Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 27,749 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.
Changing stroke rehab and research worldwide now.Time is Brain!trillions and trillions of neuronsthatDIEeach day because there areNOeffective 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.
Occupational therapy’s role in the rehabilitation of stroke
includes the evaluation, assessment, and treatment of sensorimotor,
musculoskeletal, cognitive, and psychosocial symptoms (Rowland, Cooke,
& Gustafsson, 2008). Additionally, occupational therapists have been
identified by the American Stroke Association as a key member of the
rehabilitation team as part of a stroke survivor’s recovery (American
Stroke Association, 2022). We looked at how senori-motor interventions
given in occupational therapy could effect upper extremity motor
function in patients who have experienced a stroke.
Findings: We found that sensori-motor interventions of mirror therapy,
repetitive peripheral nerve simulation and hands-on therapy, in
conjunction with traditional occupational therapy services can improve
upper extremity motor function in patients who have experienced a
stroke.
You'll have to ask your doctor if this would help your post stroke cognitive impairment. But then if you have to ask the question it means your doctor isn't up-to-date on the latest research. You need a new one.
Those with amnestic mild cognitive impairment who used the BrainHQ
app for visual speed and attention exercises improved neuropsychological
measures of speed, attention, memory and connectivity.
Amnestic mild cognitive impairment is a sub-classification of those
with mild cognitive impairment who show significant memory impairment
and are among the highest at risk for Alzheimer’s disease.
Source: Shutterstock.com.
Quanjing Chen, PhD, MS, a
postdoctoral researcher at University of Rochester, and colleagues
enrolled 84 patients with amnestic mild cognitive impairment. Chen and
colleagues randomized them into an intervention group who used the
BrainHQ app from Posit Science and an active control group who played
brain-stimulating games, such as sudoku or solitaire.
Each group was asked to engage in their activities for 1 hour, four
times a week, for 6 weeks. Compared with the control group, the
intervention group showed significant improvement in standard measures
of speed, attention and working memory.
“It was not long ago that the consensus was there’s little to be done for patients with [mild cognitive impairment],” Henry Mahncke, PhD, CEO of Posit Science, said in a company-issued press release. “Fortunately, that consensus is changing.”
According to the release, more than 100 published studies have shown
the benefits of the BrainHQ app, and it has shown gains in standard
measures of cognition and quality of life. BrainHQ is now offered
through Medicare Advantage plus.
With your good chance of getting dementia
this test should be prescribed by your doctor to establish a baseline
for you. And then if found implement THOSE EXACT DEMENTIA PREVENTION PROTOCOLS your doctor should have competently already set up.
Your risk of dementia, has your doctor told you of this?
Researchers
have identified a blood biomarker that could help identify people with
the earliest signs of dementia, even before the onset of symptoms.
The findings were published in the Journal of Alzheimer’s Disease.
Emer
McGrath, MD, College of Medicine Nursing and Health Sciences, National
University of Ireland Galway, Galway, Ireland, and colleagues measured
blood levels of P-tau181, a marker of neurodegeneration, in 52
cognitively healthy adults who were part of the US-based Framingham
Heart Study, who later went on to have specialised brain positron
emission tomography (PET) scans. The blood samples were taken from
people who had no cognitive symptoms and who had normal cognitive
testing at the time of blood testing.
The analysis found that
elevated levels of P-tau181 in the blood were associated with greater
accumulation of ß-amyloid on specialised brain scans. These scans were
completed on average 7 years after the blood test.
Further analysis showed the biomarker P-tau181 outperformed t2other biomarkers in predicting signs of ß-amyloid on brain scans.
“The
results of this study are very promising,” said Dr. McGrath. “P-tau181
has the potential to help us identify individuals at high risk of
dementia at a very early stage of the disease, before they develop
memory difficulties or changes in behaviour.”
The research team said the identification of a biomarker also points to the potential for a population screening programme.
“This
study was carried out among people living in the community, reflecting
those attending GP practices,” said Dr. McGrath. “A blood test measuring
P-tau181 levels could potentially be used as a population-level
screening tool for predicting risk of dementia in individuals at mid to
late-life, or even earlier. This research also has important potential
implications in the context of clinical trials. Blood levels of P-tau181
could be used to identify suitable participants for further research,
including in clinical trials of new therapies for dementia. We could use
this biomarker to identify those at a high risk of developing dementia
but still at a very early stage in the disease, when there is still an
opportunity to prevent the disease from progressing.”
