Screening for Social Determinants of Health (SDOH) and Cognitive Function in Individuals With History of Stroke

 Screening DOES NOTHING TO GET SURVIVORS RECOVERED! Useless. 

Screening for Social Determinants of Health (SDOH) and Cognitive Function in Individuals With History of Stroke

ClinicalTrials.gov IDNCT06615973

SponsorNational Institute of Neurological Disorders and Stroke (NINDS)

Information Provided byRebecca F Gottesman, M.D.

Study Start (Estimated)2025-12-03

Primary Completion (Estimated) 2026-02-01

Study Completion (Estimated)2026-02-01

Enrollment (Estimated)450

Study TypeObservational

Last Update Posted2025-12-01

Study Overview

Brief Summary

Background:

Stroke is the fifth leading cause of death in the United States. It is also a leading cause of disability. More than 70% of people who survive strokes have mental impairment or dementia. Medical factors, such as the severity of the stroke, affect whether a person will have mental impairment afterward. But social factors, such as education and ethnicity, seem to play a role as well. Researchers want to learn more about how social and lifestyle factors affect a person s chances of maintaining mental functions after a stroke.

Objective:

To better understand how social and lifestyle factors affect the risk of mental impairment after a stroke.

Eligibility:

People aged 18 years and older who had a stroke and a brain scan while they were enrolled in NIH Study 01N0007 (Natural History of Stroke Study).

Design:

Participants will have 1 study visit, by telephone. The call will last about 45 minutes. Participants will talk about their health since their stroke. They will answer questions about themselves. Topics will include:

• Their race
• Education
• Ethnicity
• Employment
• Marital status
• Residence address
• Recent health history
• Medical insurance

They will have tests of their memory, attention, and language skills. They will repeat numbers and words forward and backward.

Researchers will look at the data and imaging scans collected during participant s enrollment in NIH Study 01N0007. This data will include:

• The hospital that first saw the participant at the time of their stroke.
• The type of imaging that was first used then.
• The primary diagnosis at admission.
• Other medical details.

Detailed Description

Study Description:

Clinical health outcomes and the likelihood of post stroke cognitive impairment and dementia (PSCID) can greatly vary following stroke incidence. Thus, developing a better understanding of what characteristics might provide resilience and enrich post-stroke recovery is of utmost importance. The NINDS Natural History of Stroke study (01N0007) was designed with the intention to generate natural history data of participants with or at-risk for acute stroke, transient ischemic attack (TIA), and other disturbances of cerebrovascular circulation. Through use of participants enrolled in the Natural History of Stroke study within the past six years, we aim to characterize social determinants of health (SDOH) and present-day cognitive function in this cohort. Following the collection of these data, we will examine how the core volume of acute supratentorial infarcts relates to post-stroke function as measured by the NIHSS, and how this association is modified based upon SDOH features and independent of treatment.

Objectives:

• To characterize SDOH and assess if such characteristics modify the relationship between MRI core infarct volume and post-stroke function (i.e., NIHSS) at baseline and/or discharge. Resilience will thus be assessed by evaluating how specified SDOH modify the correlation between MRI core infarct volume and NIHSS.
• To assess present cognitive function and assess if SDOH modify the relationship between MRI core infarct volume and present-day cognition. Resilience will thus be assessed by evaluating how SDOH modify the correlation between infarct volume and present-day cognition.
• To assess if SDOH modify the relationship between poststroke function (i.e. NIHSS) at baseline and/or discharge with present-day cognition. Resilience will thus be assessed by evaluating how SDOH modify the correlation between NIHSS and present-day cognition.

Endpoints:

The primary purpose of this study is to assess SDOH and cognitive function in participants who have had a stroke in the past six years. To this end, the primary study outcomes will be post-stroke function as defined by NIHSS and present-day cognitive function.

• Primary Endpoint: Association between MRI core infarct volume and post-stroke function (i.e. NIHSS) as modified by SDOH.
• Secondary Endpoints: Association between MRI core infarct volume and present-day cognitive function as modified by SDOH.
• Exploratory Endpoint: Association between post-stroke function (i.e. NIHSS) and present-day cognitive function as modified by SDOH.

