CSF Biomarker Flags Parkinson's Pathology Years Before Symptoms Appear

 With your heightened chance of getting Parkinsons due to your stroke, your doctor should have this test in their protocol. So if positive they can initiate the Parkinsons prevention protocols. I don't give a damn that those prevention protocols don't exist yet. Your doctor and hospital ARE RESPONSIBLE FOR GETTING THEM CREATED, only three years to get them created. Or you can let sleeping dogs lie and let them be incompetent in peace. What other business allows failure to continue for decades at a time? Obviously failure is an option in the medical world because the failures don't impact the providers directly.

Parkinson’s Disease May Have Link to Stroke March 2017 

The latest here:

CSF Biomarker Flags Parkinson's Pathology Years Before Symptoms Appear

Strong sensitivity, specificity in early study

by Judy George, Senior Staff Writer, MedPage Today March 4, 2021

Real-time quaking-induced conversion (RT-QuIC), a test for pathological misfolded protein, detected alpha-synuclein in the cerebrospinal fluid (CSF) of patients with isolated rapid-eye-movement (REM) sleep behavior disorder (IRBD), years before clinical symptoms of Parkinson's disease or dementia with Lewy bodies emerged.

In these patients, RT-QuIC detected misfolded alpha-synuclein in CSF with both sensitivity and specificity of 90%, reported Alison Green, PhD, of the University of Edinburgh in Scotland, and co-authors, in Lancet Neurology. Alpha-synuclein positivity was associated with increased risk of subsequent diagnosis of Parkinson's disease or dementia with Lewy bodies.

"The detection of pathological alpha-synuclein preceded the development of clinical symptoms by a mean of 3.2 years, with a range of 6 months to 9 years," Green said.

"This is the first step towards having a reliable biomarker for early, pre-symptomatic disease which will enable therapeutic interventions, including potential neuroprotective treatments,(What the fuck are those treatments? Useless since you didn't point to where those treatments are listed.) to start in a more timely manner," she told MedPage Today.

RT-QuIC was developed initially to detect abnormally folded prion protein. The "technique is based on prion seed-induced misfolding and aggregation of recombinant protein substrate, accelerated by alternating cycles of shaking and rest in fluorescence plate readers," said Inga Zerr, MD, of the Georg-August University in Göttingen, Germany, in an accompanying editorial.

Seeding activity of misfolded alpha-synuclein had previously been studied in people with Parkinson's disease and dementia with Lewy bodies using brain tissue, CSF, submandibular gland tissues, olfactory mucosa samples, and skin biopsies, Zerr added.

IRBD can be part of the prodromal stage of Parkinson's disease and dementia with Lewy bodies. In this study, Green and colleagues evaluated CSF samples obtained from 52 patients who had IRBD confirmed by video polysomnography at a sleep disorders center in Barcelona and 40 matched controls who were free of neurological disease.

Lumbar punctures for CSF were obtained from 2008 to 2017. Mean follow-up from lumbar puncture until the end of the study in 2020 was 7.1 years in the IRBD group and 7.7 years in controls.

During follow-up, 32 patients (62%) were diagnosed with Parkinson's disease or dementia with Lewy bodies a mean 3.4 years after lumbar puncture, of whom 31 (97%) were alpha-synuclein positive at baseline. Specifically, 16 people developed Parkinson's (15 of whom were positive for CSF alpha-synuclein), and 16 developed dementia with Lewy bodies (all were positive for CSF alpha-synuclein).

CSF alpha-­synuclein RT-­QuIC was positive in 47 (90%) of 52 patients and in four (10%) of 40 healthy controls, resulting in a sensitivity of 90.4% (95% CI 79.4–95.8) and a specificity of 90.0% (95% CI 76.9–96.0).

The average interval for people who were alpha-synuclein positive at baseline to convert to clinically defined Parkinson's or dementia with Lewy bodies was 3.2 years. Patients with IRBD who were alpha-synuclein negative had lower risk for developing Parkinson's disease or dementia with Lewy bodies at 2, 4, 6, 8, and 10 years of follow-up than patients with IRBD who were alpha-synuclein positive. During follow-up, none of the controls developed an alpha-synucleinopathy.

"This result clearly demonstrates the potential of the RT-QuIC method to detect alpha-synucleinopathies, such as Parkinson's disease and dementia with Lewy bodies, early before typical clinical manifestation," Zerr said.