So this did nothing for getting survivors recovered. What is the only goal in stroke? 100% recovery! All stroke research should solve that problem. You can go down the stroke prevention route after you solve 100% recovery.
Intracranial
atherosclerotic disease is one of the leading causes of ischemic
strokes and poses a moderate risk of recurrence. Diagnosis is currently
limited to stenosis on luminal imaging, which likely underestimates the
true prevalence of the disease. Detection of non-stenosing intracranial
atherosclerosis is important in order to optimize secondary stroke
prevention strategies. This review collates findings from the early
seminal trials and the latest studies in advanced radiological
techniques that characterize symptomatic intracranial atherosclerotic
disease across various imaging modalities. While computed tomography
angiography (CTA) and magnetic resonance angiography (MRA) comprise
diagnostic mainstays in identifying stenotic changes secondary to
atherosclerosis, emerging techniques such as high-resolution MRA,
quantitative MRA, and computational fluid dynamics may reveal a myriad
of other underlying pathophysiological mechanisms.
If you want to increase your lung capacity to live longer, I suppose you could ask your doctor, but more likely you just need to read the book, 'Breath' by James Nestor. Pages 58-71, but actually the whole book needs to be absorbed and followed.
Forced expiratory volume (FEV). This is the amount of air expired during the first, second, and third seconds of the FVC test.
To read the full-text of this research, you can request a copy directly from the authors.
Abstract
Results
from several studies have described a relationship between pulmonary
function and both all-cause and cause-specific mortality. The purpose of
this study was to investigate the predictive value of pulmonary
function by gender after 29 years of follow-up.
Prospective study with 29-year follow-up of the Buffalo Health Study
cohort.
Randomly selected sample of 554 men and 641 women, aged 20 to 89 years,
from all listed households of the city of Buffalo, NY.
Baseline measurements were performed in 1960 to 1961. Pulmonary function
was assessed based on FEV(1) expressed as the normal percent predicted
(FEV(1)%pred). FEV(1)%pred adjusted by age, body mass index, systolic
BP, education, and smoking status was inversely related to all-cause
mortality in both men and women (p<0.01). A sequential survival
analysis in participants who had a survival time of at least 5, 10, 15,
20, and 25 years after enrollment in the study was also performed.
Except for men who survived for > 25 years, we observed a
statistically significant negative association between FEV(1)%pred and
all-cause mortality. FEV(1)%pred was also inversely related to ischemic
heart disease (IHD) mortality. When participants were divided into
quintiles of FEV(1)%pred, participants in the lowest quintile of
FEV(1)%pred experienced significantly higher all-cause mortality
compared with participants in the highest quintile of FEV(1)%pred. For
the entire follow-up period, the adjusted hazard ratios for all-cause
mortality were 2.24 (95% confidence interval [CI], 1.60 to 3.13) for men
and 1. 81 (95% CI, 1.24 to 2.63) for women, respectively. Hazard ratios
for death from IHD in the lowest quintile of FEV(1)%pred were 2.11 (95%
CI, 1.20 to 3.71) and 1.96 (95% CI, 0.99 to 3.88) for men and women,
respectively.
These results suggest that pulmonary function is a long-term predictor
for overall survival rates in both genders and could be used as a tool
in general health assessment.
Stroke survivors should never have to be considered heroes. With 100% recovery protocols they just have to do the work as prescribed and recovery will occur.
American Stroke Association Confers Prestigious Honor to Three-Time Stroke Survivor
LOS GATOS, Calif., April 28, 2022 /PRNewswire/ -- The American Stroke Association has bestowed its annual Stroke Survivor Hero Award to Deb Shaw, a three-time stroke survivor and the Founder and President of Champion the Challenges,
a nonprofit foundation committed to helping inspire and motivate stroke
survivors and their families to persevere during this life challenge.
The American Stroke Association, a division of the American Heart
Association, the world's leading voluntary health organization devoted
to fighting cardiovascular disease and stroke, created the Stroke Hero
Awards to honor stroke survivors, health care professionals, and family
caregivers from around the country.