Official Title

Screening for Social Determinants of Health (SDOH) and Cognitive Function in Individuals With History of Stroke

Mass ECG screening for atrial fibrillation in older adults does not seem to prevent stroke

 Of course screening does nothing to prevent stroke! Are you that blitheringly stupid not seeing that interventions would be needed based upon screening and that those interventions can prevent stroke? My god, the stupidity!

Mass ECG screening for atrial fibrillation in older adults does not seem to prevent stroke

Key takeaways:

• Two studies found that mass screening for atrial fibrillation in older adults does not reduce stroke.
• In one study, levels of a biomarker may indicate who does not need to be screened.

Mass ECG screening for atrial fibrillation in older adults did not reduce the incidence of stroke or stroke hospitalization, according to the results of two trials presented at the European Society of Cardiology Congress.

In the GUARD-AF study, screening U.S. adults from primary care practices aged 70 years or older for AF did not reduce risk for stroke compared with the usual care.

Two studies found that mass screening for atrial fibrillation in older adults does not reduce stroke. Image: Adobe Stock

In the STROKESTOP II study, screening Swedish adults aged 75 or 76 years for AF did not reduce risk for stroke or systemic embolism compared with no screening, but individuals with a low N-terminal pro-B natriuretic peptide level were at low risk for stroke and may represent a population that does not need ECG screening for AF.

GUARD-AF

Renato D. Lopes

For GUARD-AF, simultaneously published in the Journal of the American College of Cardiology, Renato D. Lopes, MD, PhD, professor of medicine at Duke University School of Medicine and a member of the Duke Clinical Research Institute, and colleagues randomly assigned 11,905 participants aged 70 years or older (median age, 75 years; 56.6% women) from 149 U.S. primary care practices to receive screening for AF via wearing a single-lead continuous ECG monitor (Zio XT, iRhythm Technologies) for 14 days or to receive the usual care. Participants were followed for a median of 15.3 months.

“Recent trials of brief one-time screening for AFib have not consistently shown an increase in the diagnosis of AFib,” Lopes said during a press conference at the ESC Congress. “Conversely, trials that use longer-term screening strategies have shown an increase in the diagnosis of AFib. But today, no trials have established that AFib screening can actually reduce stroke. Therefore, the main goal of the GUARD-AF trial was to determine whether AFib screening reduces the risk of stroke and provides a net clinical benefit compared with the usual care.”

The trial was scheduled to enroll more than 50,000 participants but was terminated early after the sponsor pulled funding due to the COVID-19 pandemic, Lopes said at the press conference.

The primary efficacy outcome of hospitalization for stroke did not differ between the screening (0.7%) and usual care groups (0.6%; HR = 1.1; 95% CI, 0.69-1.75), he said.

The primary safety outcome of hospitalization for bleeding also did not differ between the groups (screening, 1%; usual care, 1.1%; HR = 0.87; 95% CI, 0.6-1.26), according to the researchers.

Clinical diagnosis of AF or atrial flutter was 52% greater in the screening group compared with the usual care group (4 per 100 person-years vs. 2.63 per 100 person-years), and the screening group was more likely to have a prescription for oral anticoagulation filled during the study period than the usual care group (4.2% vs. 2.8%), Lopes and colleagues found.

Most AF episodes detected were short, and most patients diagnosed with AF had paroxysmal AF, Lopes said.

“Screening ... increased the detection of AFib by 52% and increased initiation of oral anticoagulation, but did not reduce hospitalization for stroke,” he said. “No differences were seen in the rates of hospitalization for bleeding or all-cause mortality between the study groups. The premature termination of enrollment and low statistical power unfortunately do not allow for a definitive conclusion about the effect of AFib screening on stroke prevention.”

Factors beyond age will be needed to identify a population at high-enough risk to benefit from AF screening, he said.

STROKESTOP II

For STROKESTOP II, simultaneously published in Circulation, Katrin Kemp Gudmundsdottir, MD, PhD, from the division of cardiology in the department of clinical sciences at Danderyd University Hospital, Stockholm, Sweden, and colleagues randomly assigned all adults aged 75 and 76 years in the Stockholm region to be invited to screening or serve as a control group.

