Grip Strength: An Indispensable Biomarker For Older Adults

 My doctor and therapists COMPLETELY FAILED AT RECOVERING MY LEFT HAND! So this really has no basis for me, but my right hand is stronger than ever. 

I'd fire anyone doing prediction, biomarkers, prognistication or assessments. None of them do a damn thing at getting survivors recovered! All they do is turn on anxiety and depression!

Grip Strength: An Indispensable Biomarker For Older Adults

Richard W Bohannon ^1,✉

PMCID: PMC6778477  PMID: 31631989

Abstract

Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.

Association Between Nutritional Status and Mortality/Neurological Outcomes in Stroke Patients: A Systematic Review and Meta-Analysis.

 

Where the hell is the diet protocol that prevents this problem? You didn't think actually solving the problem was necessary? Prognostication was all you were planning on doing? Remind me to never hire you for any job.  An incompetent? doctor will have done nothing for 6 years, like yours! NO protocol; NOTHING!

49% malnutrition post-stroke (1 post to April 2025)

malnutrition (3 posts to August 2019)

muscle wasting (4 posts to September 2012)

Association Between Nutritional Status and Mortality/Neurological Outcomes in Stroke Patients: A Systematic Review and Meta-Analysis.

Jihui Hu, Yang Liu, Yi Zhang, Meng Zhang

J Stroke Cerebrovasc Dis. 2025 Jul 15 108398 [Epub ahead of print]

OBJECTIVE

To systematically evaluate the association between Nutritional Risk Screening 2002 (NRS-2002), Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and 3-month mortality and poor neurological outcomes (modified Rankin Scale [mRS] ≥3) in stroke patients.

METHODS

A systematic search of PubMed, Embase, and other databases up to April 2025 identified 11 observational studies (6 prospective cohorts; n=7,696). Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity, sensitivity, and publication bias were assessed. Meta-regression explored sources of heterogeneity. A gradient boosting classifier and Bayesian MCMC simulations were used for supplementary modeling.

RESULTS

NRS-2002 ≥3 (OR=3.42, 95% CI: 2.59-4.51), CONUT ≥5 (OR=3.66, 95% CI: 2.47-5.43), and GNRI <98 (OR=2.68, 95% CI: 1.86-3.84) were significantly associated with poor functional outcomes. These indices also predicted higher 3-month mortality: NRS-2002 ≥3 (OR=4.13), CONUT ≥5 (OR=3.57), GNRI <98 (OR=2.93). Heterogeneity ranged from moderate to high (I²=42.1%-68.9%). Meta-regression implicated regional and clinical factors as sources of variability. Predictive modeling (AUROC = 0.81) identified GNRI <92, age ≥75, and NIHSS as key mortality predictors, consistent with SHAP and Bayesian analyses.

CONCLUSION

Malnutrition-particularly as defined by NRS-2002 ≥3, CONUT ≥5, and GNRI <98-is strongly linked to early mortality and poor recovery after stroke. GNRI showed high predictive value in older patients. Integrating nutritional screening into acute stroke care may enable early, cost-effective interventions to improve outcomes.

Source: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

Comparative Prognostic Value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in Supratentorial and Infratentorial Stroke Patients in Western India

 

 Prognostication is fucking useless, NOTHING HERE WILL GET YOU RECOVERED! I'd have you all fired!

Comparative Prognostic Value of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in Supratentorial and Infratentorial Stroke Patients in Western India

Vishal Padwale • Chidanand Chivate • Vijendra Kirnake • Harshal Patil • Sunil Kumar • Nikhil Pantbalekundri

Published: July 30, 2024

DOI: 10.7759/cureus.65778 

Peer-Reviewed 

 

Abstract

Background

Acute coronary syndrome is the most common cause of mortality; cerebral vascular accident ranks second. Stroke is the fourth most common cause of disability worldwide, with nearly 20 million people suffering a stroke every year around the world and an estimated five million dead. Slightly more than 85.5% of stroke-related deaths take place in developing countries. In short, blockage (thrombus or emboli) and decreased blood supply for cerebral tissues lead to a stroke that permanently damages brain tissue. A stroke is clinically defined as rapidly developing clinical symptoms of focal cerebral dysfunction lasting >24 hours or leading to death, as characterized by the World Health Organization (WHO).

Objective

The present study was designed to compare the efficacy of the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow Coma Scale (GCS) in determining the prognosis of supratentorial and infratentorial stroke.

Methods

This observational prospective study was performed on over 100 patients admitted to Bharati Hospital, Sangli, who had cerebrovascular accidents from February 2018 to June 2019. Eligibility criteria were adults more than 18 years of age with clinical and computed tomography/magnet resonance imaging (CT/MRI) evidence consistent with acute stroke. Trauma and concomitant supra- and infratentorial strokes were excluded. GCS and NIH stroke scale scores were measured daily, and scores were noted on the first and last day of hospitalization. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), including mean, standard deviation, paired t-test, and Chi-square test.