"However, a matter that needs to be addressed further in longitudinal studies is the interpretation of positive test results in a cross-sectional setting," she continued. "There were four positive test reactions in 40 healthy controls and in 16 patients with IRBD who did not (by the end of the study) develop clinical symptoms indicative of alpha-synucleinopathy. The probability of some participants having a subclinical alpha-synucleinopathy that did not evolve into Parkinson's disease or dementia with Lewy bodies within the observation period cannot be excluded and requires further investigation."

Other limitations, Green and co-authors noted, were that the results are based on a single­-center study with a fairly small number of participants.

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The study was funded by the Department of Health and Social Care Policy Research Programme, the Scottish Government, and the Weston Brain Institute.

Green reported no competing interests; co-authors reported relationships with AbbVie, Roche, Takeda, Jazz, UCB, Wave Pharmaceuticals, Teva, Bial, Prevail, Boehringer Ingelheim, Biogen, the Spanish Network for Research on Neurodegenerative Disorders, and the Michael J. Fox Foundation for Parkinson's Research.

Zerr reported no conflicting interests.

Primary Source

Lancet Neurology

Source Reference: Iranzo A, et al "Detection of α-synuclein in CSF by RT-QuIC in patients with isolated rapid-eye-movement sleep behaviour disorder: a longitudinal observational study" Lancet Neurology 2021; DOI: https://doi.org/10.1016/S1474-4422(20)30449-X.

Secondary Source

Lancet Neurology

Source Reference: Zerr I "RT-QuIC for detection of prodromal α-synucleinopathies" Lancet Neurology 2021; DOI: https://doi.org/10.1016/S1474-4422(21)00036-3.

 

Revisiting Poststroke Upper Limb Stratification: Resilience in a Larger Cohort

Stratification is totally useless since there are NO PROTOCOLS that can be mapped to those levels.

Revisiting Poststroke Upper Limb Stratification: Resilience in a Larger Cohort

Show all authors

Benjamin J. Varley, Christine T. Shiner, PhD, Liam Johnson, PhD, ...

First Published February 1, 2021 Research Article

Abstract

Background

Upper limb (UL) impairment in stroke survivors is both multifactorial and heterogeneous. Stratification of motor function helps identify the most sensitive and appropriate assessments, which in turn aids the design of effective and individualized rehabilitation strategies. We previously developed a stratification method combining the Grooved Pegboard Test (GPT) and Box and Block Test (BBT) to stratify poststroke UL motor function.

Objective

To investigate the resilience of the stratification method in a larger cohort and establish its appropriateness for clinical practice by investigating limitations of the GPT completion time.

Methods

Post hoc analysis of motor function for 96 community-dwelling participants with stroke (n = 68 male, 28 female, age 60.8 ± 14 years, 24.4 ± 36.6 months poststroke) was performed using the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (F-M), BBT, and GPT. Hypothesis-free and hypothesis-based hierarchical cluster analyses were conducted to determine the resilience of the stratification method.

Results

The hypothesis-based analysis identified the same functional groupings as the hypothesis-free analysis: low (n = 32), moderate (n = 26), and high motor function (n = 38), with 3 exceptions. Thirty-three of the 38 participants with fine manual dexterity completed the GPT in ≤5 minutes. The remaining 5 participants took 6 to 25 minutes to place all 25 pegs but used alternative movement strategies to complete the test. The GPT time restriction changed the functional profile of the moderate and high motor function groups leading to more misclassifications.

Conclusion

The stratification method unambiguously classifies participants by UL motor function. While the inclusion of a 5-minute cutoff time for the GPT is preferred for clinical practice, it is not recommended for stratification purposes.

Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study

 

But is it better than the book Margaret Yekutiel wrote in 2001, 'Sensory Re-Education of the Hand After Stroke'? WHOM is going to answer that simple question? I want a specific name since we have NO STROKE LEADERSHIP.

Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study

Show all authors

Svetlana Pundik, MD, MSc, Margaret Skelly, PhD, Jessica McCabe, DPT, ...

First Published January 29, 2021 Research Article Find in PubMed 

Abstract

Background

Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct to peripherally administered rehabilitation therapies.

Objective

To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity.

