Physical activity and risk of Alzheimer disease: A 2-sample Mendelian randomization study

 

Not understandable to me, maybe you'd rather try this article?

This one suggests 8900 steps a day.

Can Exercise Protect Against Alzheimer's?

The latest here:

Physical activity and risk of Alzheimer disease: A 2-sample Mendelian randomization study

Baumeister SE, Karch A, Bahls M, et al.

Neurology|September 29, 2020

Researchers assessed if physical activity can protect against Alzheimer disease (AD) via a 2-sample Mendelian randomization analysis. They used summary data on genome-wide association studies regarding physical activity and AD. The sample consisted of 21,982 patients with AD and 41,944 controls who were cognitively normal. Eight single nucleotide polymorphisms (SNPs) known at p < 5 × 10⁻⁸ to be linked to average accelerations and 8 SNPs correlated at  p < 5 × 10⁻⁷ linked with vigorous(definition?) physical activity (fraction of accelerations > 425 milligravities) acted as instrumental variables. Genetic liability for fraction of accelerations >425 milligravities was irrelevant to the risk of AD. A causal link between physical activity and AD risk is not confirmed by the current research.

Read the full article on Neurology.

 

Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients

 I understood nothing here.

Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients

Eliane C. Miotto^1*, Paulo R. Bazán², Alana X. Batista¹, Adriana B. Conforto¹, Eberval G. Figueiredo¹, Maria da Graça M. Martin², Isabella B. Avolio¹, Edson Amaro Jr.² and Manoel J. Teixeira¹

• ¹Department of Neurology, University of São Paulo, São Paulo, Brazil
• ²Institute of Radiology, LIM-44, University of São Paulo, São Paulo, Brazil

Stroke lesions are frequently followed by cognitive impairments. Cognitive training is a non-pharmacological intervention that can promote neural compensation mechanisms and strategies to remediate cognitive impairments. The aims of this study were: (1) To investigate the cognitive performance, generalization effects, and neural correlates of semantic organization strategy training (SOST) in patients with chronic left frontoparietal stroke and healthy controls (HC); and (2) to compare the behavioral effects and neural correlates of SOST with an active control psychoeducation intervention (PI). In this randomized controlled study, all participants were randomly allocated into two groups, one group received SOST, and the other received PI intervention. Participants underwent two fMRI sessions, one prior and the other, after intervention. In each fMRI session, images were obtained during memory encoding task using a list of semantically related words. We found improved post-intervention memory performance in participants that received SOST (both patients and controls), indicated by number of words recalled, word clustering scores, and performance in a generalization task. The fMRI analysis revealed negative correlation between task performance and regions of the default-mode network. These results suggest that cognitive training using semantic organization strategy can improve episodic memory performance and promote potential functional neuroplasticity in patients with ischemic stroke lesions.

Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03644290.

Introduction

Cognitive impairment occurs in more than one third of patients with stroke and persists in many individuals for years, producing long-term disabilities (1, 2). Up to half of patients with cognitive deficits following stroke show significant impairment in episodic memory (3, 4). Episodic memory is a system implicated in the capacity to learn and recall past information or events (5). Cognitive rehabilitation is a traditional non-pharmacological treatment approach directed at the restoration of cognitive activity or the acquisition of efficient strategies to compensate for impaired cognitive function, particularly episodic memory (6, 7). In patients with memory impairments due to vascular and traumatic brain lesions, cognitive interventions have been recommended as a practice standard, including the use of internalized strategies (e.g., verbal association, visual imagery, etc.) and external memory compensation (e.g., cellphones, notebooks, diaries) (6–8). Recent studies demonstrated that patients with vascular lesions can benefit from different cognitive interventions including face-name training to remember people's names and repetition-lag memory training, developed to increase recollection as opposed to familiarity in recognition memory tasks (9, 10). There is also recent evidence of memory and attention improvement after computerized cognitive training and telehealth options for remote delivery of compensatory memory skills training after stroke (11, 12).

Semantic organization strategy training (SOST) is a cognitive intervention designed to recruit executive functions, semantic categorization, working memory, engaging regions of frontoparietal network, particularly in the left hemisphere due to verbal stimuli processing (13–15). This cognitive training (CT) intervention is based on the application of semantic organization strategy to word-lists in order to improve free verbal episodic memory recall and to enhance encoding by grouping words together that belong to the same category. Previous studies using SOST showed improvement in episodic memory in healthy adult individuals, patients with left frontal glioma excisions and mild cognitive impairment (14–16). Nevertheless, the underlying brain mechanisms related to cognitive interventions in patients with stroke remain largely unknown. In particular, no study has investigated, as yet, the effects of CT using SOST in patients with stroke in the left frontoparietal hemisphere.