Results

Out of 100 patients, 77% had suffered supratentorial strokes, and thus the other 23% had infratentorial strokes. Alcohol consumption was associated with a higher risk of infratentorial strokes, while smoking was linked to a higher risk of supratentorial strokes. Diabetes and hypertension did not differ statistically between the two groups. Compared to patients with supratentorial strokes, those who suffered from infratentorial strokes had a greater death rate and less favorable recovery results. Patients with supratentorial strokes who recovered completely or partially showed considerable improvements in their GCS scores, but patients with infratentorial strokes showed minimal to no improvement. On the other hand, the NIHSS score significantly improved in patients who achieved both complete or partial recovery and no improvement or mortality in both supratentorial and infratentorial stroke. NIHSS is preferred over GCS because it provides a better insight into morbidity and neurological outcomes of both types of strokes in comparison with GCS, which is more useful in predicting mortalities.

Conclusion

According to this study, supratentorial strokes were more common, whereas infratentorial strokes had a worse prognosis. Alcohol ingestion and smoking may have an impact on the location of a stroke. Compared to GCS, the NIHSS score provided a more thorough evaluation of stroke recovery, indicating its potential for better patient care.

Introduction

Acute coronary syndrome is the most common cause of mortality; cerebral vascular accident ranks second. It ranks as the fourth most prevalent primary cause of disability globally. Every year, stroke affects around 20 million people, and five million of them pass away. Although the number of stroke-related deaths is declining in the industrialized world, 85.5% of all stroke deaths happen in developing nations. Stroke morbidity was around seven times higher in underdeveloped than developed nations [1].

Thrombus or emboli cause a decreased or absent vascular supply to the cerebral tissues, which is what causes an ischemic stroke. The oxygen and glucose are cut off by this reduction in blood flow, permanently harming the brain parenchyma's tissues. "Rapidly developing clinical symptoms and signs of focal cerebral disturbance lasting more than 24 hours or leading to death with no apparent cause other than vascular origin" is how the World Health Organization (WHO) defines stroke clinically [2,3].

A typical ischemic stroke is clinically characterized by its mode of onset and subsequent course. It often manifests as an abrupt start of a localized neurological impairment. The signs and symptoms, as well as indications of interventions depending on an ischemic stroke, are dependent on the position of the blood artery blockage and the extent of peripheral flow. The hallmark of stroke is sudden onset hemiparesis in an individual [4-6].

These days, stroke syndromes are further divided into supratentorial and infratentorial strokes according to the area of the brain parenchyma affected and where it is in relation to the tentorium cerebelli. Supratentorial compartment stroke comprises the stroke due to occlusion of the internal carotid artery and its branches. Conversely, infratentorial compartment syndrome refers to a stroke brought on by the vertebral artery and its branch obstruction. Infratentorial stroke accounts for approximately 20% of all strokes, and it is due to posterior circulation thrombosis or embolism [7-9].

Determining the disease's prognosis requires a precise assessment of the disease's severity. Acute Physiology and Chronic Health Evaluation (APACHE) II and III, the Glasgow Coma Scale (GCS) score, the Chinese Stroke Scale (CSS), the National Institutes of Health Stroke Score (NIHSS), and the activities of daily living (ADL) (Barthel Index, BI) are among the various tests that are employed. The grading systems are used to assess the degree of illness and forecast the likelihood of disease.

The most popular rating method for determining a stroke's severity is the NIHSS. It is primarily used to assess prognosis, therapeutic impact, and the degree of neurological damage. The GCS scale, often known as the coma scale, was created in 1978 by Teasdale et al. for patients undergoing brain surgery. It is typically used to examine the functional abnormalities of the neurological system and the degree of consciousness of stroke patients [10,11].

By providing clinicians the greatest possible assistance in diagnosing and treating stroke patients, comparison of stroke scales improves the overall quality of stroke care. It will also highlight each one's weaknesses and advantages, pointing out areas in need of development or further study [12]. Very few studies compare NIHSS and GCS scoring systems to determine the prognosis of supratentorial and infratentorial strokes. Thus, the present study compared NIHSS and GCS systems to determine the prognosis, morbidity, and mortality of supratentorial and infratentorial strokes.