“The ESC AF guidelines recommend AF screening in adults aged 75 years or older or those at high risk of stroke,” Kemp Gudmundsdottir said during a press conference at the Congress. “Our questions were, can atrial fibrillation screening using NT-pro BNP combined with ECG reduce stroke or systemic embolism, and what is the prognostic value of NT-pro BNP in AF screening.”

After exclusion of individuals who died or emigrated, the study population (mean age, 76.5 years; 53% women) consisted of 13,905 adults in the screening group and 13,884 adults in the control group. The latter “received no information on the study and no intervention,” she said. Results were registry-based.

The response rate of the screening group was 49.2%, translating to 6,843 people, Kemp Gudmundsdottir said at the press conference. Of the screening group, 6,288 had available NT-pro BNP levels, and of those, 40% were classified as low risk (less than 125 ng/L) and 60% were classified as high risk (125 ng/L or more), she said, noting the low-risk group had a one-time ECG screening at the initial visit and the high-risk group had a prolonged screening — 30 seconds of ECG four times daily for 2 weeks.

Among the screening group, 2.4% had newly detected AF (an additional 0.8% had known but untreated AF), and at 5 years, there was no difference between the screening and control groups in prevalence of AF or treatment with oral anticoagulation, according to the researchers.

However, those in the screening group classified as high risk based on NT-pro BNP had greater risk for new AF compared with those classified as low risk (HR = 2.42; 95% CI, 2.02-2.9; P < .001), they reported.

At a median follow-up of 5.1 years, there was no difference between the screening and control groups in the primary outcome of stroke or systemic embolism (HR = 0.96; 95% CI, 0.86-1.06; P = .412), Kemp Gudmundsdottir said at the press conference.

But compared with controls, the low-risk individuals in the screening group had reduced risk for stroke or systemic embolism (HR = 0.59; 95% CI, 0.46-0.74; P = .001), she said.

In addition, the high-risk individuals in the screening group had elevated risk for stroke or systemic embolism compared with the low-risk individuals (HR = 1.57; 95% CI, 1.22-2.02; P = .001), according to the researchers.

“NT-pro BNP can safely be used to determine who not to screen for AF,” Kemp Gudmundsdottir said.

References:

• Kemp Gudmundsdottir K, et al. Hot line 9. Presented at: European Society of Cardiology Congress; Aug. 30-Sept. 2, 2024; London (hybrid meeting).
• Kemp Gudmundsdottir K, et al. Circulation. 2024;doi:10.1161/CIRCULATIONAHA.124.071176.
• Lopes RD, et al. J Am Coll Cardiol. 2024;doi:10.1016/j.jacc.2024.08.019.

Screening for Asymptomatic Carotid Artery Stenosis Lack of Clinical Benefit, Potential for Harm

 I had zero risk factors for this and was totally asymptomatic, except that my Dad had 80% blockage and his doctor failed to tell him that any children had moved into the high risk category for carotid stenosis. So my stroke was totally preventable except my Dads' doctor failed at getting me informed of my risk.

Screening for Asymptomatic Carotid Artery Stenosis Lack of Clinical Benefit, Potential for Harm

Larry B. Goldstein, MD¹

Author Affiliations

JAMA. 2021;325(5):443-444. doi:10.1001/jama.2020.26440

editorial comment icon

Editorial

Comment

related articles icon

Related

Articles

author interview icon

Interviews

• Editorial
  To Screen or Not to Screen for Carotid Stenosis
  Seemant Chaturvedi, MD
• Editorial
  Screening for Asymptomatic Carotid Artery Stenosis in Adult Patients
  Salomeh Keyhani, MD, MPH; Eric M. Cheng, MD
• Editorial
  USPSTF Recommendations for Screening for Carotid Stenosis to Prevent Stroke
  Rebecca Smith-Bindman, MD; Kirsten Bibbins-Domingo, PhD, MD, MAS