Methods

Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions.

Results

Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected (F(2, 76.163) = 3.5, P = .035) and unaffected arm (F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 (F(2, 133.027) = 3.518, P = .032) and N45-P60 (F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 (F(2, 69.64) = 3.37, P = .04), N60 (F(2, 47.343) = 4.375, P = .018), and P100 (F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later.

Conclusions

Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.

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Mild Stroke Affects Pointing Movements Made in Different Frames of Reference

 

I could see ABSOLUTELY NOTHING HERE that helps survivors recover.

Mild Stroke Affects Pointing Movements Made in Different Frames of Reference

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Fariba Hasanbarani, PhD, Marc Aureli Pique Batalla, MSc, Anatol G. Feldman, PhD,

First Published January 29, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/1545968321989348

Article information 

Abstract

Background

Motor performance is a complex process controlled in task-specific spatial frames of reference (FRs). Movements can be made within the framework of the body (egocentric FR) or external space (exocentric FR). People with stroke have impaired reaching, which may be related to deficits in movement production in different FRs.

Objective

To characterize rapid motor responses to changes in the number of degrees of freedom for movements made in different FRs and their relationship with sensorimotor and cognitive impairment in individuals with mild chronic stroke.

Methods

Healthy and poststroke individuals moved their hand along the contralateral forearm (egocentric task) and between targets in the peripersonal space (exocentric task) without vision while flexing the trunk. Trunk movement was blocked in randomized trials.

Results

For the egocentric task, controls produced the same endpoint trajectories in both conditions (free- and blocked-trunk) by preserving similar shoulder-elbow interjoint coordination (IJC). However, endpoint trajectories were dissimilar because of altered IJC in stroke. For the exocentric task, controls produced the same endpoint trajectories when the trunk was free or blocked by rapidly changing the IJC, whereas this was not the case in stroke. Deficits in exocentric movement after stroke were related to cognitive but not sensorimotor impairment.

Conclusions

Individuals with mild stroke have deficits rapidly responding to changing conditions for complex reaching tasks. This may be related to cognitive deficits and limitations in the regulation of tonic stretch reflex thresholds. Such deficits should be considered in rehabilitation programs encouraging the reintegration of the affected arm into activities of daily living.

Keywords upper limb, motor control, motor equivalence, stroke, kinematics

Introduction

Reaching movements require perceptual-motor transformations depending on the spatial frame of reference (FR) in which they are performed.^1-6 A FR or system of coordinates consists of elements, the positions of which are defined by their distance from a specific point called the origin or referent point. The brain can use different FRs to accomplish motor actions. For example, reaching movements can be directed to a person’s body in an egocentric FR, or away from the body to a target located in external space in an exocentric FR.

Arm trajectories and interjoint coordination (IJC) differ for reaches made in egocentric and exocentric FRs.⁷ Healthy individuals have no difficulty rapidly changing reaching patterns in different FRs, practically without learning (ie, 1-trial adaptation).⁸ This behavior illustrates the principle of motor equivalence⁹: the ability to reach the same motor goal using different combinations of joint rotations, often referred to as kinematic redundancy.^10,11 This type of rapid reaction, critical for everyday life, is related to sensory feedback and the cognitive ability to find motor-equivalent solutions through motor problem-solving.^5,8,12-15

Egocentric and exocentric reaches involve partially overlapping but different neural structures. The parietal cortex constructs multiple spatial FRs⁵ and strongly interacts with the frontal cortex (premotor cortex, supplementary eye fields), which encodes object locations in different spatial FRs.¹⁶ Egocentric coding is associated with the parietal and frontal cortices, whereas exocentric coding is associated with the temporal cortex.^17,18 Damage to the parietal cortex and associated areas, such as that occurring after stroke, may lead to impairments in producing movements in both egocentric and exocentric FRs,¹⁹ but rapid motor responsiveness in different FRs has not been investigated.