Materials & Methods

This observational prospective study included a total of 100 individuals with cerebrovascular accidents who were admitted to Bharati Hospital, Sangli, India, and placed in the medicine ward or intensive care unit (ICU) and who met the study's inclusion criteria. The research was carried out between February 2018 and June 2019. Informed written consent was obtained from patients and their relatives in their language. The study included patients older than 18 years of age with strong clinical evidence of cerebrovascular accident, as well as those with computed tomography (CT) or magnetic resonance imaging (MRI) evidence of cerebrovascular accident. Patients with extradural hemorrhages, subdural hemorrhages, subarachnoid hemorrhages, and cerebral hemorrhages due to any traumatic cause and patients with simultaneous occurrence of both supratentorial and infratentorial cerebrovascular accidents were excluded from the study.

A detailed history was taken from patients and, in some cases, from reliable relatives of the patients. Only while the patient was in the hospital were all cases followed. All laboratory tests, clinical characteristics, and examinations were finished and recorded on proformas. Every clinical symptom and indication was taken into account. In addition to noting CT or MRI results for every patient and entering them into proformas, GCS and NIHS scores have been calculated and recorded onto the proforma provided on the first day. Cases were followed daily with reference to the Glasgow Coma Scale, National Institute of Health Stroke Scale (NIHSS), CT and MRI findings, day-to-day improvement or deterioration, need for mechanical ventilation, and weaning. All patients underwent CT and/or MRI on the first day of admission and/or in between during the hospital stay. Final observations were made on the day of discharge, that is, the last day, concerning the outcome of patients and all clinical features in the form of scoring systems. All details about every case were entered in the master chart. Simple mean, median, mode, standard deviation, unpaired t-test, and Chi-square test were applied for tabulated data analysis. The chi-square value was calculated for a degree of freedom and a probability of 0.05. The null hypothesis was accepted if the computed value was less than the tabulated value.

Results

Among these completely recovered cases, the GCS scores improved significantly from 11.65 ± 0.79 on the first day to 14.24 ± 0.44 on the last day (p < 0.001) in supratentorial stroke. The GCS scores increased from 11.75 ± 0.50 on the first day to 12.75 ± 0.50 on the last day, but this change was not statistically significant (p = 0.124) in infratentorial strokes. Among partially recovered cases, there was a significant improvement in GCS scores from 9.31 ± 1.13 on the first day to 11.83 ± 1.22 on the last day (p < 0.001) in supratentorial strokes. The GCS scores increased slightly from 11.20 ± 1.10 on the first day to 11.30 ± 1.10 on the last day, but the change was not statistically significant (p = 0.345) in infratentorial strokes. Among cases with no improvement, the GCS scores decreased from 7.89 ± 0.76 on the first day to 7 ± 1.28 on the last day, indicating a significant decline (p = 0.025). The GCS scores significantly declined from 10 ± 0 on the first day to 5 ± 0 on the last day (p = 0.05) in infratentorial stroke. Among the cases with mortality, the GCS scores decreased from 8.29 ± 0.76 on the first day to 6.14 ± 2.97 on the last day, which is marginally significant (p = 0.05) in supratentorial stroke. The GCS scores significantly declined from 9.15 ± 1.28 on the first day to 3.69 ± 0.75 on the last day (p < 0.001) in infratentorial stroke (Table 1).

Neuron-specific enolase as a prognostic biomarker in acute ischemic stroke patients treated with reperfusion therapies

 Prognostication is fucking useless, NOTHING HERE GET YOU RECOVERED! I'd have you all fired!

Neuron-specific enolase as a prognostic biomarker in acute ischemic stroke patients treated with reperfusion therapies

Tiago Esteves Freitas^1*†Ana Isabel Costa²Leonor Neves³Carolina Barros¹Mariana Martins¹Pedro Freitas¹Duarte Noronha⁴Patrício Freitas¹Teresa Faria²Sofia Borges⁵Sónia Freitas⁵Eva Henriques⁵Ana Célia Sousa⁵

• ¹Stroke Centre, Hospital Dr. Nélio Mendonça, Funchal, Portugal
• ²Internal Medicine Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal
• ³Internal Medicine Department II, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
• ⁴Neurology Department, Hospital Dr. Nélio Mendonça, Funchal, Portugal
• ⁵Centro de Investigação Clínica Dra. Maria Isabel Mendonça, Funchal, Portugal

Introduction: Ischemic stroke is a significant global health concern, with reperfusion therapies playing a vital role in patient management. Neuron-specific enolase (NSE) has been suggested as a potential biomarker for assessing stroke severity and prognosis, however, the role of NSE in predicting long-term outcomes in patients undergoing reperfusion therapies is still scarce.

Aim: To investigate the association between serum NSE levels at admission and 48 h after reperfusion therapies, and functional outcomes at 90 days in ischemic stroke patients.