Neuroimaging methods, particularly functional magnetic resonance imaging (fMRI), have been used to investigate the neural substrates underlying cerebral plasticity after cognitive training in a limited number of studies in patients with traumatic brain injury (17–20). In patients with vascular lesions or stroke, one study demonstrated changes in activation after training in default-mode network regions, such as the posterior cingulate cortex, precuneus, and angular gyrus, as well as in lateral occipital and temporal regions in parallel to behavior improvements (9).

Another study found memory and executive function improvement and increased resting-state functional connectivity of the hippocampus with the frontal lobe (right inferior, right middle, left middle, left inferior, and left superior frontal gyrus) and the left parietal lobe in a small sample of patients with heterogeneous stroke lesions after computerized cognitive training using the RehaCom software package (21). The authors associated these findings with mechanisms of brain compensation and cognitive recovery in patients who received cognitive training.

The investigation of the impact of individual CT interventions, such as SOST, visual imagery, etc., outside the context of multi-domain cognitive and holistic rehabilitation programs is highly relevant to understand the effectiveness of each specific approach and its brain mechanisms to plan cognitive rehabilitation programs in a more effective way. Yet, no study has explored the behavioral effects and neural correlates of SOST intervention in patients with stroke, particularly, involving the left frontoparietal brain regions known to affect episodic memory encoding due to reduced strategy and efficient executive processes application (13–15). As described above, SOST intervention is thought to recruit left frontoparietal network regions due to its verbal stimuli word-list presentation and semantic strategy application in order to improve encoding and verbal episodic memory recall. Previous studies using SOST were carried in patients with left frontal tumors and MCI people (15, 16). Nevertheless, no investigation has, so far, been conducted in stroke patients, especially with lesions in those areas of the left frontoparietal network thought to be involved in this strategy. To pursue this investigation, a sample of healthy control participants would be necessary in order to investigate specific cerebral metabolic changes and extent of improvement in behavior in patients with left frontoparietal stroke lesions in comparison to what is seen healthy subjects.

Therefore, the aims of the current study were: (1) to investigate the cognitive performance changes, generalization effects and neural correlates of SOST intervention in patients with left frontoparietal stroke and healthy controls; and (2) to compare the behavioral and transfer or generalization effects and neural correlates of SOST with an active control psychoeducation intervention (PI). We hypothesized that all participants, particularly the stroke patients (SP), would benefit from SOST in comparison to the control intervention, and that different neuronal brain mechanisms would be involved in patients with ischemic stroke lesions in relation to healthy controls.

 

Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

Way beyond my pay grade to understand and obviously there was no consideration to make it readable for stroke survivors. So unless your doctor can decipher this and put it into a consent for treatment form, this was a total waste of time. 

Intravenous thrombolysis pretreatment and other predictors of infarct in a new previously unaffected territory (INT) in ELVO strokes treated with mechanical thrombectomy

1. Nitin Goyal1,
2. Georgios Tsivgoulis2,
3. Jason J Chang3,
4. Konark Malhotra4,
5. Juan Goyanes1,
6. Abhi Pandhi1,
7. Rashi Krishnan5,
8. Muhammad F Ishfaq1,
9. Daniel Hoit6,
10. Christopher Nickele7,
11. Violiza Inoa-Acosta8,
12. Aristeidis H Katsanos9,
13. Lucas Elijovich10,
14. Andrei Alexandrov11,
15. Adam S Arthur12

Author affiliations

Abstract

Introduction One uncommon complication of mechanical thrombectomy (MT) is an infarct in a new previously unaffected territory (infarct in new territory (INT)).

Objective To evaluate the predictors of INT with special focus on intravenous thrombolysis(IVT)pretreatmentbefore MT.

Methods Consecutive patients with emergent large vessel occlusion (ELVO) treated with MT during a 5-year period were evaluated. INT was defined using standardized methodology proposed by ESCAPE investigators. The predictors of INT and its impact on outcomes were investigated.

