ASA: Nearly One in Five People Develop Dementia After Stroke

 You're the ASA, don't just lazily tell us this problem exists! SOLVE THE FUCKING PROBLEM! Or get out of the way and let survivors run the ASA.

ASA: Nearly One in Five People Develop Dementia After Stroke

Almost one-fifth of people develop dementia after stroke, according to a study presented at the American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.

Raed A. Joundi, M.D., D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues used linked administrative databases to compare risk and time course of dementia among all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI). The analysis included 180,940 people with acute stroke matched (1:1) on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities and excluded people with prior dementia.

The researchers found that during a mean follow-up of 5.5 years, 33,765 individuals with acute stroke (18.7 percent) developed dementia. The rate of dementia was highest after acute stroke when compared with the general population (3.40 versus 1.88 per 100 person-years) and versus AMI (3.23 versus 1.81 per 100 person-years). Compared with the general population, the overall risk for dementia was higher in those with acute stroke (hazard ratio [HR], 1.79) and particularly after ICH (HR, 2.43). Results were similar compared with AMI (HR, 1.77). In the first year after stroke, there was an almost threefold higher risk for dementia, which decreased to 1.5-fold by five years but remained elevated even 20 years after.

“Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said in a statement.

Several authors disclosed ties to industry.

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By:

Lori Solomon

Medically Reviewed By:

Mark Arredondo, M.D.

Published on: 

Feb 08, 2024, 11:56 am

Updated on: 

Feb 08, 2024, 11:56 am

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THURSDAY, Feb. 8, 2024 (HealthDay News) -- Almost one-fifth of people develop dementia after stroke, according to a study presented at the American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.

Raed A. Joundi, M.D., D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues used linked administrative databases to compare risk and time course of dementia among all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI). The analysis included 180,940 people with acute stroke matched (1:1) on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities and excluded people with prior dementia.

The researchers found that during a mean follow-up of 5.5 years, 33,765 individuals with acute stroke (18.7 percent) developed dementia. The rate of dementia was highest after acute stroke when compared with the general population (3.40 versus 1.88 per 100 person-years) and versus AMI (3.23 versus 1.81 per 100 person-years). Compared with the general population, the overall risk for dementia was higher in those with acute stroke (hazard ratio [HR], 1.79) and particularly after ICH (HR, 2.43). Results were similar compared with AMI (HR, 1.77). In the first year after stroke, there was an almost threefold higher risk for dementia, which decreased to 1.5-fold by five years but remained elevated even 20 years after.

“Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said in a statement.

Several authors disclosed ties to industry.

Press Release

More Information

Adobe Stock

By:

Lori Solomon

Medically Reviewed By:

Mark Arredondo, M.D.

Published on: 

Feb 08, 2024, 11:56 am

Updated on: 

Feb 08, 2024, 11:56 am

• 
  
  
  

THURSDAY, Feb. 8, 2024 (HealthDay News) -- Almost one-fifth of people develop dementia after stroke, according to a study presented at the American Stroke Association International Stroke Conference 2024, held from Feb. 7 to 9 in Phoenix.

Raed A. Joundi, M.D., D.Phil., from McMaster University in Hamilton, Ontario, Canada, and colleagues used linked administrative databases to compare risk and time course of dementia among all 90-day survivors of first acute ischemic stroke or intracerebral hemorrhage (ICH) to controls in the general population and with acute myocardial infarction (AMI). The analysis included 180,940 people with acute stroke matched (1:1) on age, sex, rural residence, neighborhood marginalization, and vascular comorbidities and excluded people with prior dementia.

The researchers found that during a mean follow-up of 5.5 years, 33,765 individuals with acute stroke (18.7 percent) developed dementia. The rate of dementia was highest after acute stroke when compared with the general population (3.40 versus 1.88 per 100 person-years) and versus AMI (3.23 versus 1.81 per 100 person-years). Compared with the general population, the overall risk for dementia was higher in those with acute stroke (hazard ratio [HR], 1.79) and particularly after ICH (HR, 2.43). Results were similar compared with AMI (HR, 1.77). In the first year after stroke, there was an almost threefold higher risk for dementia, which decreased to 1.5-fold by five years but remained elevated even 20 years after.

“Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said in a statement.

Several authors disclosed ties to industry.

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Congratulations to Prof. @BoNorrving for receiving his 2020 ESO Presidential Award during #ESOC2022 in Lyon today, in recognition of his outstanding achievements and contribution in the field of #stroke 👏@ESOstroke

 Really, what are they? As president of the WSO I saw nothing during his term that got survivors better recovery. President of the World Stroke Organization (WSO) from 2008 to 2012 he created this.

The World Stroke Organization Synergium in 2010 you can see why in my opinion this is totally worthless.

Explain to me honoring someone in stroke that did nothing for survivors. 

The WSO has NO FUCKING CLUE what survivors want and really should just get the hell out of the way. 100% recovery is the only goal in stroke and every piece of stroke research should be creating protocols towards that. NOT PREDICTIONS, BIOMARKERS, OR PREVENTION.

They have zero survivor outreach, NO REHAB PROTOCOLS, no database on stroke research,  NO STRATEGY TO SOLVE STROKE. They are completely fucking useless for survivors.

I look forward to an explicit rebuttal from the president of the WSO, curious as to what excuses will be used.

Great message from @BoNorrving presenting global action plans for stroke in the Targeting Stroke Globally – Joint session with @WHO at #ESOWSO2020 the session was chaired by our fantastic Italian lead @caso_valeria

If this is anything like the World Stroke Organization Synergium in 2010 you can see why in my opinion this will also be totally worthless.

 Probably 99.9% of the research I've seen has completely the wrong objective. The WSO has NO FUCKING CLUE what survivors want and really should just get the hell out of the way. 100% recovery is the only goal in stroke and every piece of stroke research should be creating protocols towards that. NOT PREDICTIONS, BIOMARKERS, OR PREVENTION.

They have zero survivor outreach, NO REHAB PROTOCOLS, no database on stroke research,  NO STRATEGY TO SOLVE STROKE. They are completely fucking useless for survivors.

I look forward to an explicit rebuttal from the president of the WSO, curious as to what excuses will be used.

 

 

 

 Great message from @BoNorrving presenting global action plans for stroke in the Targeting Stroke Globally – Joint session with @WHO at #ESOWSO2020 the session was chaired by our fantastic Italian lead @caso_valeria

Perfect world of stroke rehab - recovery plan

From a conversation with another survivor points out the current situation.
Not good.

Lead, Follow, or GET OUT OF THE WAY!

Doesn't this just about sum up our feelings about the role doctors and therapists should play?

The one thing that pisses me off more than any other is this.  The identification and implementation of a recovery plan is apparently NOT the responsibility of doctors or therapists.  Isn't it ironic that they still maintain that proprietary attitude when a patient appears to be trespassing into what they perceive as their realm.  They manage to dismiss our ideas while effectively providing none of their own.

I once brought in an article on hand recovery using the Saeboflex. My doctor totally dismissed it, I don't think he had even thought or researched it at all. He was just never going to listen to a patient's ideas. I was so fucking mad I left him and went to a different doctor telling him the only reason I was using him was to get the Saeboflex even though my extension was not enough to meet the criteria for use. I really hated the Saeboflex, the bead chains for adjusting the tension are almost impossible to adjust one-handed and just getting it on was an extreme challenge. When I complained to Saeboflex their excuse was that the unit was supposed to be used with a therapists help. In my opinion, bad design since all stroke rehab implements should be able to be put on solo one handed with no outside interventions. 

Perfect World!!!

With decent scientific therapy protocols this could be resolved.  
This is the 100% recovery plan.

Stroke patient warned she would not recover by NHS doctors is back to health after treatment in South Africa

This is where the prognostication by the doctor takes a strange turn. If my doctor had told me I wouldn't recover I would have privately said to myself, 'Fuck you, you know nothing about what I can do, get the hell out of my way.' but others could take this nocebo response and decide to give up on recovery since the doctor told them they wouldn't recover.  Doctors need to state valid efficacy of the stroke protocols they are using. But then your doctor knows fucking nothing about stroke rehab if they write prescriptions E.T. (Evaluate and Treat) to the PT, OT and ST. 