Upper limb (UL) motor impairment is a common and challenging sensorimotor deficit after stroke.²⁰ Compared with healthy individuals, movements of the affected UL after stroke are generally slower, more variable, more spatially and temporally segmented, and characterized by abnormal patterns of muscle activation and IJC, which may be related to deficits in the regulation of tonic stretch reflex thresholds.^21,22 Stroke research has mainly focused on UL reaching in exocentric FRs. For example, in trunk-assisted reaching to beyond-reach exocentric targets, when trunk movement was suddenly arrested, healthy individuals preserved the hand trajectory and reaching accuracy by rapidly modifying shoulder and elbow movements.²³ However, those with stroke had difficulty modifying arm joint movements in response to trunk arrest. Only one study assessed differences in egocentric and exocentric movements in poststroke individuals during a finger-to-nose test.⁷ Individuals with stroke had impaired IJC and used more trunk compensation for both egocentric and exocentric pointing phases compared with controls,⁷ but the causes of movement deficits in different FRs were not elucidated.

Mechanisms underlying motor deficits after stroke may be better understood using perturbation methods compared with movement description alone.²⁴ Our objective was to identify deficits in producing pointing movements in egocentric and exocentric FRs in individuals with stroke. We hypothesized that individuals with stroke, unlike healthy controls, would have impairments in rapidly modifying shoulder-elbow IJC to reproduce similar reaching trajectories when trunk movements were present or blocked, in both egocentric and exocentric FRs. Because this behavior depends on sensory information and problem-solving, we also hypothesized that deficits in rapid response ability would be related to levels of UL sensorimotor and cognitive impairment. Preliminary results have appeared in abstract form.²⁵

 

Low Prevalence of Stroke in Patients With COVID-19

I think this is diminishing the problems from COVID-19 too much. Your doctor better not rely on this in not preventing all sequelae from COVID-19. I'd be more worried about this research showing problems. YOUR DOCTOR'S RESPONSIBILITY to prevent any problems.

A third of COVID-19 survivors are diagnosed with conditions like stroke, dementia, and psychosis

The latest here:

Low Prevalence of Stroke in Patients With COVID-19

A review of nearly 28,000 emergency department records shows less than 2% of patients diagnosed with coronavirus disease 2019 (COVID-19) suffered an ischaemic stroke, but those who did had an increased risk of requiring long-term care after hospital discharge.

The findings are published in the journal Stroke.

Adnan I. Qureshi, MD, University of Missouri Institute for Data Science and Informatics, Columbia, Missouri, and colleagues found that, among 8,163 patients with COVID-19, 103 (1.3%) developed ischaemic stroke, compared with 199 (1.0%) of 19,513 patients who didn’t have COVID-19.

“Patients with COVID-19 who developed acute ischaemic stroke were older, more likely to be black, and had a higher frequency of cardiovascular risk factors,” said Dr. Qureshi, MD.

The mean age of patients with COVID-19 who experienced a stroke was 68.8 years compared with 54.4 years for those who did not experience a stroke. Among those with COVID-19 and stroke, 45% were Black, 36% were white, and 6% were Hispanic. These patients also tended to have higher rates of hypertension (84%), triglycerides, (75%) and diabetes (56%).

“We also found that patients with COVID-19 with stroke had a significantly higher rate of discharge to a destination other than home compared to stroke patients without COVID-19,” said Dr. Qureshi. “Patients with COVID-19 tend to have multisystem involvement and elevated markers of inflammation, which have been shown to increase the rate of death or disability.”

He noted that the findings are somewhat different from earlier studies that suggested patients with COVID-19 who developed stroke were younger and did not have pre-existing cardiovascular risk factors.

“Even if COVID-19 was a predisposing factor, the risk was mainly seen in those who were already at risk for stroke due to other cardiovascular risk factors,” said Dr. Qureshi.

Reference: https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.031786

SOURCE: University of Missouri-Columbia

European Life After Stroke Forum Webinar Series; Bo Norrving

I wouldn't listen to anything Bo Norrving has to say. He was president of the WSO and if anything useful for survivors(meaning 100% recovery) came out I didn't see it. He could easily contact me and  prove otherwise.

European Life After Stroke Forum Webinar Series; Bo Norrving

Delirium REduction after Administration of Melatonin in acute ischemic Stroke (DREAMS): A Propensity Score Matched Analysis

I had not heard of this problem. You'll have to hope like hell that your doctor has and knows the protocol to prevent it.  

