powdered caffeine can contain the same amount of caffeine as 28 cups of coffee, and a half cup of a liquid highly concentrated caffeine product contains the equivalent of more than 20 cups of coffee. These are toxic amounts that can have serious health consequences, including death.

7. Is it okay for kids to consume caffeine?

We recommend you consult with your health care provider for advice regarding your child’s caffeine consumption.

8. Is drinking a lot of caffeine a substitute for sleep?

No. Caffeine is a stimulant, which may cause you to be more alert and awake, but it is not a substitute for sleep. Typically, it can take 4 to 6 hours for your body to metabolize half of what you consumed. So, a cup of coffee at dinner may keep you awake at bedtime.

9. How can I cut back on caffeine without causing unpleasant side effects?

If you’re used to drinking caffeine-containing beverages every day, and want to cut back, it’s best to do so gradually. Stopping abruptly can cause withdrawal symptoms such as headaches, anxiety, and nervousness. Unlike opioid or alcohol withdrawal, caffeine withdrawal is not considered dangerous, but it can be unpleasant. You may want to talk to your health care provider about how to cut back.
To read more, click here.

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training

I would think that perturbation training would be much better because you would be able to recover from balance problems and thus prevent the fall.  But I know nothing, I'm not medically trained. This falls under the same category that you learn faster from your mistakes than from practicing perfection. 

Decreasing Fear of Falling in Chronic Stroke Survivors Through Cognitive Behavior Therapy and Task-Oriented Training

Originally publishedStroke. 2018;0:STROKEAHA.118.022406

Background and Purpose—

Research has shown that balance training is effective for reducing the fear of falling in individuals with a history of stroke. In this study, we evaluated (1) whether cognitive behavior therapy could augment the beneficial effects of task-oriented balance training (TOBT) in reducing the fear of falling in chronic stroke survivors and (2) whether it could, in turn, reduce fear-avoidance behavior and improve related health outcomes.


Eighty-nine cognitively intact subjects with mildly impaired balance ability were randomized into the following 2 groups that underwent 90-minutes interventions 2 days per week for 8 weeks: (1) cognitive behavior therapy + TOBT or (2) general health education + TOBT (control). The primary outcome was the fear of falling, and the secondary outcomes were fear-avoidance behavior, balance, fall risk, independent daily living, community integration, and health-related quality of life. The outcomes were assessed at baseline, after 4 and 8 weeks of intervention, and 3 and 12 months after completing the intervention.


Eighty-two subjects completed the intervention and follow-up assessments. From postintervention to 12 months after completing the intervention, the cognitive behavior therapy + TOBT participants reported greater reduction in the fear of falling and fear-avoidance behavior and greater improvements in balance and independent daily living than the general health education + TOBT participants.


Cognitive behavior therapy should be considered as an adjuvant therapy to standard physiotherapy for cognitively intact individuals(So you cherry picked participants?, I expect recovery for all. Yes that will be more difficult but leaders tackle difficult problems. Are you a mouse or a leader?)  with a history of stroke.

Clinical Trial Registration—

URL: Unique identifier: NCT02937532

UK Stroke Association Project Grants

YOU have to infiltrate this to make sure that there is a stroke strategy being followed that will solve all the problems in stroke.   

Then that ALL research results in stroke rehab protocols.

And only research that can be mapped to the stroke strategy is funded. 

I see nothing here that suggests a strategy is being followed. Survivors need to be in charge, this is way too fucking important to leave to non-survivors. They have NO understanding of what needs to be done.  

UK Stroke Association Project Grants

Elderly Mississippi man murders wife who had stroke, police say

You can blame the stroke doctors for this. They did nothing to stopthe 5 causes of the neuronal cascade of death in the first week.  And then had NO stroke rehab protocols to get to 100% recovery. No hope, no way ahead.