Results A total of 419 consecutive patients with ELVO received MT (mean age 64±15 years, 50% men, median baseline National Institutes of Health Stroke Scale score 16 points (IQR 11–20), 69% pretreated with IVT). The incidence of INT was lower in patients treated with combination therapy (IVTandMT) than in patients treated with MT alone, respectively (10% vs 20%; p=0.011). The INT group had more patients with posterior circulation occlusions than the group without INT (28% vs 10%, respectively; p<0.001). The rates of 3-month functional independence were lower in patients with INT (30% vs 50%; p=0.007). IVT pretreatment was not independently related to INT (OR=0.75; 95% CI 0.32 to 1.76), and INT did not emerge as an independent predictor of 3-month functional independence (OR=0.69; 95% CI 0.29 to 1.62) on multivariable logistic regression models. Location of posterior circulation occlusion was independently associated with a higher odds of INT (OR=3.33; 95% CI 1.43 to 7.69; p=0.005).

Conclusions IVT pretreatment is not independently associated with a lower likelihood of INT in patients with ELVO treated with MT. Patients with ELVO with posterior circulation occlusion are more likely to have INT after MT.

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http://dx.doi.org/10.1136/neurintsurg-2019-014935

Harmful neutrophil subsets in patients with ischemic stroke Association with disease severity

I didn't understand what is going on here.  Are they trying to say neutrophils are bad? But they give no indication of how to reduce them, so this is useless.

Harmful neutrophil subsets in patients with ischemic stroke - Association with disease severity

David Weisenburger-Lile, Yuan Dong, Marion Yger, Gaëlle Weisenburger, Giulia Frasca Polara, Thomas Chaigneau, Riccardo Zapata Ochoa, Beatrice Marro, Bertrand Lapergue, Sonia Alamowitch, Carole Elbim

First published May 15, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000571

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Abstract

Objective To better understand the functional state of circulating neutrophils in patients with ischemic stroke (IS) for planning future clinical trials.

Methods We analyzed by flow cytometry activation state of circulating neutrophils and the distribution of neutrophil peripheral subsets in 41 patients with acute IS less than 6 hours before admission and compared them with 22 age-matched healthy controls.

Results Our results demonstrated continuous basal hyperactivation of circulating neutrophils during acute IS, characterized by lower l-selectin expression and higher CD11b expression at the cell surface, increased ROS production by neutrophils, and greater circulating levels of neutrophil elastase. Neutrophil hyperactivation was associated with deregulation of the equilibrium between apoptotic and necrotic. Patients also had higher percentages than controls of the overactive senescent (CXCR4^bright/CD62L^dim) neutrophil subset and increased percentage of neutrophils with a reverse transendothelial migration (CD54^highCXCR1^low) phenotype. Importantly, neutrophil alterations were associated with the clinical severity of the stroke, evaluated by its NIH Stroke Scale score.

Conclusion Altogether, our results indicate that during acute IS, the inflammatory properties of circulating neutrophils rise, associated with the expansion of harmful neutrophil subsets. These changes in neutrophil homeostasis, associated with disease severity, may play an instrumental role by contributing to systemic inflammation and to the blood-brain barrier breakdown. Our findings highlight new potential therapeutic approaches of stroke by rebalancing the ratio of senescent to immunosuppressive neutrophils or decreasing reverse neutrophil transmigration or both.

Glossary

AAD=

amino-actinomycin D;

ANOVA=

analysis of variance;

APC=

allophycocyanine;

BBB=

blood-brain barrier;

DAMP=

danger-associated molecular pattern;

fMLP=

N-formylmethionyl-leucyl-phenylalanine;

HC=

healthy control;

HE=

hydroethidine;

HMGB=

high-mobility group box;

IS=

ischemic stroke;

LPS=

lipopolysaccharide;

MMP=

matrix metalloproteinase;

MPO=

myeloperoxidase;

NET=

neutrophil extracellular trap;

NIHSS=

NIH Stroke Scale;

NLR=

Nod-like receptor;

PBS=

phosphate buffered saline;

PMN=

polymorphonuclear neutrophil;

ROS=

reactive oxygen species;

rTEM=

reverse transendothelial migration;

sJAM-C=

soluble JAM-C;

TNF=

tumor necrosis factor;

TLR=

Toll-like receptor

Footnotes

• Go to Neurology.org/NN for full disclosures. Funding information are provided at the end of the article.
• The Article Processing Charge was funded by the authors.
• Editorial, page e570

• Received December 19, 2018.
• Accepted in final form March 12, 2019.

• Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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Physical inactivity, cardiometabolic disease, and risk of dementia: An individual-participant meta-analysis

Too many big words in combinations I didn't understand, so ask your doctor for clarification. 

Physical inactivity, cardiometabolic disease, and risk of dementia: An individual-participant meta-analysis

BMJ — Kivimäki M, et al. | April 18, 2019

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In this meta-analysis of 19 prospective observational cohort studies, researchers ascertained if physical inactivity is a risk factor for dementia, focusing on the role of cardiometabolic disease in this association, and reverse causation bias resulting from changes in physical activity during the preclinical (prodromal) phase of dementia. According to results, physical inactivity was non-significantly linked to dementia among people in whom cardiometabolic disease preceded dementia. Physical inactivity was not related to all-cause dementia or Alzheimer’s disease in analyses that addressed bias due to reverse causation, although an indication of excess dementia risk was noted in a subgroup of physically inactive people who developed the cardiometabolic disease.

• See Also: Risk of incident dementia according to metabolic health and obesity status in late-life: A population-based cohort study

Read the full article on BMJ

Association of cardiovascular health level in older age with cognitive decline and incident dementia

No fucking clue what these statistics mean. I assume it is written that way so laypersons will not understand it. 

Association of cardiovascular health level in older age with cognitive decline and incident dementia

JAMA — Samieri C, et al. | August 24, 2018

Researchers explored the link between cardiovascular health level (defined using the 7-item tool from the American Heart Association [AHA]) and risk of dementia and cognitive decline in older persons. They observed that increased numbers of optimal cardiovascular health metrics and a higher cardiovascular health score were related to a lower risk of dementia and lower rates of cognitive decline. Promoting cardiovascular health as a means to prevent risk factors correlated with cognitive decline and dementia was supported in this analysis.

Methods

• Study participants in this population-based cohort study were persons aged 65 years or older from Bordeaux, Dijon, and Montpellier, France, without history of cardiovascular diseases or dementia at baseline who had repeated in-person neuropsychological testing (January 1999–July 2016) and systematic detection of incident dementia (date of final follow-up, July 26, 2016).
• Main exposures were the number of the AHA’s Life’s Simple 7 metrics at recommended optimal level (nonsmoking, body mass index < 25, regular physical activity, eating fish twice a week or more and fruits and vegetables at least 3 times a day, cholesterol < 200 mg/dL [untreated], fasting glucose < 100 mg/dL [untreated], and blood pressure < 120/80 mm Hg [untreated]; score range, 0-7) and a global cardiovascular health score (range, 0-14; poor, intermediate, and optimal levels of each metric assigned a value of 0, 1, and 2, respectively).
• Main outcomes and measures were incident dementia validated by an expert committee and change in a composite score of global cognition (in standard units, with values indicating distance from population means, 0 equal to the mean, and +1 and -1 equal to 1 SD above and below the mean).

Results

• At baseline, among 6,626 study participants (mean age, 73.7 years; 4,200 women [63.4%]), 2,412 (36.5%), 3,781 (57.1%), and 433 (6.5%) had 0 to 2, 3 to 4, and 5 to 7 health metrics at optimal levels, respectively.
• Seven hundred forty-five study participants had incident adjudicated dementia over a mean follow-up duration of 8.5 (range, 0.6-16.6) years.
• The absolute differences in incident dementia rates for 2, 3, 4, 5, and 6 to 7 metrics were, respectively, -0.26 (95% CI, -0.48 to -0.04), -0.59 (95% CI, -0.80 to -0.38), -0.43 (95% CI, -0.65 to -0.21), -0.93 (95% CI, -1.18 to -0.68), and -0.96 (95% CI, -1.37 to -0.56) per 100 person-years compared with the incidence rate of dementia of 1.76 (95% CI, 1.38-2.15) per 100 person-years among those with 0 or 1 health metrics at optimal levels.
• The hazard ratios for dementia were 0.90 (95% CI, 0.84-0.97) per additional optimal metric and 0.92 (95% CI, 0.89-0.96) per additional point on the global score in multivariable models.
• The study results showed that the gain in global cognition related to each additional optimal metric at baseline was 0.031 (95% CI, 0.009-0.053) standard units at inclusion, 0.068 (95% CI, 0.045-0.092) units at year 6, and 0.072 (95% CI, 0.042-0.102) units at year 12.