Methods: This study conducted a prospective cross-sectional analysis on consecutive acute ischemic stroke patients undergoing intravenous fibrinolysis and/or endovascular thrombectomy. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days post-stroke and two groups were defined according to having unfavorable (mRS3-6) or favorable (mRS0-2) outcome. Demographic, clinical, radiological, and laboratory data were collected, including NSE levels at admission and 48 h. Spearman’s coefficient evaluated the correlation between analyzed variables. Logistic regression analysis was performed to verify which variables were independently associated with unfavorable outcome. Two ROC curves determined the cut-off points for NSE at admission and 48 h, being compared by Delong test.

Results: Analysis of 79 patients undergoing reperfusion treatment following acute stroke revealed that patients with mRS 3–6 had higher NIHSS at admission (p < 0.0001), higher NIHSS at 24 h (p < 0.0001), and higher NSE levels at 48 h (p = 0.008) when compared to those with mRS 0–2. Optimal cut-off values for NSE₀ (>14.2 ng/mL) and NSE_48h (>26.3 ng/mL) were identified, showing associations with worse clinical outcomes. Adjusted analyses demonstrated that patients with NSE_48h > 26.3 ng/mL had a 13.5 times higher risk of unfavorable outcome, while each unit increase in NIHSS_24h score was associated with a 22% increase in unfavorable outcome. Receiver operating characteristic analysis indicated similar predictive abilities of NSE levels at admission and 48 h (p = 0.298). Additionally, a strong positive correlation was observed between NSE_48h levels and mRS at 90 days (r = 0.400 and p < 0.0001), suggesting that higher NSE levels indicate worse neurological disability post-stroke.

Conclusion: Serum NSE levels at 48 h post-reperfusion therapies are associated with functional outcomes in ischemic stroke patients, serving as potential tool for patient long-term prognosis.

1 Introduction

Prognostication plays an essential role(NO it doesn't, because currently this will predict failure to recover. Prognostication is totally fucking useless in getting survivors recovered! Since you don't know that, you are all fired! Change that to; 'Do these protocols and you will 100% recover! Anything less is medical malpractice!') in decision making by offering patients and their families the necessary information to set realistic and achievable care goals. It helps determine eligibility for specific benefits and targets interventions to those who are most likely to benefit. Prognostication includes three main components: clinicians estimate the likelihood of a particular outcome over a certain period using their clinical judgment or other tools; this estimate is shared with the patient according to their preferred way of receiving information; and the patient or their surrogate uses this information to make informed clinical decisions (1).

Age, stroke severity, stoke mechanism, infarct location, comorbid conditions, clinical findings, and related complications influence stroke prognosis. Whether reperfusion therapies (fibrinolysis and/or thrombectomy) are conducted and the quality of stroke unit care given, including early start of physical rehabilitation and prompt introduction of secondary prevention measures, also influence the outcome of ischemic stroke (2).

Patient history, clinical examination and imaging technology have been the cornerstone in assessing stroke patients, guiding therapeutic decisions, and monitoring disease progression. Akin to the established gold standard in Cardiology, where biomarkers such as high sensitivity troponins have revolutionized the assessment of myocardial infarction (3), incorporating biomarkers into stroke management holds immense potential. These biomarkers offer a promising avenue to identify patients at heightened risk of severe disease, tailor treatment strategies, predict the response to reperfusion therapies and reasonably predict the overall prognosis and outcomes. While numerous proteins serve as markers of brain tissue damage, inflammation and coagulation/thrombosis, their utility is hindered by a lack of specificity to ischemic stroke, given that various other diseases processes can also damage the brain tissue (4).

For a biomarker to prove useful in stroke management, it should meet some basic criteria: be specific to the brain tissue, rise immediately within hours of a tissue insult, proportionally reflect the extent of brain damage, and ultimately serve as a reliable prognostic indicator for the event (5). Numerous biomarkers have been associated with short-and long-term clinical outcomes after stroke, but most of them have failed to improve the prediction capacities of conventional clinical variables. Biomarkers of ischemic brain injury include S100 calcium binding protein B (S-100B), neuron-specific enolase (NSE), myelin basic protein and glial fibrillary acid protein, among others (6).

The NSE is a dimeric intracellular neuronal glycolytic enzyme, primarily located in the cytoplasm of neurons, cells of the diffuse neuroendocrine system and erythrocytes. Elevated levels of NSE have been observed in response to sudden central nervous system events, such as cerebral infarction, subarachnoid hemorrhage, head injury, hypoxia, seizures, and cardiac arrest. These conditions are characterized by the disruption of the blood–brain barrier and subsequent damage of neuronal cells, leading to a leakage of NSE, which can be detected in cerebral spinal fluid but also in saliva or blood samples (7). Several studies propose NSE as a marker of brain damage following an ischemic event. There is also a correlation between NSE levels and acute ischemic stroke severity, infarction volume, extent of brain tissue damage [as clinically measured by the National Institutes of Health Stroke Scale (NIHSS) score], and poor functional outcomes (5, 8, 9).