"I am humbled and grateful to be honored with the 2022 Stroke Survivor Hero Award," said Deb Shaw.
"This has been a pivotal point in my life to dedicate my focus,
first-hand experience, and commitment to helping the challenges of
stroke worldwide."
In September 2016, Shaw survived a PONS
ischemic stroke in her sleep that immobilized her dominant right side.
She spent seven days in the ICU and another month at Good Samaritan
Hospital in Los Gatos, California, for in-patient rehabilitation.
In December 2016, Shaw avoided some
complications from a second stroke when, in her doctor's office for a
follow-up, she experienced stroke symptoms. While in the ER, doctors
administered a TPA-IV immediately, and she spent six days in the ICU.
Then in May 2019, Shaw suffered a third stroke in her right retina, resulting in another five-day stay in the hospital.
Shaw channeled her energies into launching Champion the Challenges,
uncovering several therapies such as Healthcare VR, Neuro Acupuncture
and Hyperbaric Oxygen, to name a few that she incorporated into her
aggressive healing regimen. Her philosophy is focused on staying
patient, remaining positive, and practicing stretches in between
therapies for continuous improvement.
In the first year since Deb co-founded her nonprofit foundation with her husband Bob Shaw,
she has inspired 750+ stroke survivors and families, and served as a
featured speaker at more than 30 stroke awareness events and support
groups. Champion the Challenges has also provided nearly 1,000
quick-read self-help booklets for free to area hospitals and stroke
survivors. She has also helped stroke survivors write and tell their
stories which she has featured on the group's website.
"The Stroke Hero Awards were created in 2020 as a way to nationally
recognize incredible individuals and groups who are working to prevent,
treat or beat stroke, the No. 5 killer and a leading cause of disability
in the U.S.," said Stephanie Mohl, vice president of the American Stroke Association. "This year we recognize Deb Shaw
as the Survivor Hero for the incredible impact she has made and the
work she continues to do to help educate, inspire and raise awareness
about stroke."
The winners of the Stroke Hero Awards demonstrate that resilience in
the face of change is possible and should be celebrated. Winners were
selected by a panel of volunteer judges from the American Stroke
Association. Winners receive a plaque and have their stories featured on
stroke.org and on the American Stroke Association's social media
accounts.
About Champion the Challenges
Champion the Challenges is a non-profit foundation with a mission to
help stroke survivors, therapists, family, and friends to reimagine
stroke rehabilitation. This is a journey everyone needs to be a part of
to achieve the best results. Founded in 2021, Champion the Challenges
provides inspiring ideas and helpful resources for everyone to use and
share.
So your 'best' is still a complete failure, none are referred to as 100% recovered. Who is being fired for that incompetence? If I never 100% solved the problems I was assigned I would be fired immediately. You can't allow the tyranny of low expectations to allow your hospital to retain incompetent persons.
The study covered in this summary was published in medRxiv.org as a preprint and has not yet been peer reviewed.
Key Takeaways
Recipients of the return home program (RHP) were admitted
to a long-term care facility less frequently and later than other
patients, suggesting that institutionalization is sometimes a
consequence of inadequate or late home care.
Implementing an integrated care program of healthcare and social care for stroke
patients at discharge successfully promoted early domiciliary care
delivery, resulting in less frequent and later institutionalization in a
long-term care facility.
The benefits of postdischarge integrated care services for
stroke patients are likely to increase through the pooling of budgets
and approaches that integrate social services and healthcare services as
a whole.
Why This Matters
Stroke affects over 80 million people worldwide and is the leading cause of disability among adults.
Owing to their limited capacity for activities of daily
living, stroke patients often require domiciliary care after hospital
discharge.
The healthcare burden of stroke is expected to increase in
the upcoming years. There is thus a need for implementing integrated
care pathways that efficiently screen stroke patients. There is also a
need for adequate postdischarge care plans that meet the social and
healthcare needs of patients.
Study Design
The health outcomes and the use of resources of 92 stroke
patients who received care within the RHP program were compared with
those of a population-based matched control group using central
healthcare records regarding routine care.
Patients in the intervention group received domiciliary
care service, home rehabilitation, and telecare significantly earlier
than the matched control patients.