Elderly Mississippi man murders wife who had stroke, police say

An elderly man is accused of shooting and killing his wife in a possible mercy killing, the Clinton Police Department said Wednesday.
The husband was identified as Thomas Ballenger, 70. He is accused of fatally shooting his wife Rebecca Ballenger, also 70, Clinton Police Lt. Josh Frazier said.
The couple had been married for over 40 years.
Frazier said Rebecca Ballenger had a stroke and that Thomas Ballenger told police his wife told him she didn't want to live that way.
Ballenger has been charged with murder and denied bond.
Police responded to a call Tuesday at around 10 p.m. for a report of a shot or shots fired at Woodlands Rehabilitation and Healthcare Center, according to Clinton Police Department spokesman Mark Jones. When officers arrived, they found Rebecca Ballenger dead.
Frazier said Thomas Ballenger used a revolver and shot his wife more than once. Thomas Ballenger surrendered to the nursing staff outside of his wife's room after the shooting, Frazier said.
Police said Thomas Ballenger said he was depressed and felt very guilty about his wife's stroke.
Officials at the Hinds County Jail said there was no one named Ballenger at their facility Wednesday. Frazier said the police department would not be releasing Ballenger's mugshot. When asked if Thomas Ballenger was on suicide watch, Frazier said, "we're keeping a close eye on him."
"This is the saddest crime I've ever worked, Frazier said.
Tuesday night's shooting was the first homicide since 2014, according to Clinton Police Dept. spokesman Mark Jones.
Mercy killings are not allowed in most states, including Mississippi law. However, withholding or withdrawal of "life-sustaining" measures may be permitted in some circumstances.
Contact Harold Gater at 601-961-7368 or Follow him on Twitter.


Wednesday, December 12, 2018

Impact of Microbleeds on Outcome Following Recanalization in Patients With Acute Ischemic Stroke

Just why the hell are we using the Rankin scale for measuring anything in stroke? It has no discriminatory power and nothing objective except for 6 - death.

Impact of Microbleeds on Outcome Following Recanalization in Patients With Acute Ischemic Stroke

Originally publishedStroke. 2018;0:STROKEAHA.118.023084

Background and Purpose—

We analyzed the association between cerebral microbleeds (CMBs) and clinical outcome in acute ischemic stroke patients and especially in a subgroup of patients with successful recanalization.(Your definition of success is obviously not what it should be. 100% recovery, not the lazy, 'Hey we got the artery open')


A total of 1532 acute ischemic stroke patients treated with intravenous thrombolysis or mechanical thrombectomy were enrolled in this prospective cohort study. The primary outcome was measured using the modified Rankin Scale at 3 months, according to the CMB status based on magnetic resonance imaging at admission. Favorable outcome was defined as functional independence with modified Rankin Scale scores of 0 to 2. Secondary outcomes included the occurrence of symptomatic intracranial hemorrhage.


There was no statistically significant association between the presence of CMB and favorable outcome at 3 months when considering all patients (44.3% versus 37.6%; P=0.121). In patients with recanalization, the number of patients with favorable outcomes was significantly higher in the CMB-negative than in the CMB-positive group (57.0% versus 36.0%; P<0.001). In the final multivariate analysis, the presence of CMB, and in particular high CMB burden (≥5), and lobar location, were significantly associated with less favorable 3-month outcomes (odds ratio=0.57; 95% CI, 0.33−0.97; P=0.038) and symptomatic intracranial hemorrhage (odds ratio=3.21; 95% CI, 1.37−7.49; P=0.007) in patients with recanalization. In the analysis of subgroups, a statistically significant interaction was found between CMB presence and recanalization in predicting functional outcomes at 3 months.


These results indicate that the presence of CMBs, and especially high burden and lobar location, are independent predictors of poor 3-month clinical outcomes and may increase symptomatic intracranial hemorrhage risk in acute ischemic stroke patients with recanalization. Our findings suggest that CMBs lead to more unfavorable effects in patients with recanalization after large vessel occlusion than in those without recanalization.