• Research Letter
  Screening for Asymptomatic Carotid Artery Stenosis in the General Population
  Janelle M. Guirguis-Blake, MD; Elizabeth M. Webber, MS; Erin L. Coppola, MPH
• US Preventive Services Task Force
  USPSTF Recommendation: Screening for Asymptomatic Carotid Artery Stenosis
  US Preventive Services Task Force; Alex H. Krist, MD, MPH; Karina W. Davidson, PhD, MASc; Carol M. Mangione, MD, MSPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Katrina Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD
• JAMA Patient Page
  USPSTF Recommendation: Screening for Carotid Artery Stenosis
  Jill Jin, MD, MPH

Conversations with Dr Bauchner (21:08)

USPSTF Recommendation: Carotid Artery Stenosis

  

1x

0:00 / 0:00

Subscribe to Podcast

In the Recommendation Statement published in this issue of JAMA,¹ the US Preventive Services Task Force (USPTF) has reaffirmed its 2014 recommendation, stating that “The USPTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population (D recommendation),” based on evidence that the harms of screening for carotid artery stenosis in asymptomatic adults outweigh the benefits, with no new evidence that would change the previous recommendation. The rationale for this confirmation is based on a combination of considerations, including the effects of false-positive results when screening the general population with duplex ultrasonography; inadequate evidence that screening for asymptomatic carotid artery stenosis leads to a reduction in stroke or death; and the likelihoods of small to moderate harms(What harm does ultrasound screening cause?) of screening for and treatment of asymptomatic carotid artery stenosis. The restated recommendation is also consistent with that of the 2014 guidelines from the American Heart Association not to screen low-risk populations for asymptomatic carotid artery stenosis.²

• Editorial
  To Screen or Not to Screen for Carotid Stenosis
• Editorial
  Screening for Asymptomatic Carotid Artery Stenosis in Adult Patients
• Editorial
  USPSTF Recommendations for Screening for Carotid Stenosis to Prevent Stroke

Full Text

 

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack

This is so simple. A binary question: Did the test provide 100% accuracy? Yes/No?  If no,  then find something with the required accuracy.

Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack

Cochrane Systematic Review - Diagnostic Version published: 09 April 2019

View article information

• Zhivko Zhelev
• Greg Walker
• Nicholas Henschke
• Jonathan Fridhandler
• Samuel Yip

View authors' declarations of interest

Abstract

Background

Rapid and accurate detection of stroke by paramedics or other emergency clinicians at the time of first contact is crucial for timely initiation of appropriate treatment. Several stroke recognition scales have been developed to support the initial triage. However, their accuracy remains uncertain and there is no agreement which of the scales perform better.

Objectives

To systematically identify and review the evidence pertaining to the test accuracy of validated stroke recognition scales, as used in a prehospital or emergency room (ER) setting to screen people suspected of having stroke.

Search methods

We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and the Science Citation Index to 30 January 2018. We handsearched the reference lists of all included studies and other relevant publications and contacted experts in the field to identify additional studies or unpublished data.

Selection criteria

We included studies evaluating the accuracy of stroke recognition scales used in a prehospital or ER setting to identify stroke and transient Ischemic attack (TIA) in people suspected of stroke. The scales had to be applied to actual people and the results compared to a final diagnosis of stroke or TIA. We excluded studies that applied scales to patient records; enrolled only screen‐positive participants and without complete 2 × 2 data.

Data collection and analysis

Two review authors independently conducted a two‐stage screening of all publications identified by the searches, extracted data and assessed the methodologic quality of the included studies using a tailored version of QUADAS‐2. A third review author acted as an arbiter. We recalculated study‐level sensitivity and specificity with 95% confidence intervals (CI), and presented them in forest plots and in the receiver operating characteristics (ROC) space. When a sufficient number of studies reported the accuracy of the test in the same setting (prehospital or ER) and the level of heterogeneity was relatively low, we pooled the results using the bivariate random‐effects model. We plotted the results in the summary ROC (SROC) space presenting an estimate point (mean sensitivity and specificity) with 95% CI and prediction regions. Because of the small number of studies, we did not conduct meta‐regression to investigate between‐study heterogeneity and the relative accuracy of the scales. Instead, we summarized the results in tables and diagrams, and presented our findings narratively.