The primary objective of the study was to assess the time
to key events, which included adverse endpoints (ie, death and
institutionalization in a long-term care facility) and service provision
endpoints (ie, receiving domiciliary care, telecare, and at-home
rehabilitation services).
Key Results
Within the first 2 years after the stroke episode,
recipients of the RHP program were less frequently institutionalized in a
long-term care facility (5% vs 15%).
The use of primary care services, nonemergency transport, and telecare services was more frequent in the RHP group.
Two years after the index stroke episode, domiciliary care
was being provided to 92.4% of patients in the RHP group and to 19.1% of
the control group. Telecare services were provided to 75.5% of the RHP
group and to 44.5% of the control group 2 years after the index episode.
Two years after the index stroke episode, 98.4% of patients
in the RHP group were receiving at-home rehabilitation; among the
control group, 84.8% were receiving at-home rehabilitation.
The semi-humanoid Pepper robot is being used in The Cognition, Aging and
Rehabilitation Lab at Ben-Gurion University of the Negev to help
stroke patients.
New studies on rehabilitation support the theory that not all therapy needs to be hands-on.
Take
stroke patients, for instance. While for most stroke patients,
rehabilitation requires physical therapy as patients need to relearn
simple motor activities like walking and sitting, occupational therapy
(relearning daily activities like eating and dressing), and speech
therapy, formal caregivers are not always available due to budget
constraints or insufficient staff, and informal caregivers (spouses,
family members) don’t always have the skill set or the patience.
Prof.
Shelly Levy-Tzedek says socially assistive robots, or robots that
assist using social cues, can help support and treat patients in
rehabilitation from stroke or other conditions when human caregivers are
not available. In her work leading The Cognition, Aging and
Rehabilitation Lab at Ben-Gurion University, she regularly conducts
studies with other researchers on how these social robots help improve
the well-being of people who need rehabilitation.
Prof.
Shelly Levy-Tzedek and her team at The Cognition, Aging and
Rehabilitation Lab are using socially assistive robots to help stroke
patients. Photo by Dani Machlis / BGU
Earlier
this year, Levy-Tzedek, and fellow professors Ayelet Dembovski and Yael
Amitai, published the methodology for their system and the initial
results of a study that highlighted the use of socially assistive robots
that support patients dealing with stroke. The team developed a
robot-based gamified exercise platform for long-term post-stroke
rehabilitation, came up with seven gamified based on functional tasks,
and used the semi-humanoid robot Pepper manufactured by Softbank
Robotics for the study.
The study looked at mixed attitudes
towards the robots, motivation for use, and the differences in
interaction between the patient and a human therapist vs. a patient and
an assistive robot. The study was published in the journal Frontiers in Rehabilitation Science.
Socially
assistive robots “help the person, not physically – they don’t move
their limbs or they don’t move something in the world for the person –
but they get them to do something themselves. So one of the biggest
projects in the lab in the past few years has been a socially assistive
robot that helps people who’ve had a stroke, do their exercise,” Prof.
Shelly Levy-Tzedek tells NoCamels.
While the person can do the
exercise on their own, Prof. Levy-Tzedek says socially assistive robots
can provide extra benefits like motivation, companionship, and a
gamified system that could make the patient feel like he is playing a
game rather than relearning skills or completing tasks.
The other benefit is that the robot could be taken home in the future.
In
the study, researchers collected and analyzed information from 23
patients (11 stroke patients and 12 informal caregivers) who
participated in a total of six focus-group discussions. The patients
answered questions regarding the use of a socially assistive robot to
promote physical exercises during the rehabilitation process including
the advantages and disadvantages, specific needs the robot would
address, adaptions the patient would propose to include, and concerns
regarding the technology.
A team headed by Prof. Shelly Levy-Tzedek used the semi-humanoid robot Pepper to help support stroke patients. Deposit Photos
“We
found that the majority of the participants in both groups were
interested in experiencing the use of a SAR (socially assistive robot)
for rehabilitation, in the clinic and at home,” the authors wrote in the
study.
“This is a study that we ran in the clinic with patients
who have had a stroke, previously being healthy individuals. This was a
pilot experiment in the lab, and then we ran it with actual stroke
patients in the clinic. We did over two years during COVID-19,” she
explains.