Read the full article on JAMA

Self-efficacy mediates the relationship between balance/walking performance, activity, and participation after stroke

Whatever the hell self-efficacy is? I understood nothing here. 

Self-efficacy mediates the relationship between balance/walking performance, activity, and participation after stroke

Topics in Stroke Rehabilitation , Volume 23(2) , Pgs. 77-83.

NARIC Accession Number: J77346.  What's this?
ISSN: 1074-9357.
Author(s): French, Margaret A.; Moore, Meghan F.; Pohlig, Ryan; Reisman, Darcy.
Publication Year: 2016.
Number of Pages: 7.
Abstract: Study explored the relationships between different outcome measures and activity and participation in people after stroke. Fifty-nine subjects with stroke participated in an assessment including self-selected walking speed, 6-Mminute Walk Test, Timed Up and Go test, Berg Balance Scale, Functional Gait Assessment, Walk 12, and Activity-specific Balance Confidence Scale. StepWatch Activity Monitoring (SAM) was used as a measure of activity and Stroke Impact Scale-Participation (SIS-P) as a measure of participation. Exploratory Factor. Analysis was performed including all measures except SAM and SIS-P. Two factors were extracted and termed performance-based (PB) and self-efficacy (SE). A path analysis assessed the role of SE as a mediator in the relationships of PB and SAM/SIS-P. In the path analysis, PB significantly predicts SE, but not SAM or SIS-P. SE significantly predicts both SAM and SIS-P. The indirect effects of PB on SAM and SIS-P were significant. These results suggest that SE mediates the relationship between PB and activity and participation after stroke, reinforcing that improving activity and participation is more complicated than only targeting performance. Clinicians should administer SE and PB measures to determine the most accurate view of patients after stroke and seek to improve SE through interventions.
Descriptor Terms: AMBULATION, EQUILIBRIUM, MEASUREMENTS, MOBILITY, OUTCOMES, SELF CONCEPT, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: French, Margaret A., Moore, Meghan F., Pohlig, Ryan, Reisman, Darcy. (2016). Self-efficacy mediates the relationship between balance/walking performance, activity, and participation after stroke.  Topics in Stroke Rehabilitation , 23(2), Pgs. 77-83. Retrieved 1/14/2018, from REHABDATA database.

Social identity and stroke: ‘they don't make me feel like, there's something wrong with me’

You blithering idiots, you are blaming the patient for not getting socially engaged post-stroke. You need to blame the doctor for not getting them 100% recovered. Do you not understand anything about what survivors want? 

Social identity and stroke: ‘they don't make me feel like, there's something wrong with me’

• First published: 2 November 2012Full publication history
• DOI: 10.1111/j.1471-6712.2012.01086.x  View/save citation
• Cited by (CrossRef): 10 articles Check for update

Abstract

Over 85% of the people survive stroke; and of those, over 80% are discharged to the community. However, the majority do not recover completely. Loss of identity is a commonly reported experience after stroke. Studies focus on the individual survivors' use of their own cognitive resources to adapt to change, rather than examining the effects of social interactions on stroke survivors' identities. Social relationships are the foundation upon which survivors rebuild skills to engage with the world, yet little is known about the ways in which families, friends and neighbours provide a context for the recreation of a sense of self and activities after stroke. This article draws on situational analysis grounded theory analysis of in-depth individual interviews with nine middle-aged survivors of stroke. In situational analysis, the original grounded theory methods proposed by Glaser and Strauss are used; however, the situational context, and how environments and relationships influence actions, is explicitly analysed. Our objective was to understand the ways in which family, social, and community resources might enhance stroke survivors' participation in personally meaningful activities over the long term. The qualitative accounts of these survivors reveal how social support helped them maintain or more importantly regain a position in society. Following any life-changing event, people's sense of self is fluid. A relevant social position entitles stroke survivors to become actively involved in setting their own goals and maintaining a positive identity. However, as these participants attested, stroke impaired their social position and resources to reject an imposed social position. It was difficult for these survivors to construct a valued social identity without the support of other people. Future studies should explore the consequences of social interactions with others and how social attitudes about stroke disability affects individual's activity options, professional practice, and ultimately development of a positive poststroke identity.

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