Main results

We selected 23 studies for inclusion (22 journal articles and one conference abstract). We evaluated the following scales: Cincinnati Prehospital Stroke Scale (CPSS; 11 studies), Recognition of Stroke in the Emergency Room (ROSIER; eight studies), Face Arm Speech Time (FAST; five studies), Los Angeles Prehospital Stroke Scale (LAPSS; five studies), Melbourne Ambulance Stroke Scale (MASS; three studies), Ontario Prehospital Stroke Screening Tool (OPSST; one study), Medic Prehospital Assessment for Code Stroke (MedPACS; one study) and PreHospital Ambulance Stroke Test (PreHAST; one study). Nine studies compared the accuracy of two or more scales. We considered 12 studies at high risk of bias and one with applicability concerns in the patient selection domain; 14 at unclear risk of bias and one with applicability concerns in the reference standard domain; and the risk of bias in the flow and timing domain was high in one study and unclear in another 16.
We pooled the results from five studies evaluating ROSIER in the ER and five studies evaluating LAPSS in a prehospital setting. The studies included in the meta‐analysis of ROSIER were of relatively good methodologic quality and produced a summary sensitivity of 0.88 (95% CI 0.84 to 0.91), with the prediction interval ranging from approximately 0.75 to 0.95. This means that the test will miss on average 12% of people with stroke/TIA which, depending on the circumstances, could range from 5% to 25%. We could not obtain a reliable summary estimate of specificity due to extreme heterogeneity in study‐level results. The summary sensitivity of LAPSS was 0.83 (95% CI 0.75 to 0.89) and summary specificity 0.93 (95% CI 0.88 to 0.96). However, we were uncertain in the validity of these results as four of the studies were at high and one at uncertain risk of bias. We did not report summary estimates for the rest of the scales, as the number of studies per test per setting was small, the risk of bias was high or uncertain, the results were highly heterogenous, or a combination of these.
Studies comparing two or more scales in the same participants reported that ROSIER and FAST had similar accuracy when used in the ER. In the field, CPSS was more sensitive than MedPACS and LAPSS, but had similar sensitivity to that of MASS; and MASS was more sensitive than LAPSS. In contrast, MASS, ROSIER and MedPACS were more specific than CPSS; and the difference in the specificities of MASS and LAPSS was not statistically significant.

Authors' conclusions

In the field, CPSS had consistently the highest sensitivity(But not 100%?) and, therefore, should be preferred to other scales. Further evidence is needed to determine its absolute accuracy and whether alternatives scales, such as MASS and ROSIER, which might have comparable sensitivity but higher specificity, should be used instead, to achieve better overall accuracy. In the ER, ROSIER should be the test of choice, as it was evaluated in more studies than FAST and showed consistently high sensitivity. In a cohort of 100 people of whom 62 have stroke/TIA, the test will miss on average seven people with stroke/TIA (ranging from three to 16). We were unable to obtain an estimate of its summary specificity. Because of the small number of studies per test per setting, high risk of bias, substantial differences in study characteristics and large between‐study heterogeneity, these findings should be treated as provisional hypotheses that need further verification in better‐designed studies.