The clinical results have not yet been published, but Levy-Tzedek says they are “promising.”
“This
is the first experiment of its kind in the world in that it’s a
long-term experiment with stroke patients in the clinic with a social
robot. So this hasn’t been done before. There were studies with stroke
patients that were just one-off meetings with a robot which is a good
first start, but You need to do the experiment in the long term because
rehabilitation is a long-term endeavor. So you have to see how people
react to it over the long term and whether the novelty wears off after a
while. And then do people still continue and we see that they do,” she
says.
Rehab robots assist stroke patients
Levy
Tzedek, a biomedical engineer who studied at UC Berkeley and earned a
Master of Science and PhD from Massachusetts Institute of Technology
(MIT,) uses what she calls “off-the-shelf robots” and fits them with a
platform developed in the lab. “Off-the-shelf” means they are
commercially available.
“It’s
not a robot we built. What we did is build a whole platform around it,”
she explains. In the case of stroke patients, “this is a platform that
helps people after stroke perform exercises.”
“Now, you might
wonder, is it the robot that matters? Or is it the platform that we
developed? People who used the computer instead of the robot to give
them instructions and feedback – so exactly the same platform, but a
computer was providing the instructions and the feedback [instead of the
robot] – they also got better, but not to the same extent,” she
explains, “So more people got better with a robot.”
People who
have had a stroke often lose the ability to perform tasks that were
trivial before something like buttoning their own shirt, slicing bread,
or placing a jar on a shelf. These are things that have to be practiced
thousands of times, and some of this practice is done in a clinic with a
physical therapist or an occupational therapist, but a lot of the
practice has to be done on its own.
“In general, when we look at
compliance with physical therapy exercises, it’s around 30 percent. So
we wanted to get people to do more self-exercise, but in a guided way –
giving them motivation but also feedback. So that’s the idea behind
this,” she says.
Stroke patients often lose the ability to perform
daily actions with everyday objects. Tasks that were trivial before —
like buttoning a shirt, slicing bread, or placing a jar on a shelf — are
suddenly tasks that have to be practiced thousands of times. Some of
the practice is done in a clinic with a physical therapist but a lot of
it is done at home, where the patient needs to do it on his own.
Prof. Shelly Levy-Tzedek (left) and Lab Engineer Yuliya Berdichevsky. Photo by Dani Machlis / BGU
“So
if they have to relearn how to button a shirt, they actually have to
use a button and try to do the actual activity because they have to
relearn how to coordinate their muscle activity. And just strengthening
their muscles is not enough, using virtual reality is good, but not
sufficient, they have to actually do the tasks that they’re trying to
relearn how to do, which is why we use everyday objects in all of the
practice,” Levy-Tzedek explains, “
The everyday objects have RFID
(radio frequency identification) tags on them. RFID is a form of
wireless communication that can identify an object. This is done so researchers can know where each item is placed and the robot can give feedback to the person.
“What
they do is they give a task using the screen and also speech and they
say to place the, in this case, orange, green and blue cups in this
particular arrangement. And the person does that. And because we have
these sensors, we know exactly where they place the objects and we and
the robot can then give them feedback,” Levy-Tzedek says.
During
the interview, Levy-Tzedek showed some of the setups where a patient was
practicing various tasks using the help of a socially assistive robot.
In one kitchen setup, the patient was tasked with placing kitchen items
on a shelf. They had to place the items as well as remember where they
should be placed. In another escape room setup, they had to find items
as requested by the robot. In a third setup, a robot played Blackjack
with the patient and the patient had to remember his cards and play the
game correctly.
The value of a socially assistive robot
What
is it about the robot that makes it better or different from a human?
Levy-Tzedek says it’s “something that we’re trying to figure out.” Her
team has done numerous in-depth interviews with people over time,
including in the beginning and middle of the experiment, and even after
they’ve completed it.
“We asked them about their experience and
what they thought and it seems that at the same time they were treating
it as a human but then also not as a human,” she explains, citing
examples that the robot made mistakes (they would tell the patient he
did something wrong when he was correct) and some were frustrated by the
incident while others let it roll off their back. On the other hand,
patients were afraid that a human therapist would be judgemental of
them, even though therapists aren’t supposed to be judgemental. The
robot could not be judgemental and this was a plus.