Stroke patient warned she would not recover by NHS doctors is back to health after treatment in South Africa 

2 September 2017 • 7:00pm

A stroke patient who was warned she had ‘no capacity for recovery’ by NHS doctors is almost back to full fitness after her husband took her for rehabilitation in South Africa.
Rita Guthrie, a former laboratory chemist of Essex, was given just 30 per cent chance of survival and left physically and mentally disabled following a hemorrhage in 2008. She could barely walk, her behaviour became erratic and she was left permanently incontinent.

After two years of sporadic care by the NHS and social services, her husband David was told there was no chance she could get any better, and was advised to move her to a care home.

 

It’s a sad state of affairs that Rita’s recovery relied on the manpower and expertise of another nationDavid Guthrie

However after a friend suggested the couple try a change of climate, Mr Guthrie took his wife to Fish Hoek near Cape Town where she underwent 18 months of intensive rehabilitation over several years, which included tailor-made exercises, walking  and hydrotherapy.

A carer working to improve Mrs Guthrie's balance and coordination 

Now mother of-three Mrs Guthrie, 78, is back to full health, and has only been left with damage to her short term memory.
Mr Guthrie has written a new book, entitled Pushing the Boundaries, to encourage other Britons in a similar situation to look elsewhere for treatment. All profits will go to stroke charities.

“The experience was awful for both of us and I hate to see anyone else having to go through a similar situation,” said Mr Guthrie, 80, who met his wife when they both worked UK Atomic Energy Authority at Dounreay, Caithness.
“The lack of support or practical help from the outset in the UK left Rita being diagnosed as having ‘no capacity for recovery.
“The treatment available locally for Rita in no way matched the well-documented recommendations, such as the National Stroke Strategy, for Stroke recovery in the UK. Nor did I receive any form of training in how to cope as a carer.
“The South African therapists started with the positive assumption that Rita was able to recover, a full about turn from the conclusions drawn by our own health system which had taken a very negative view of her prospects.”

David Guthrie has written a book to encourage stroke survivors to seek better treatment  Credit: David Guthrie 

Around 152,000 people in Britain suffer a stroke each year and two thirds of those will leave hospital with a disability.  But recent figures from the Chartered Society of Physiotherapy found 85 per cent of health trusts do not offer stroke victims physiotherapy within two weeks of leaving hospital. A fifth make them wait at least 13 weeks and 4 per cent cannot offer sessions until after 18 weeks.

Figures by the Stroke Association show that nearly half of stroke survivors feel abandoned when they leave hospital, a finding that the charity described as ‘deeply concerning.’
A survey of more than 1,000 patients for the charity found more than one third reported that they returned home without a care plan or appropriate support in place for their recovery.
Almost half said they were not contacted by a healthcare professional when they returned home from hospital while 39 per cent said they did not received a six month assessment of their social care needs.

Mrs Guthrie can now enjoy hikes again 

Mrs Guthrie’s entire treatment programme in South Africa is estimated to have cost £20,000, less than half of the annual cost of a care home in Britain.
“It is nonsense to suggest that the straightforward therapy used in Fish Hoek could not be easily set up in the UK,” said Mr Guthrie.
“Seven years on from that trip to South Africa, Rita is almost back to full health although short term memory can be a little suspect at times.
“Apart from that she’s as fit and alert as any 78-year-old would expect to be.
I’ve got my wife back. We are able to do five kilometre hikes together and she was able to nurse me when I developed pneumonia.

“It’s a sad state of affairs that Rita’s recovery relied on the manpower and expertise of another nation but I hope ‘Pushing the Boundaries’ and other similar stories of fortitude can help to change our mindset in the UK.”
Pushing the Boundaries, a Personal Account of Recovery from Stroke” is available through York Publishing Services Ltd and on Amazon.

A Home-Based Functional Hand-Extremity Assessment System for Stroke Rehabilitation

What survivor gives a fuck about assessment? They want solutions you blithering idiots. Get them there or get out of the way.