NSE levels change dynamically following symptom onset, reflecting the necrosis of neuronal cells within the ischemic penumbra. Lower NSE levels are associated with clinical diffusion mismatch (7), serving as an alternative indicator for salvageable ischemic tissue that may be more responsive to interventions such as intravenous fibrinolysis and/or mechanical thrombectomy. However, high NSE levels are not exclusive to ischemic stroke and can also be found in other diseases such as neuroendocrine cell cancers like small cell lung cancers, neuroblastomas, melanomas and carcinoid tumors (10).

Since its approval by the European Stroke Organization in 2008, intravenous thrombolysis with alteplase has been a recognized systemic reperfusion treatment for patients with acute ischemic stroke (11). The pivotal MR CLEAN study published in 2015 further solidified the landscape by demonstrating the safety, efficacy and favorable impact on functional outcomes associated with intraarterial thrombectomy (12).

Building upon these advancements, our study aimed to evaluate the relationship between NSE levels at patient admission and 48 h post-reperfusion therapies, and functional outcome in ischemic stroke patients.

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

 Useless! Do the research that gets these older survivors recovered. That is what stroke researchers should be doing. 100% recovery for all. NOT biomarkers, predictions, guidelines, prognostication, assessments, 'care', or describing a problem with no solution offered. Leaders solve problems, are you leaders or not?

Investigating cognitive impairment, biopsychosocial barriers, and predictors of return to daily life among older stroke survivors

Alexandra Björck^1*Marie Matérne^2,3Mialinn Arvidsson Lindvall^2,4Gustav Jarl^2,5

• ¹School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ²University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
• ³School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
• ⁴School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
• ⁵Department of Prosthetics and Orthotics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Purpose: The aim was to investigate the associations between cognitive impairment and biopsychosocial factors among older stroke survivors and predictors of poststroke return to daily life.

Materials and methods: This cross-sectional study involved 117 stroke survivors (61% men) with an average age of 77 years (range 65–91). The participants completed two questionnaires (Riksstroke and Short Form 36 questionnaires). The Montreal Cognitive Assessment (MoCA) was used to assess cognitive abilities. The International Classification of Functioning, Disability, and Health (ICF) framework guided the selection of biopsychosocial variables. We used Spearman’s correlation coefficient and multiple logistic regression in the analyses.

Results: The average MoCA score was 21.7 points (range: 4–30, SD 5.6). The need for assistance from relatives and professionals, need for help with dressing and household chores, reliance on others for mobility, and reading and balance problems were correlated with more severe cognitive impairment (r = 0.20–0.33). Cognitive impairment, fatigue, and balance issues predicted an unfavorable return to daily life (odds ratio: 6.2–6.8).

Conclusion: The study indicated that cognitive impairment is associated with difficulties in all ICF domains. Cognitive impairment, fatigue, and balance issues are associated with an unsuccessful return to daily life(Well then solve those problems.). Prioritizing these factors and screening for cognitive impairment with objective assessment tools may improve rehabilitation outcomes and enhance overall quality of life poststroke.

Introduction

Stroke is a leading cause of long-term disability worldwide, impacting the lives of more than 100 million individuals (1, 2). Stroke disrupts cerebral blood flow, causing tissue damage and neurological deficits. The neuroplasticity enables the brain to adapt and reorganize post-stroke, aiding recovery (3) but a common consequence of stroke is poststroke cognitive impairment (PSCI). PSCI is a broad term that includes conditions ranging from mild cognitive impairment to dementia. Common disorders are problems with memory, attention, executive abilities, language, visual processing, and information management (4, 5). Usually, PSCI occurs within 3 months post-stroke, but can also develop over time (3). One year after stroke onset, one in four stroke survivors has PSCI (6, 7), and approximately seven of 10 stroke survivors will develop PSCI over time (8). PSCI often gives negative consequences on problem solving, organized planning and social interaction (9, 10), which has a negative effect on individuals’ overall health and well-being. There is a prioritized and ongoing global effort to understand the complexity of PSCI and develop interventions to prevent cognitive decline (11). PSCI predominantly affects the older population, which is growing globally (11, 12), making it a priority in stroke research (11). An emerging issue in stroke research is investigating how cognitive function is connected to other biopsychosocial factors to develop personalized interventions (4).