“At the same
time, they treat it as a human, but then also not as a human. And they
take the best out of each. And I will say, though, that people were
most interested in continuing to work with a robot when they felt that
they actually had a benefit to their functional rehabilitation and when
they felt they got better when they would go home at the end of the
session, and they were able to do something that they weren’t able to do
before,” Levy-Tzedek explains, “That was the strongest predictor of how
much they would want to come and then work with it again, and continue
working with a robot. So it wasn’t just some sort of halo effect of
using technology, but the actual benefit that they reaped from working
with it.
Rare, Revolutionary Simulation Machines to Be Tested in Centerville, Utah with Stroke/TBI Survivors for Viability in Neurorehabilitation Market
CENTERVILLE, Utah, April 27, 2022
/PRNewswire-PRWeb/ -- Torque3, the company combining VR and motion
simulation technology currently designed for stroke and TBI
rehabilitation, announced today the opening of the Alpha Program
– its private pay assessment program developed to evaluate its
proprietary experience that puts survivors in direct control of their
recovery.
Right now, participants have a rare chance to be one of
the first few stroke or TBI survivors to experience this revolutionary
neurorehabilitation platform. The exclusive opportunity is limited to
just 40 participants.
Torque3
has created a simulated environment that mimics real-life through
tactile feedback from the motion sim base, pedals, and steering arms.
Survivors can even feel the G-forces when they make a hard turn, the
wind on their face, and smell the forest or waterfall as they pedal
past. This fully immersive, multi-modal experience transforms 'going to
therapy' into a thrilling adventure!
The
program is anticipated to run for at least six months and is seeking
participants who are serious about regaining their independence.
Torque3's engineers will be actively involved with these 40 participants
to create an experience tailored to meet their specific requirements,
and these survivors will be individually accommodated as much as
possible.
The Alpha Program is scheduled to open in the Summer of 2022, in Centerville, Utah (about 10 miles north of Salt Lake City).
This
new approach to stroke therapy is designed to be infinitely more
tolerable — even enjoyable — than traditional physical therapy, in hopes
of making attendance and participation much higher. The goal is to
achieve even greater gains and faster results.
During this Alpha
Program, Torque3 will continue to gather data and fine-tune the survivor
experience before moving into the next phase. There are only four of
these platforms on the planet, and only three of these can be accessed
at any one time. This is an opportunity to be one of the first to
explore the benefits of this truly revolutionary rehabilitation platform
before it makes its product offering to the rehabilitation market
expected in Q4 of 2022.
"There is nothing like this for recovery
exercise offered anywhere for stroke or TBI survivors, who are often
told they've 'plateaued,' and no further gain is possible. If you don't
accept that, you are perfect for our program. You don't want to miss out
on this incredible opportunity with extremely limited spots available,"
said Torque3 CEO David Ellzey.
Torque3
offers the only rehabilitation solution that engages the mind, body,
and all the senses in an intense, deeply immersive task-orientated
therapy.
Currently, neurorehabilitation for stroke survivors
results is fewer than 10 percent resuming an active, independent
lifestyle. This is where Torque3 believes it can make the most
significant impact.
The ideal candidate for this intensive stroke rehabilitation
program is not satisfied with learning to live with their 'new normal'
of limited mobility and lack of independence after their stroke or TBI.
In addition, they often feel overwhelmed and demoralized because of the
neurological impact of their stroke/TBI and just want to feel whole
again.
You'll have to ask your doctor what the common names of these are so you can be informed and ask your doctor why drugs are given that carry a risk of stroke.
Correspondence to: A Bénard-Laribière, Service de Pharmacologie Médicale, Hôpital Pellegrin, Bordeaux, France, anne.benard@u-bordeaux.fr
Accepted 15 February 2022
Abstract
Objective To estimate the risk of ischaemic stroke associated with antidopaminergic antiemetic (ADA) use.
Design Case-time-control study.
Setting Data from the nationwide French reimbursement healthcare system database Système National des Données de Santé (SNDS).