1 in 4 have delirium post stroke from this research:

Delirium – an overlooked complication of stroke

The latest here:

Delirium REduction after Administration of Melatonin in acute ischemic Stroke (DREAMS): A Propensity Score Matched Analysis

Annerose Mengel

Jan Zurloh

Christian Boßelmann

Bettina Brendel

Vera Stadler

Jennifer Sartor‐Pfeiffer

Andreas Meisel

Robert Fleischmann

Ulf Ziemann

Sven Poli

Maria‐Ioanna Stefanou

First published: 03 March 2021

https://doi.org/10.1111/ene.14792

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ene.14792

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Abstract

Background

Post‐stroke delirium (PSD) comprises a common and severe complication after stroke. Yet, treatment options for PSD remain insufficient. We investigated whether prophylactic melatonin supplementation may be associated with reduced risk for PSD.

Methods

Consecutive patients admitted to Tübingen University Stroke Unit, Germany, with acute ischemic stroke (AIS), who underwent standard care (between August and December 2017) and patients who additionally received prophylactic melatonin (2 mg per day at night) within 24 hours of symptom onset (between August and December 2018) were included. Primary outcomes were: (i) PSD prevalence in AIS patients, (ii) PSD risk and PSD‐free survival in patients with cerebral infarction who underwent melatonin supplementation compared to propensity‐score‐matched (PSM) controls. Secondary outcomes included time of PSD‐onset and PSD‐duration.

Results

Out of 465 (81.2%) with cerebral infarction and 108 (18.8%) TIA patients, 152 (26.5%) developed PSD (median time‐to‐onset [IQR]: 16 [8,32] hours; duration 24 [8,40] hours). Higher age, cerebral infarction (rather than TIA), higher NIHSS and aphasia on admission were significant predictors of PSD. After PSM (164 melatonin‐treated patients with cerebral infarction versus 164 matched‐controls), 42 (25.6%) melatonin‐treated patients developed PSD vs. 60 (36.6%) controls (OR [95% CI]: 0.597 [0.372‐0.958], p=.032). PSD‐free survival differed significantly between groups (p=.027), favoring melatonin‐treated patients. In patients with PSD, no between‐group differences in the time of PSD‐onset and PSD‐duration were noted.

Conclusions

Patients prophylactically treated with melatonin within 24 hours of AIS onset had lower risk for PSD than patients undergoing standard care. Prospective randomized trials are warranted to corroborate these findings.

 

Should You Get the COVID-19 Vaccine if You've Had a Stroke?

Hell yes, in my opinion. Considering all the bad things that can happen getting COVID-19, this should be a no-brainer.  But then I know some brainless people not getting vaccinated.

Should You Get the COVID-19 Vaccine if You've Had a Stroke?

Shazam Hussain, M.D., Pravin George, D.O.

Tue, March 2, 2021, 9:16 AM

Should a person get the COVID-19 vaccine if they've had a stroke? This is a common question many neurology experts are fielding right now. Having a stroke puts you at a higher risk of developing severe symptoms and even dying from COVID-19. The simple answer to the question of whether or not to get the vaccine if you've suffered a stroke is, for most people, yes.

[Read: Vaccine Study Volunteers: Taking Their Shot to Beat COVID-19.]

Ever since the first COVID-19 vaccines became available in late December, there has been natural hesitation from some people as to whether or not to get the shot. This hesitancy is understandable, as these vaccines are the first large-scale roll out of a new vaccine technology. What's important to understand is that these vaccines were studied on tens of thousands of adults from all different genders, races and ages, all around the country and over the course of several months. These new vaccines are incredibly effective. Side effects, allergic responses and adverse events were closely examined in the population studied and were minimal, especially when compared to getting infected with the actual virus.

The most important point to realize is that people with underlying conditions such as stroke and heart disease have a higher chance of developing complications from the virus that causes COVID-19 than from the vaccine itself. This point was strongly emphasized by the scientific leadership of the American Heart Association, who in January 2021 released a statement urging all heart attack and stroke survivors to get the COVID-19 vaccines to keep themselves, their family members and their community healthy and safe.

- ADVERTISEMENT -

[READ: COVID-19 Vaccine: Should I Get Vaccinated?]

Understanding the risks and benefits to any medication or therapy is especially important. Here are some essential points to appreciate about the COVID-19 vaccines when considering whether to get the shot:

-- The Moderna and Pfizer vaccines are different than traditional vaccines (which are generally weakened or inactivated forms of a disease-causing organism) in that they deliver a small genetic code (mRNA) that causes your body to create the harmless spike proteins of the coronavirus. This triggers your immune system to recognize the spike particles and form antibodies so that when it sees it on the actual coronavirus, it's ready to attack.

