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.

Tuesday, June 14, 2022

Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study

 Quit making excuses for not getting stroke patients 100% recovered.  My directors never allowed excuses even for the hardest problems given to me to solve.  Some of my programming problems took months to solve. I wasn't allowed to give up like this research does.

Association of Pre-stroke Frailty With Prognosis of Elderly Patients With Acute Cerebral Infarction: A Cohort Study

Fuxia Yang, Nan Li, Lu Yang, Jie Chang*, Aijuan Yan* and Wenshi Wei*
  • Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China

Background: Frailty is a state of cumulative degradation of physiological functions that leads to adverse outcomes such as disability or mortality. Currently, there is still little understanding of the prognosis of pre-stroke frailty status with acute cerebral infarction in the elderly.

Objective: We investigated the association between pre-stroke frailty status, 28-day and 1-year survival outcomes, and functional recovery after acute cerebral infarction.

Methods: Clinical data were collected from 314 patients with acute cerebral infarction aged 65–99 years. A total of 261 patients completed follow-up in the survival cohort analysis and 215 patients in the functional recovery cohort analysis. Pre-stroke frailty status was assessed using the FRAIL score, the prognosis was assessed using the modified Rankin Scale (mRS), and disease severity using the National Institutes of Health Stroke Scale (NIHSS).

Results: Frailty was independently associated with 28-day mortality in the survival analysis cohort [hazard ratio (HR) = 4.30, 95% CI 1.35–13.67, p = 0.014]. However, frailty had no independent effect on 1-year mortality (HR = 1.47, 95% CI 0.78–2.79, p = 0.237), but it was independently associated with advanced age, the severity of cerebral infarction, and combined infection during hospitalization. Logistic regression analysis after adjusting for potential confounders in the functional recovery cohort revealed frailty, and the NIHSS score was significantly associated with post-stroke severe disability (mRS > 2) at 28 days [pre-frailty adjusted odds ratio (aOR): 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.002] or 1 year (pre-frailty aOR: 8.86, 95% CI 3.07–25.58, p < 0.001; frailty aOR: 7.68, 95% CI 2.03–29.12, p = 0.003).

Conclusions: Pre-stroke frailty is an independent risk factor for 28-day mortality and 28-day or 1-year severe disability. Age, the NIHSS score, and co-infection are likewise independent risk factors for 1-year mortality.

Introduction

Stroke has become the second largest cause of death and the third largest cause of disability after ischemic heart disease and is an important factor in disability-adjusted life-years (DALYs) lost in people over 50 years old (1). In China, the prevalence of stroke exceeds that of ischemic heart disease, with more than 2 million new cases per year, making stroke the most DALYs lost among all diseases (2). Although measures such as endovascular intervention and the establishment of stroke centers have significantly reduced the mortality of the cerebrovascular disease, surviving patients have also increased the social disability burden (3). Functional recovery tended to stabilize at 3–6 months after stroke, but the recovery of different patients still showed individual differences, and some patients had accelerated accumulation of disabilities over time (46).

Frailty status is a meaningful manifestation of aging in the population, characterized by a decline in function across multiple physiological systems. This decline is a disproportionate change in health status caused by small stress events accompanied by an increased vulnerability to stressors (7). Frailty is more prone to negative outcomes and is a predictor of all-cause mortality (8, 9). Acute cerebral infarction produces a major impact on the body and makes patients more prone to adverse events, such as poststroke pneumonia (10), persistent disability (11), and neurocognitive disorders (12).

Shanghai, the country's most populous city, has 3,824,400 registered residents aged 65 years and above in 2020, nearly 25.9% of the population (13). There are 40 large-scale general hospitals in Shanghai. A cross-sectional study based on Fried's frailty phenotype was used to assess frailty status was performed in 780 Shanghai suburban older adults aged 65–74 years in 2019. The percentages of robust, pre-frail, and frail were 48.46, 47.69, and 3.85% (14).

This study aimed to establish the relationship between pre-stroke frailty and outcomes after acute ischemic stroke. We divided participants into survival and functional recovery cohorts and explored 28-day and 1-year post-stroke outcomes.

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