Participants
Eligible participants were ≥18 years with a first ischaemic stroke
between 2012 and 2016 and at least one reimbursement for any ADA in the
70 days before stroke. Frequencies of ADA reimbursements were compared
for a risk period (days -14 to -1 before stroke) and three matched
reference periods (days -70 to -57, -56 to -43, and -42 to -29) for each
patient. Time trend of ADA use was controlled by using a control group
of 21 859 randomly selected people free of the event who were
individually matched to patients with stroke according to age, sex, and
risk factors of ischaemic stroke.
Main outcome measures
Association between ADA use and risk of ischaemic stroke was assessed
by estimating the ratio of the odds ratios of exposure evaluated in
patients with stroke and in controls. Analyses were adjusted for time
varying confounders (anticoagulants, antiplatelets, and prothrombotic or
vasoconstrictive drugs).
Results
Among the 2612 patients identified with incident stroke, 1250 received
an ADA in the risk period and 1060 in the reference periods. The
comparison with the 5128 and 13 165 controls who received an ADA in the
same periods yielded a ratio of adjusted odds ratios of 3.12 (95%
confidence interval 2.85 to 3.42). Analyses stratified by age, sex, and
history of dementia showed similar results. Ratio of adjusted odds
ratios for analyses stratified by ADA was 2.51 (2.18 to 2.88) for
domperidone, 3.62 (3.11 to 4.23) for metopimazine, and 3.53 (2.62 to
4.76) for metoclopramide. Sensitivity analyses suggested the risk would
be higher in the first days of use.
Conclusions
Using French nationwide exhaustive reimbursement data, this
self-controlled study reported an increased risk of ischaemic stroke
with recent ADA use. The highest increase was found for metopimazine and
metoclopramide.
Introduction
The
risk of ischaemic stroke with centrally acting antidopaminergic
antipsychotics has been highlighted in large observational studies,
especially in older patients and among people with dementia.123
The risk is considerable at the start of treatment, 12 times higher in
the first month of use, and progressively declines over time and falls
to baseline after three months of treatment.456
Dopamine receptor antagonism is the main determinant of antipsychotic
action. Although antipsychotics also block a variety of other receptors
(muscarinic, histaminergic, serotoninergic, adrenergic), possible
mechanisms by which these drugs might cause stroke could relate to this
dopamine antagonism.6
Research is lacking on the risk of stroke for non-antipsychotic
dopamine receptor antagonists, such as antidopaminergic antiemetics
(ADAs). ADAs are peripheral D2 receptor antagonists with a direct effect
on the chemoreceptor trigger zone, which lies outside the blood-brain
barrier. However, some ADAs, such as metoclopramide, cross the
blood-brain barrier and are also low potency central antidopaminergics.
Moreover, stroke occurrence can be triggered by mechanisms that do not
require any crossing of the blood-brain barrier because blood vessels
are located outside the blood-brain barrier. ADAs are widely used in
general practice for the treatment of nausea and vomiting of different
causes (migraine, chemotherapy or radiotherapy, postoperative). Given
the well known risk of ischaemic stroke associated with antidopaminergic
antipsychotics and the widespread use of ADAs, we assessed the
association between ischaemic stroke and ADAs in a real world setting.
Older adults had a 16% lower risk for developing parkinsonism after
taking statins for 6 years compared with those not on statins, a report
published in Neurology showed.
Shahram Oveisgharan, MD, assistant professor
of neurological sciences at Rush Medical College in Chicago, and
colleagues assessed 2,841 people (average age, 76 years) who did not
have parkinsonism, 936 of whom were taking statins. Researchers
monitored participants annually for an average of 6 years to check
statin usage and signs of parkinsonism.
Source: Adobe Stock.
At the conclusion of the study, 1,432 people (50%) had developed
signs of parkinsonism. Of the 936 who were taking statins, 418 people
(45%) had developed parkinsonism compared with 1,014 of 1,905 (53%) who
were not taking statins.
“Our results suggest people using statins may have a lower risk of
parkinsonism, and that may be partly caused by the protective effect
statins may have on arteries in the brain,” Oveisgharan said in a press
release from the American Academy of Neurology. “Our results are
exciting, because movement problems in older adults that come under the
umbrella of parkinsonism are common, often debilitating and generally
untreatable.”
Further, about 79% of participants on statins were taking moderate or
high intensity doses. Those taking higher intensity doses had a 7%
lower risk for developing parkinsonism vs. those taking low intensity
doses.