Previous research has indicated that PSCI affects several biopsychosocial aspects. It affects the overall recovery process poststroke due to the negative impact on the body’s motor function recovery (13). PSCI makes it more challenging to participate in physical rehabilitation; therefore, persons with PSCI are less physically active (14). Individuals with PSCI are also more prone to psychological deficits such as depression and fatigue (15, 16), which further affects their ability to engage in various leisure and social activities (17). PSCI affects both basic and instrumental activities of daily living, such as dressing, performing personal hygiene and household chores, and cooking (18). It also impairs communication (19), participation in social activities and interactions with others (18, 20). Despite extensive PSCI research, the understanding of how different levels of PSCI affect biopsychosocial factors in older stroke survivors is incomplete. There is also limited research exploring which factors are associated with a successful return to daily life for older persons with PSCI. Previous studies investigating factors associated with return to daily life and leisure activities after stroke have shown that cognitive ability, age, and mobility are important factors (21, 22). However, most related studies have focused on younger stroke survivors (23, 24).

This study adopted a biopsychosocial perspective and used the International Classification of Functioning, Disability and Health (ICF) model (25) as a framework. This approach was chosen to capture the complexity of the interaction between PSCI and daily life. The study aimed to investigate (1) the associations between levels of cognitive impairment and biopsychosocial factors and (2) how these factors are associated with return to daily life. Through comprehensive insights into these biopsychosocial factors, poststroke well-being and recovery can be enhanced, allowing for tailored interventions for affected individuals.

Machine learning-based nomogram: integrating MRI radiomics and clinical indicators for prognostic assessment in acute ischemic stroke

 So a triple failure; My god, the mentors and senior researchers need remedial education in the point of stroke research! Getting survivors recovered!

1. Predicting failure to recover.

2. 'Assessments'

3. Prognostication
   

Machine learning-based nomogram: integrating MRI radiomics and clinical indicators for prognostic assessment in acute ischemic stroke

Kun Guo¹Bo Zhu¹Rong Li¹Jing Xi¹Qi Wang²KongBo Chen³Yuan Shao³Jiaqi Liu³Weili Cao¹Zhiqin Liu¹Zhengli Di¹Naibing Gu^1*

• ¹Xi'an Central Hospital, Xi’an, China
• ²China-Japan Union Hospital of Jilin University, Changchun, China
• ³Tongchuan Mining Bureau Central Hospital, Tongchuan, China

Background: Acute Ischemic Stroke (AIS) remains a leading cause of mortality and disability worldwide. Rapid and precise prognostication of AIS is crucial for optimizing treatment strategies and improving patient outcomes. This study explores the integration of machine learning-derived radiomics signatures from multi-parametric MRI with clinical factors to forecast AIS prognosis.(So predicting failure to recover? How does that help survivors?)

Objective: To develop and validate a nomogram that combines a multi-MRI radiomics signature with clinical factors for predicting the prognosis of AIS.

Methods: This retrospective study involved 506 AIS patients from two centers, divided into training (n = 277) and validation (n = 229) cohorts. 4,682 radiomic features were extracted from T1-weighted, T2-weighted, and diffusion-weighted imaging. Logistic regression analysis identified significant clinical risk factors, which, alongside radiomics features, were used to construct a predictive clinical-radiomics nomogram. The model’s predictive accuracy was evaluated using calibration and ROC curves, focusing on distinguishing between favorable (mRS ≤ 2) and unfavorable (mRS > 2) outcomes.

Results: Key findings highlight coronary heart disease, platelet-to-lymphocyte ratio, uric acid, glucose levels, homocysteine, and radiomics features as independent predictors of AIS outcomes. The clinical-radiomics model achieved a ROC-AUC of 0.940 (95% CI: 0.912–0.969) in the training set and 0.854 (95% CI: 0.781–0.926) in the validation set, underscoring its predictive reliability and clinical utility.

Conclusion: The study underscores the efficacy of the clinical-radiomics model in forecasting AIS prognosis, showcasing the pivotal role of artificial intelligence in fostering personalized treatment plans and enhancing patient care. This innovative approach promises to revolutionize AIS management, offering a significant leap toward more individualized and effective healthcare solutions.

Highlights

- High predictive accuracy for AIS prognosis.

- Integrates MRI radiomics with clinical factors.

- Utilizes advanced machine learning techniques.

- Provides a validated clinical-radiomics nomogram.

- Facilitates personalized AIS management.

Elevated BNP and NT-proBNP levels as prognostic biomarkers of short-term walking independence in post-acute stroke rehabilitation

 Prognostication DOES NOTHING TO GET SURVIVORS RECOVERED! Think about delivering EXACT REHAB PROTOCOLS that survivors need!