Plain language summary

Accuracy of prehospital stroke scales to identify people with stroke or transient ischemic attack (TIA)
Background
Stroke is a life‐threatening medical condition in which brain tissue is damaged. This could be caused by a clot blocking the blood supply to part of the brain or bleeding in the brain. If symptoms resolve within 24 hours without lasting consequences, the condition is called TIA (mini stroke). Effective treatment depends on early identification of stroke and any delays may result in brain damage or death.
Emergency medical services are the first point of contact for people experiencing symptoms suggestive of stroke. Medical responders could identify people with stroke more accurately if they use checklists called stroke recognition scales. Such scales include symptoms and other readily‐available information. A positive result on the scale indicates high risk of stroke and the need of urgent specialist assessment. The scales do not differentiate between stroke and TIA; this is done in hospital by a neurologist or stroke physician.
Our objective was to review the research evidence on how accurately stroke recognition scales can detect stroke or TIA when used by paramedics or other prehospital clinicians, who are the first point of contact for people suspected of stroke.
Study characteristics
The evidence is current to 30 January 2018. We included studies assessing the accuracy of stroke recognition scales when applied to adults suspected of stroke out of hospital.
We included 23 studies evaluating the following scales: Cincinnati Prehospital Stroke Scale (CPSS; 11 studies), Recognition of Stroke in the Emergency Room (ROSIER; eight studies), Face Arm Speech Time (FAST; five studies), Los Angeles Prehospital Stroke Scale (LAPSS; five studies), Melbourne Ambulance Stroke Scale (MASS; three studies), Ontario Prehospital Stroke Screening Tool (OPSST; one study), Medic Prehospital Assessment for Code Stroke (MedPACS; one study) and PreHospital Ambulance Stroke Test (PreHAST; one study). Nine studies compared two or more scales in the same people. The results from five studies were combined to estimate the accuracy of ROSIER in the emergency room (ER) and five studies to estimate the accuracy of LAPSS when used by ambulance clinicians.
Quality of the evidence
Many of the studies were of poor or unclear quality and we could not be sure that their results were valid.
Key results of the accuracy of the evaluated prehospital stroke scales
Studies differed considerably in terms of included participants and other characteristics. As a consequence, studies evaluating the same scale reported variable results.
We combined five studies evaluating ROSIER in the ER and obtained average sensitivity of 88% (88 out of 100 people with stroke/TIA will test positive on ROSIER). We were unable to obtain an estimate of specificity (how many people without stroke/TIA will test negative).
We also combined the results for LAPSS, but the included studies were of poor quality and the results may not be valid. The rest of the scales were evaluated in a smaller number of studies or the results were too variable to be combined statistically.
A small number of studies compared two or more scales when applied to the same participants. Such studies are more likely to produce valid results as the scales are used in the same circumstances. They reported that in the ER, ROSIER and FAST had similar accuracy, but ROSIER was evaluated in more studies. When used by ambulance staff, CPSS identified more people with stroke/TIA in all studies, but also more people without stroke/TIA tested positive.
Conclusion
Current evidence suggests(Stop using weasel words) that CPSS should be used by ambulance clinicians in the field. Further research is needed to estimate the proportion of wrong results and whether alternatives scales, such as MASS and ROSIER, which might have comparable sensitivity but higher specificity, should be used instead to achieve better overall accuracy. In the ER, ROSIER should be the test of choice. In a group of 100 people of whom 62 have stroke/TIA, the test will miss on average seven people with stroke/TIA (ranging from three to 16). Because of the small number of studies evaluating the tests in a specific setting, poor quality, substantial differences in study characteristics and variability in results, these findings should be treated with caution and need further verification in better‐designed studies.

THE CLINICAL AND DIAGNOSTIC PROFILE OF VERTIGINOUS SYNDROMES IN EMERGENCY DEPARTMENT

What will it take to get 100% accuracy in detecting strokes rather than these mimics? Don't just describe a problem and throw up your hands in defeat. Our stroke leadership should have a strategy to solve this problem. But we have neither so stroke patients will continue to be screwed forever.

THE CLINICAL AND DIAGNOSTIC PROFILE OF VERTIGINOUS SYNDROMES IN EMERGENCY DEPARTMENT

StrokeApp NIHSS Calculator

Once again using subjective means to diagnose a stroke. Fuck-it-all, do it objectively, maybe these 17 diagnosis possibilities to find out which one is the best? Or maybe the Qualcomm Xprize for the tricorder? With this you better have the major classical symptoms to accurately diagnose a stroke and not be blown off by suggesting you are drunk or drugged.  I don't care that it has been used since 1983, is it 100% accurate? Appeal to authority and appeal to antiquity are not valid scientific reasons to keep using this.