Researchers also noted that 1,044 participants died during the study,
and post-mortem examination of their brains revealed that those taking
statins had 37% reduced odds of atherosclerosis compared with those who
had not been taking statins.
“More research is needed, but statins could be a therapeutic
option in the future to help reduce the effects of parkinsonism in the
general population of older adults, not just people with high
cholesterol or who are at risk for stroke,” Oveisgharan said. “At a
minimum, our study suggests brain scans or vascular testing may be
beneficial for older adults who show signs of parkinsonism but don’t
have classic signs of Parkinson’s disease or do not respond to
Parkinson’s disease medications.”
1Department
of Neurology, The Second Affiliated Hospital, Zhejiang University
School of Medicine, Hangzhou, People’s Republic of China; 2Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China; 4School of the Second Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence:
Dehao Yang, Department of Neurology, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang,
People’s Republic of China, Email wzmcydh@163.com; Yiyun Weng,
Department of Neurology, The First Affiliated Hospital of Wenzhou
Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of
China, Email wengyiyun2012@126.com
Background and Purpose:
Albumin to globulin ratio (A/G) has been established as a
representative biomarker for assessing inflammation and nutritional
status. However, the prognostic value of A/G has rarely been reported in
acute ischemic stroke (AIS) patients with intravenous thrombolysis
(IVT). Methods: A total of 311 AIS patients who had
undergone IVT and completed 3-month follow-up were retrospectively
recruited in this study. Albumin (Alb), globulin (Glb) and A/G on
admission, within 24 hours after IVT and on day 7 were recorded. Poor
outcome was defined as death or major disability (modified Rankin Scale,
3– 6) at 3 months. Results: Among the 311 cases,
260 patients had admission blood samples, 296 cases had blood samples
within 24 hours after IVT and 126 cases had blood samples on day 7. The
patients with and without available blood samples were well-balanced.
During the first 24 h, we observed A/G to increase significantly
compared with baseline whereas at day 7 it was almost back to baseline
in patients with a poor outcome. Receiver operating characteristic (ROC)
curves analysis showed that A/G had a better performance in
discriminating patients at high risk and low risk of a poor outcome than
either Alb or Glb alone and carried the highest predictive ability on
day 7 (AUC = 0.807). Lower 7-day A/G was independently associated with a
poor outcome (per-SD increase, OR = 0.182, 95% CI: 0.074– 0.446). Conclusion: A/G is an important prognostic indicator for AIS outcomes and merits dynamic monitoring.
Acute ischemic stroke (AIS), a type of acute cerebrovascular disease,
caused by obstruction of blood vessels, is a primary disease
contributing to adult morbidity and mortality. Intravenous thrombolysis
(IVT) using recombinant tissue plasminogen activator (rt-PA) within 4.5
hours after AIS onset is accepted as a standard therapy for AIS patients
nowadays. However, nearly two-thirds of AIS patients do not experience
clinical benefit after IVT. This situation creates a need for prognostic
factors that would help clinicians identify those AIS patients who are
more likely to have poor function outcomes.
Blood biochemistry tests are one of the most commonly prescribed
tests. Blood samples could be obtained from AIS patients at an early
stage. Total serum protein is composed of albumin (Alb) and globulins
(Glb), and abnormalities in the albumin/globulin ratio (A/G) have been
observed in different clinical states including malnutrition, cancer,
severe liver disease and rheumatic diseases.1–3 A recent study reported that higher serum A/G is associated with better cognitive function in community-dwelling older people.4
Besides, A/G showed a good prognostic value and remained an independent
predictor of 90-day and 1-year mortality in patients with chronic heart
failure.5 Beamer et al.6
suggested that lower levels of A/G are associated with increased risk
for recurrent vascular events after AIS. However, few studies have
examined the prognostic value of A/G in AIS patients with r-tPA
administration. In the present study, considering Alb, Glb and A/G might
be dynamic variables during hospitalization, we aimed to investigate
(1) the dynamic profile of Alb, Glb and A/G in AIS patients during the
first 7 days; (2) the association between Alb, Glb, A/G and 3-month
clinical outcome; and (3) the predictive ability and incremental
predictive ability of Alb, Glb and A/G for poor function outcomes in AIS
patients treated with IVT r-tPA.