Elevated BNP and NT-proBNP levels as prognostic biomarkers of short-term walking independence in post-acute stroke rehabilitation

, , , , , , , ,

Author Notes

European Journal of Preventive Cardiology, Volume 31, Issue Supplement_1, June 2024, zwae175.098, https://doi.org/10.1093/eurjpc/zwae175.098

Published:

13 June 2024

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Abstract

Background

The comorbidity of heart failure (HF) and stroke is associated with delayed stroke recovery, prolonged hospitalization, and a decreased quality of life. HF can lead to acute cerebral injury, while conversely, acute cerebral injury can exacerbate HF by disrupting neural and cardiovascular regulation. This association is now recognized as the "cardio-cerebral syndrome" and the "stroke-heart syndrome," endorsed by the European Society of Cardiology (ESC). However, in many cases of newly diagnosed stroke patients, the appropriate diagnosis of HF is often overlooked.

Brain natriuretic peptide (BNP) and the N-terminal prohormone of BNP (NT-proBNP) are used for HF screening and risk assessment. Nevertheless, their potential as predictive markers for functional independence in post-acute stroke patients remains uncertain.

Purpose

This study aimed to investigate the correlation between BNP or NT-proBNP levels and walking independence in patients with ischemic or hemorrhagic stroke during the post-acute phase.

Methods

This retrospective observational study included 650 post-acute phase ischemic or hemorrhagic stroke patients admitted to our hospital for rehabilitation between February 2019 and December 2022, all of whom underwent BNP or NT-proBNP testing upon admission. Patients were categorized into two groups: those with BNP≥200 pg/ml or NT-proBNP≥900 pg/ml ("High group") and those without ("Low group"). We examined the relationship between BNP or NT-proBNP levels and ambulatory independence within 90 days using multivariable logistic regression analysis. We also performed subgroup analyses to take into account factors such as age, atrial fibrillation, obesity and renal function that may affect BNP or NT-proBNP levels. Walking independence was defined as the ability to walk without assistance or supervision, irrespective of the use of walking aids and orthoses.

Results

The mean age of the subjects was 75.1±11.2 years, with males comprising 53.2% of the population. One hundred and seven patients (16.4% of the total) were classified as the High group. High BNP or NT-proBNP levels were significantly associated with difficulty walking independently within 90 days after adjusting for other functional prognostic factors (odds ratio, 2.62; 95% confidence interval, 1.30-5.27; p=0.007). Furthermore, even in subgroup analyses with factors influencing BNP or NT-proBNP levels, elevated BNP or NT-proBNP levels were associated with difficulty walking independently within 90 days (p<0.05, respectively).

Conclusions

Our findings suggest that elevated serum levels of BNP or NT-proBNP may serve as functional prognostic indicators in post-acute stroke patients.

UCSF Neurologist to Receive Prestigious Scientific Award

Three pages in Google Scholar and I see 'management' and prognostication but NOTHING ON ACTUALLY GETTING SURVIVORS RECOVERED! In my opinion this is an invalid award at least as far as stroke is concerned. I expect stroke researchers to tell us EXACTLY how their research gets survivors recovered. If it doesn't do that, they need to find a new research field.

UCSF Neurologist to Receive Prestigious Scientific Award

 

American Brain Foundation to Honor Physician-Researcher Bruce Ovbiagele, MD, for Research in Health Equity and Stroke Prevention

13-Feb-2024 8:00 AM EST, by University of California, San Francisco (UCSF)

Credit: UCSF

Bruce Ovbiagele, MD, MAS, FAAN, UCSF Professor of Neurology and Associate Dean of the San Francisco VA Healthcare System

Newswise — Bruce Ovbiagele, MD, MSC, MAS, MBA, MLS, FAAN, UC San Francisco Professor of Neurology and Associate Dean of the San Francisco VA Healthcare System, has been chosen by the American Brain Foundation (ABF) to receive its annual Scientific Breakthrough Award. Ovbiagele is being honored for his transformative work in health equity and inclusion, improving stroke outcomes for underserved and vulnerable populations.  

The Scientific Breakthrough Award is given to an individual or group whose research has led to meaningful advances for the care of patients living with neurological disease. In bestowing the award, the foundation noted that, “Dr. Ovbiagele’s impact on the field has been tremendous; his research and his role as a mentor have made the field and the atmosphere for discovery immensely better. He has also helped to train, mentor, and inspire individuals from underrepresented groups in medicine to conduct high-quality neurological research.” 

Ovbiagele will receive the award at the American Brain Foundation’s annual Commitment to Cures gala on April 13 in Denver, celebrating researchers and advocates working toward life without brain disease. The event is held in conjunction with the American Academy of Neurology’s (AAN) 2024 annual meeting. 

“I thank the American Brain Foundation for this wonderful honor, which I accept with gratitude and on behalf of the many other colleagues across national borders with whom I have collaborated,” said Ovbiagele.  