A Home-Based Functional Hand-Extremity Assessment System for Stroke Rehabilitation

Author(s)

Tri Vu ; Hoan Tran ; Feng Lin ; Jeanne Langan ; Lora Cavuoto ; Wenyao Xu

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Abstract:

This paper presents a novel hand-grip system for evaluation and rehabilitation of individuals with stroke. This system contains a pair of hand dynamometers, which are sensors for the input of grip force, and LabVIEW VI software to translate the grip force into meaningful data. The hand-grip system requires the subjects to move a small ball on a computer screen toward a target, using the hand grip sensor to control the movement of the ball. It goes far beyond measuring maximum grip strength, a common clinical assessment, to adapt grip force and coordinate hands to perform daily functional activities. This system also provides advancement in home-rehabilitation options to improve the hand-grip control of individuals with stroke.

Published in: Connected Health: Applications, Systems and Engineering Technologies (CHASE), 2017 IEEE/ACM International Conference on

Date of Conference: 17-19 July 2017

Date Added to IEEE Xplore: 17 August 2017

ISBN Information:

DOI: 10.1109/CHASE.2017.105

Publisher: IEEE

Conference Location: Philadelphia, PA, USA, USA

Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice

This is totally pathetic. The goal should be negative DTN time. With an objective diagnosis in the ambulance with no neurologist needed you should be able to deliver tPA before you get to the hospital. If that is not your goal then get the fuck out of the way and let actual leaders get that done.  No endpoint was measured of total tPA efficacy of reversing the stroke. What a complete fucking waste of otherwise good research. We might have gotten how many minutes do you have to get full recovery after tPA administration. Does no one even know how to run research?
 http://circoutcomes.ahajournals.org/content/10/1/e003227?etoc=

Findings from Target: Stroke

Ying Xian, Haolin Xu, Barbara Lytle, Jason Blevins, Eric D. Peterson, Adrian F. Hernandez, Eric E. Smith, Jeffrey L. Saver, Steven R. Messé, Mary Paulsen, Robert E. Suter, Mathew J. Reeves, Edward C. Jauch, Lee H. Schwamm, Gregg C. Fonarow

https://doi.org/10.1161/CIRCOUTCOMES.116.003227

Circulation: Cardiovascular Quality and Outcomes. 2017;10:e003227

Originally published January 17, 2017

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Abstract

Background—The implementation of Target: Stroke Phase I, the first stage of the American Heart Association’s national quality improvement initiative to accelerate door-to-needle (DTN) times, was associated with an average 15-minute reduction in DTN times. Target: Stroke phase II was launched in April 2014 with a goal of promoting further reduction in treatment times for tissue-type plasminogen activator (tPA) administration.

Methods and Results—We conducted a second survey of Get With The Guidelines-Stroke hospitals regarding strategies used to reduce delays after Target: Stroke and quantify their association with DTN times. A total of 16 901 ischemic stroke patients were treated with intravenous tPA within 4.5 hours of symptom onset from 888 surveyed hospitals between June 2014 and April 2015. The patient-level median DTN time was 56 minutes (interquartile range, 42–75), with 59.3% of patients receiving intravenous tPA within 60 minutes and 30.4% within 45 minutes after hospital arrival. Most hospitals reported routinely using a majority of Target: Stroke key practice strategies, although direct transport of patients to computed tomographic/magenetic resonance imaging scanner, premix of tPA ahead of time, initiation of tPA in brain imaging suite, and prompt data feedback to emergency medical services providers were used less frequently. Overall, we identified 16 strategies associated with significant reductions in DTN times. Combined, a total of 20 minutes (95% confidence intervals 15–25 minutes) could be saved if all strategies were implemented.

Conclusions—Get With The Guidelines-Stroke hospitals have initiated a majority of Target: Stroke–recommended strategies to reduce DTN times in acute ischemic stroke. Nevertheless, certain strategies were infrequently practiced and represent a potential immediate target for further improvements.

Pace of Progress in Stroke Thrombolysis Are Hospitals Running To Stand Still?

