Deans' stroke musings: Abstract TMP26: Cerebral Atrophy and Functional Outcome After Intensive Rehabilitation in Elderly Patients With Ischemic Stroke

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Monday, April 11, 2016

Abstract TMP26: Cerebral Atrophy and Functional Outcome After Intensive Rehabilitation in Elderly Patients With Ischemic Stroke

Ask your doctor what they are doing to address cerebral atrophy and don't be polite about it.

Abstract TMP26: Cerebral Atrophy and Functional Outcome After Intensive Rehabilitation in Elderly Patients With Ischemic Stroke

+ Author Affiliations

¹Dept of Stroke Medicine, Hoshigaoka Med Cntr, Osaka, Japan
²Dept of Rehabilitation, Hoshigaoka Med Cntr, Osaka, Japan
³Dept of Neurology, Hoshigaoka Med Cntr, Osaka, Japan

Abstract

Introduction: Functional outcome after stroke is predicted to be unfavorable in patients with dementia. However, sometimes it is difficult to know prestroke cognitive function in patients with aphasia and other cognitive impairments.

Hypothesis: Cerebral atrophy in patients without dementia is a predictive marker for functional outcome following intensive rehabilitation after ischemic stroke.

Methods: In patients aged 65 years or older with acute ischemic stroke in our stroke center, those who were moved to a rehabilitation unit and underwent intensive rehabilitation for 1–3 months were selected. Patients with prestroke modified Rankin scale ≥ 2 or with diagnosed dementia were excluded. Severity of cerebral atrophy was assessed on axial brain MRI performed with routine protocols in an acute phase. Hippocampal atrophy, cortical atrophy, and subcortical atrophy were separately assessed using the visual rating scales. Functional status was measured using the Functional Independence Measure (FIM) scale after 2 weeks from onset (FIM 1), when a patient was moved to a rehabilitation unit (FIM 2), and at the time of discharge (FIM 3). We retrospectively investigated the association between cerebral atrophy and FIM scores.

Results: In a total of 197 patients (119 men and 78 women; median age, 74 years), the average time interval between stroke onset and transfer to the rehabilitation unit was 33.8 days and the length of stay in the unit was 58.7 days. FIM 1–3 scores were strongly associated with age, initial stroke severity, and cerebral atrophy. In the multivariate analyses, subcortical atrophy was significantly associated with FIM 1 (P=0.02), FIM 2 (P=0.003) and FIM 3 (P=0.008), and hippocampal atrophy was associated with FIM 3 (P=0.01) but not with FIM 1 and FIM 2 after adjusting for age, sex, stroke severity, and rehabilitation periods. Cortical atrophy was not associated with FIM scores after adjusting for age and other related factors.

Conclusion: In elderly patients without apparent dementia, subcortical atrophy and hippocampal atrophy assessed on axial brain MRI with simple visual ratings were remarkable predictors of poor functional outcome after ischemic stroke.