Dr. Ovbiagele’s research focuses on stroke outcomes in disparate populations and is chronicled in more than 630 peer-reviewed articles with over 130,000 citations.  Using innovative trial designs, genomic technologies, and community engaged methodologies, he has implemented evidence-based stroke prevention programs to reduce death and disability for high-risk populations in low-resource settings. Another focus of Dr. Ovbiagele’s professional efforts is enhancing the careers of individuals under-represented in the global biomedical research workforce. His initiatives have launched the careers of scores of individuals who are under-represented in medicine and science in the United States and beyond, into academic prominence and their own independently funded research careers.  

In addition to the Scientific Breakthrough Award, Ovbiagele has received numerous awards and honors for his work, including the W. Lester Henry Award from the American College of Physicians; the Michael Pessin Stroke Leadership Award, the Health Equity Research Award and Robert Wartenberg Lecture Award from the AAN; Audrey Penn Award from the American Neurological Association; Mridha Humanitarian Award from ABF; William Feinberg Award and Stroke Council Award from the American Stroke Association; Ron Haddock International Impact Award and Distinguished Scientist Award from the American Heart Association; Meritorious Achievement Award from the National Medical Association; and Services to Stroke Award from the World Stroke Organization. 

He currently serves on the Board of Directors of AAN (2023-2025) and has been a member of the AAN since 1998. He has served on several AAN committees and subcommittees including the Clinical Research Training Fellowship Award Committee, Clinical Research Subcommittee, Minority Scholars Subcommittee, and Education Committee. He was a “Neurology on the Hill” participant in 2008, Palatucci Advocacy Leadership Forum graduate in 2009, and Minority Scholars Visiting Professor to Morehouse School of Medicine in 2011. He has served as director of stroke courses at both the Annual Meeting and Fall Conference, faculty chair/guest editor for a Continuum® issue, and abstracts reviewer for the AAN Annual Meeting. He presently directs the Health Equity for Neurologists course at the Annual Meeting. Ovbiagele is a member of the AAN’s Media Expert Panel.  

Dr. Ovbiagele chaired the International Stroke Conference (2016–2018), served as an associate editor of Stroke (2020–2022), and is the current editor-in-chief of the Journal of the American Heart Association. He is an elected member of the National Academy of Medicine and Association of American Physicians; as well as an elected fellow of the World Academy of Sciences, International Science Council, World Stroke Organization, American Association for the Advancement of Science, Royal College of Physicians (London), and Royal Society of Public Health. He also serves on the ABF’s Research Advisory Committee. 

He received a degree in Medicine from the University of Lagos. He received fellowship training in Vascular Neurology at UCLA, his residency in General Neurology at UC Irvine and he interned in Internal Medicine and Psychiatry at Charles Drew University in Los Angeles. He also has a law degree from Washington University in St. Louis, a Master of Science from UCLA, a Master of Advanced Studies from UC San Diego and a MBA from University of Massachusetts, Amherst.   

About ABF:

The American Brain Foundation was founded to bring researchers and donors together to cure brain diseases and disorders. For more than 30 years, the organization has funded research across a broad spectrum of brain and nervous system diseases and disorders in the pursuit of improved treatments, prevention, and cures.  

About UCSF Health:

UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland; Langley Porter Psychiatric Hospital and Clinics; UCSF Benioff Children’s Physicians; and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit https://ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.

Innovations in Stroke Recovery and Rehabilitation

They suggest nothing about recovery, just biomarkers which are just a way to predict failure to recover. I'd say this is totally fucking useless.

We may as well go back to blood letting as a stroke prescription as discussed in the 1843 book, 'An Essay On The Nature and Treatment of Apoplexy'. I see no innovation, just rehashed crapola guidelines.

Ask your doctor what is the basis for their treatment of your stroke disabilities and why they moved away from bloodletting.  My doctor knew nothing and did nothing as proven by the writing of three E.T.(Evaluate and treat) prescriptions.

 

Innovations in Stroke Recovery and Rehabilitation

• Joan Stilling, MD, MS, FRCPC
• Joel Stein, MD

Published:August 02, 2023DOI:https://doi.org/10.1016/j.pmr.2023.07.003

Joan Stilling, MD, MS, FRCPC, Editor

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Joel Stein, MD, Editor

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Despite improvements in acute stroke management, many stroke survivors remain with substantial disability. Efforts to more effectively harness the brain’s plasticity and capacity for recovery have been gradually providing a more robust array of evidence to help guide practitioners. At the same time, new treatments, such as cryoneurolysis, are being incorporated into the management of long-term sequelae of stroke. In this special issue focusing on stroke rehabilitation, contributors review our current understanding of mechanisms involved in motor recovery and motor learning following stroke. Techniques to impact and augment motor control and motor learning are discussed. Biomarkers of functional outcomes following stroke are presented with regards to prognostication of both upper and lower limb recovery, with the expectation that these predictive models will ultimately be used to guide individualized treatment.

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