-- This mRNA vaccine is injected into a muscle (generally your arm) and stays locally in your muscle where your body's cells create the harmless spike proteins. The mRNA naturally disappears over a short period of time.

-- The vaccines appear to be very effective at causing your body to create antibodies and preventing you from developing coronavirus symptoms. From initial reports, they also appear to be quite effective against some of the new strains of the coronavirus appearing around the world.

-- When you get the shot, you may feel some side effects. In fact, more than 70% of people reported at least one systemic reaction, especially after the second shot. The most common reactions are fatigue, headache, muscle pain (especially in the area around the shot), body aches and fevers. These side effects are generally temporary and are normal signs that your immune system is turning on. Most of the time these symptoms can be alleviated by over-the-counter anti-fever and anti-inflammatory medications.

-- If you've had a stroke in the past, these vaccines may reduce your chances of getting the severe form of COVID-19 disease. If you get COVID-19 infection, it can cause your body's natural inflammation pathways to heighten. This can cause your blood to become thick, and especially in stroke patients, it can lead to even more neurological complications, including new strokes.

At the end of the day, the decision on whether or not to receive a vaccine, or any medical therapy for that matter, is a very personal one, especially for patients who have had a serious condition such as stroke. If you have questions about the coronavirus vaccines or whether you should get one of the vaccines and you've had a stroke in the past, consult your doctor and discuss your personal risks and benefits.

[Read: Questions to Ask Your Doctor About the COVID-19 Vaccine.]

We've all lived within the era of COVID-19 now for more than a year, and it's as important as ever to stay extremely vigilant, especially if you've had a previous stroke. If you have new stroke symptoms, even in the middle of this pandemic, it's still important to get to the emergency room immediately to safely get help.

 

gingipains, periodontitis and alzheimer's

 Just maybe you want your doctor to be up-to-date on gingipains. Up to you if you want to enforce competency and get your gum disease treated while in the hospital.

Gingipains are trypsin-like cysteine proteinases produced by Porphyromonas gingivalis, a major causative bacterium of adult periodontitis.

Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors January 2019

Determining the presence of periodontopathic virulence factors in short-term postmortem Alzheimer's disease brain tissue April 2013

Porphyromonas gingivalis periodontal infection and its putative links with Alzheimer's disease April 2015

Alzheimer's disease-like neurodegeneration in Porphyromonas gingivalis infected neurons with persistent expression of active gingipains June 2020

Microglial Cathepsin B and Porphyromonas gingivalis Gingipains as Potential Therapeutic Targets for Sporadic Alzheimer's Disease September 2020

Porphyromonas gingivalis infection may contribute to systemic and intracerebral amyloid-beta: implications for Alzheimer's disease onset July 2020

Porphyromonas gingivalis and Alzheimer disease: Recent findings and potential therapies 

  June 2020

Interaction between genetic factors, Porphyromonas gingivalis and microglia to promote Alzheimer's disease September 2020

Linking mechanisms of periodontitis to Alzheimer's disease

April 2020

Integrated #Stroke System Model Expands Availability of Endovascular Therapy While Maintaining Quality Outcomes

They beat around the bush a lot but what they are trying to say is that protocols are needed.

Integrated #Stroke System Model Expands Availability of Endovascular Therapy While Maintaining Quality Outcomes

Actual title is below:

In 2020 the Stroke Support Organization (SSO) Committee of the WSO completed the first ever global mapping of SSOs known to us globally.

Notice how totally and completely fucking useless this is. ABSOLUTELY NOTHING ON STROKE RECOVERY. 

 In 2020 the Stroke Support Organization (SSO) Committee of the WSO completed the first ever global mapping of SSOs known to us globally.

The mapping report includes data on the profile and activities of 92 organizations from 58 countries, including all geographic regions of WSO membership. This offers valuable insights into the work of these organizations globally. It is envisaged that this report will be updated at regular intervals and through ongoing promotion and dissemination, will enable further identification of SSOs that are not currently known to WSO, and it will inform the WSO’s ongoing capacity building activities for SSOs.    