 

StrokeApp NIHSS Calculator

Description

Ever wonder why the NIHSS looks so simple when neurologists or stroke nurse coordinators perform the assessment? What’s "double simultaneous stimulation"? What’s “stupor” mean? When did I test for “extinction” & how is “anosagnosia” pronounced? But mostly, how is an entire exam completed in under 10 minutes?

personalRN’s NIH StrokeApp Calculator has now made the NIHSS easy to use for any doctor or nurse from the ER to the floor, whether attending, resident, medical or nursing student! Our StrokeApp Calculator is the only automated NIHSS that streamlines clinical assessment without losing accuracy. This added efficiency becomes advantageous in a busy ER or ICU since acute stroke patients can be non-cooperative during NIHSS assessment, wasting precious clinical time and leaving patients, their loved ones & practitioners frustrated. Neurologists & stroke nurse coordinators have training and experience that allows their intuitive adjustment of the NIHSS to fit the patient's immediate clinical state and cognitive limitations. The StrokeApp Calculator's development reflects many consultation hours with stroke neurologists that are considered thought leaders in the specialty. Our calculator is designed to act as a mobile stroke neurologist on your iPad, providing insight to skip and automatically assign scores to questions with dependencies, and provide real-time adjustments based on the patient's:

- mental status
- comprehension
- visual impairment
- ability to speak, respond and interact, all of which may be affected by
- aphasia
- respiratory status requiring intubation for mechanical ventilation

All adjustments to the exam are in agreement with the rules and regulations set in place by the original NIHSS without alterations or omissions of the original 15 questions. Lastly, the StrokeApp Calculator is the only mobile application for the NIHSS supported by clinical studies at a Comprehensive Stroke Center to evaluate whether simple instructions & easy-to-understand multimedia educational content of the calculator will allow for higher accuracy obtained in less time.

We believe that healthcare should be user-friendly for everyone, whether patient, caregiver or provider. Since 1983, the NIHSS has proven to be an exceptional clinical assessment tool for the assessment of stroke by doctors & nurses. personalRN’s NIH StrokeApp Calculator preserves the standardization of the NIHSS, which has allowed for its reliability, reproducibility and validity over three decades. The NIHSS has now become accessible to any healthcare provider at any stage of their training, from the first responders like paramedics or firefighters, or rehabilitation specialists like PT, OT & speech therapists.

NHS urged to screen stroke patients for silent heart disease to prevent thousands of deaths

Stroke protocol here? Or are dying stroke survivors not a problem? I had heart artery screening 2 years later and was declared to have clean heart arteries. I had to initiate this testing on my own.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=160085&CultureCode=en
A new study has revealed that more than a third of stroke patients with no known history of heart disease have significant tightening of the arteries around their heart (coronary artery disease) and three percent will go on to suffer a heart attack within a year.
The research, led by Professor Pankaj Sharma at the Institute of Cardiovascular Research at Royal Holloway, University of London and Ashford and St Peter’s Hospital, Surrey, reviewed data from 50,000 individuals to establish the risk of heart disease and heart attack in stroke patients with no medical history of heart problems.
The research, published in BMJ Open today (20 January), establishes that stroke patients are significantly at risk of coronary artery disease and heart attack even in the absence of symptoms associated with the disease. Those with silent heart disease do not experience any symptoms and therefore can remain undiagnosed, without access to treatment that can help manage the symptoms and reduce the future chance of a heart attack.
In the largest study of its kind, researchers found that one in three stroke patients have 50 percent coronary stenosis - meaning that plaque build-up is constricting the inner diameter of the artery by half, restricting the flow of blood and oxygen to the heart. In 3 percent of cases, patients will experience a heart attack within one year of their stroke – higher than previously thought.
The researchers recommend that following a stroke all patients should be assessed by cardiologists and screened for silent heart disease and this new protocol should be mandated by the NHS, something not routinely done in the UK.
Lead researcher Professor Pankaj Sharma from the Institute of Cardiovascular Research at Royal Holloway, said: “Following a stroke most stroke patients go on to die of heart disease rather than their stroke. Our research findings go a long way to explaining why this is the case. We are urging the NHS to screen all stroke patients for silent heart disease to prevent the deaths of thousands of patients each year.