This is totally pathetic. The goal should be negative DTN time. With an objective diagnosis in the ambulance with no neurologist needed you should be able to deliver tPA before you get to the hospital. If that is not your goal then get the fuck out of the way and let actual leaders get that done. 
http://circoutcomes.ahajournals.org/content/10/1/e003438?etoc=

Scott J. Mendelson, Shyam Prabhakaran

https://doi.org/10.1161/CIRCOUTCOMES.116.003438

Circulation: Cardiovascular Quality and Outcomes. 2017;10:e003438

Originally published January 17, 2017

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Stroke is a time-sensitive medical emergency and a leading cause of disability in the United States. Therapies to halt and even reverse ischemic injury to the brain, such as intravenous tissue-type plasminogen activator (tPA), are available, but the systems to deliver them rapidly have not been optimized to ensure timely treatment of as many eligible patients as possible. Although ≈40 000 to 50 000 acute ischemic stroke patients per year receive tPA,^1,2 benefits from the drug are not simply related to receiving it or not but rather are closely linked to time from onset to treatment.^3,4 Delays to treatment lead to more disability because every additional 5 minutes is tantamount to the permanent loss of nearly 10 million brain cells.⁵ National guidelines and quality measures have, therefore, emphasized speed of stroke thrombolysis, focusing on the time between patient arrival to the hospital and tPA administration, also known as door-to-needle (DTN) time.^6,7 Alarmingly, recommendations that hospitals evaluate acute ischemic stroke patients and administer tPA within 60 minutes(Wrong goal)of a patient’s arrival to the emergency department have existed since the original National Institutes of Neurological Disorders and Stroke tPA trial.⁸ Despite this, as the first decade of the new millennium closed, US hospitals were not meeting this goal in a majority of patients.

Improving Door-to-Needle Times for Acute Ischemic Stroke

This is totally pathetic. The goal should be negative DTN time. With an objective diagnosis in the ambulance with no neurologist needed you should be able to deliver tPA before you get to the hospital. If that is not your goal then get the fuck out of the way and let actual leaders get that done. 
http://circoutcomes.ahajournals.org/content/10/1/e003242?etoc=

Effect of Rapid Patient Registration, Moving Directly to Computed Tomography, and Giving Alteplase at the Computed Tomography Scanner

Noreen Kamal, Jessalyn K. Holodinsky, Caroline Stephenson, Devika Kashayp, Andrew M. Demchuk, Michael D. Hill, Renee L. Vilneff, Erin Bugbee, Charlotte Zerna, Nancy Newcommon, Eddy Lang, Darren Knox, Eric E. Smith

https://doi.org/10.1161/CIRCOUTCOMES.116.003242

Circulation: Cardiovascular Quality and Outcomes. 2017;10:e003242

Originally published January 17, 2017

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Abstract

Background—The effectiveness of specific systems changes to reduce DTN (door-to-needle) time has not been fully evaluated. We analyzed the impact of 4 specific DTN time reduction strategies implemented prospectively in a staggered fashion.

Methods and Results—The HASTE (Hurry Acute Stroke Treatment and Evaluation) project was implemented in 3 phases at a single academic medical center. In HASTE I (June 6, 2012 to June 5, 2013), baseline performance was analyzed. In HASTE II (June 6, 2013 to January 24, 2015), 3 changes were implemented: (1) a STAT stroke protocol to prenotify the stroke team about incoming stroke patients; (2) administering alteplase at the computed tomography (CT) scanner; and (3) registering the patient as unknown to allow immediate order entry. In HASTE III (January 25, 2015 to June 29, 2015), we implemented a process to bring the patient directly to CT on the emergency medical services stretcher. Log-transformed DTN time was modeled. Data from 350 consecutive alteplase-treated patients were analyzed. Multivariable regression showed the following factors to be significant: giving alteplase in the CT (32% decrease in DTN time, 95% confidence interval [CI] 38%–55%), stretcher to CT (30% decrease in DTN time, 95% CI 16%–42%), patient registered as unknown (12% decrease in DTN time, 95% CI 3%–20%), STAT stroke protocol (11% decrease in DTN time, 95% CI 1%–20%), and stroke severity (National Institutes of Health Stroke Scale score 6–8: 19% decrease in DTN time, 95% CI 6%–31%; National Institutes of Health Stroke Scale score >8: 27% decrease in DTN time, 95% CI 17%–37%).

Conclusions—Taking the patient to CT on the emergency medical services stretcher, registering the patient as unknown, STAT stroke protocol, and administering alteplase in CT are associated with lower DTN time.