• Full bibliographic informationBMJ Open, Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50 000 participants
  Authors: Trishna Gunnoo, Nazeeha Hasan, Muhammad Saleem Khan, Julia Slark, Paul Bentley, Pankaj Sharma
  20/1/16

New, Rapid Dementia Screening Tool Rivals 'Gold Standard' Clinical Evaluations

What is your doctor using to determine your dementia status post-stroke? Anything at all? What is your doctor doing to prevent your 33% dementia chance post-stroke from an Australian study? ANYTHING AT ALL?
Or is you doctor relying on your early life experiences?
Kids' School Grades Tied to Late-Life Dementia Risk
Or you could ask your doctor about my ideas:
Dementia prevention 19 ways

Maybe this for screening?
New, Rapid Dementia Screening Tool Rivals 'Gold Standard' Clinical Evaluations

Prevalence of Brain Arteriovenous Malformations in First-Degree Relatives of Patients With a Brain Arteriovenous Malformation

For those that have AVMs.
http://stroke.ahajournals.org/content/45/11/3231.abstract?etoc

1. Janneke van Beijnum, MD, PhD;
2. H. Bart van der Worp, MD, PhD;
3. Ale Algra, MD, PhD;
4. W. Peter Vandertop, MD, PhD;
5. René van den Berg, MD, PhD;
6. Patrick A. Brouwer, MD;
7. Jan Willem Berkelbach van der Sprenkel, MD, PhD;
8. L. Jaap Kappelle, MD, PhD;
9. Gabriël J.E. Rinkel, MD, FRCPE;
10. Catharina J.M. Klijn, MD, PhD

+ Author Affiliations

1. From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (J.v.B., H.B.v.d.W., A.A., J.W.B.v.d.S., L.J.K., G.J.E.R., C.J.M.K.), and the Julius Centre for Health Science and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, The Netherlands; Departments of Neurosurgery (W.P.V.) and Radiology (R.v.d.B.), Neurosurgical Center Amsterdam, VU University Medical Center and Amsterdam Medical Center, Amsterdam, The Netherlands; and Departments of Neurosurgery (J.v.B.) and Radiology (P.A.B.), Leiden University Medical Center, Leiden, The Netherlands.

1. Correspondence to Janneke van Beijnum, MD, PhD, Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands. E-mail J.vanBeijnum@gmail.com

Abstract

Background and Purpose—It is uncertain whether familial occurrence of brain arteriovenous malformations (BAVMs) represents coincidental aggregation or a shared familial risk factor. We aimed to compare the prevalence of BAVMs in first-degree relatives (FDRs) of patients with BAVM and the prevalence in the general population.

Methods—We sent a postal questionnaire to 682 patients diagnosed with a BAVM in 1 of 4 university hospitals to retrieve information about the occurrence of BAVMs among their FDRs. We calculated a prevalence ratio using the BAVM prevalence among FDRs and the prevalence from a Scottish population-based study (93 per 628 788 adults). A prevalence ratio of ≥9 with a lower limit of the 95% confidence interval of 3 was considered indicative of a shared familial risk factor.

Results—Informed consent was given by 460 (67%) patients, who had 2992 FDRs. We identified 3 patients with a FDR with a BAVM, yielding a prevalence ratio of 6.8 (95% CI, 2.2–21).

Conclusions—The prevalence of BAVMs in FDRs of patients with a BAVM was increased but did not meet our prespecified criterion for a shared familial risk factor. In combination with the low absolute risk of a BAVM in FDRs, our results do not support screening of FDRs for BAVMs.

Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings - heart and stroke

The carotid ultrasound would have found my mostly blocked carotid artery but I never would have considered going since I had no symptoms or risk factors.

Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings - heart and stroke

Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are “unethical” and the exams are more likely to do harm than good.

In recent years, more hospitals have paired with firms offering such testing packages, partly to build community goodwill and referrals.  Hospitals say residents benefit from the testing packages, which can cost less than $150, because some will discover they are at higher risk for heart problems or stroke early enough to take steps to reduce their risks.

More at link.