The objectives of the mapping project were to:

• Increase understanding of the organizational background of SSOs globally;
• Obtain a snapshot of SSO service delivery, awareness and advocacy activities globally, focused on the 2018 calendar year;
• Obtain data for further analysis of the scale and reach of SSOs and their activities;
• Obtain data for further analysis of SSO capacity to produce evidence of value.

Key messages from the global mapping are:

• There is considerable potential for SSOs to drive improved stroke outcomes globally. The global network is growing, particularly in low- and middle-income countries (LMICs).
• SSOs are mobilizing large numbers of people affected by and engaged with stroke. These organizations have significant numbers of volunteers and members supporting them and benefiting from activities.
• SSOs are engaging beyond their local and geographic boundaries. Membership of other organizations and alliances with shared agendas is common.
• Sustainability of human and financial resources is a major challenge and key barrier to increasing SSO impact. The majority of SSOs do not receive government funding and the lack of paid staff in many SSOs limits their potential for large-scale impact.
• Inadequate national strategies and policies for stroke prevention, treatment and recovery is a major challenge that SSOs face in their work to support people affected by stroke across the stroke care pathway.
• A lack of data on stroke incidence and prevalence, low awareness of stroke symptoms and emergency response, inadequate recognition of rehabilitation, and the limited number of support services are further challenges for SSOs in their work.
• The top three solutions identified by SSOs that would aid in overcoming the challenges they face are increased partnership between SSOs and government, clinicians and academics; improved skills in fundraising; and improved skills in advocacy and campaigning.

Downloads at link.

These Emotions Increase Alzheimer’s Risk

 

This is a major reason YOUR DOCTOR IS REQUIRED TO HAVE PROTOCOLS that prevent your depression and anxiety post stroke. 100% recovery would be the best solution but your doctor doesn't have that or is even trying for that.

Post stroke anxiety(20% chance).

Post stroke depression(33% chance).

These Emotions Increase Alzheimer’s Risk

 

People with these conditions experience Alzheimer’s symptoms up to 7 years earlier.

Both depression and anxiety increase the risk of developing Alzheimer’s disease.

People who are depressed develop the symptoms of Alzheimer’s, the most common form of dementia, two years earlier, the latest research finds.

Those with anxiety develop symptoms of Alzheimer’s three years earlier.

Having multiple mental health problems is linked to developing symptoms of the disease even sooner.

Dr Zachary A. Miller, the study’s first author, said:

“More research is needed to understand the impact of psychiatric disorders such as depression and anxiety on the development of Alzheimer’s disease and whether treatment and management of depression and anxiety could help prevent or delay the onset of dementia for people who are susceptible to it.

Certainly this isn’t to say that people with depression and anxiety will necessarily develop Alzheimer’s disease, but people with these conditions might consider discussing ways to promote long-term brain health with their health care providers.”

The study included 1,500 people with Alzheimer’s disease who were asked about their mental health.

The results revealed that the more mental health problems people had, the sooner they began experiencing dementia symptoms.

Three or more psychiatric disorders together was linked to developing symptoms more than 7 years earlier them.

Both depression and anxiety were linked to a history of autoimmune disorders.

Dr Miller said:

“While this association between depression and autoimmune disease, and seizures and anxiety is quite preliminary, we hypothesize that the presentation of depression in some people could possibly reflect a greater burden of neuroinflammation.

The presence of anxiety might indicate a greater degree of neuronal hyperexcitability, where the networks in the brain are overstimulated, potentially opening up new therapeutic targets for dementia prevention.”

Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke: The NICHE Trial

 Since this was in the 3-12 month range, that is completely in the middle of spontaneous recovery. I see nothing that suggests you accounted for that. 67% compared to 65% is essentially the same response in intervention group and sham group. My conclusion would be this rTMS did nothing.

Randomized Sham-Controlled Trial of Navigated Repetitive Transcranial Magnetic Stimulation for Motor Recovery in Stroke: The NICHE Trial

 

Richard L. Harvey

,

Dylan Edwards

,

Kari Dunning

,

Felipe Fregni

,

Joel Stein

,

Jarmo Laine

,

Lynn M. Rogers

,

Ford Vox

,

Ana Durand-Sanchez

,

Marcia Bockbrader

,

Larry B. Goldstein

, … See all authors

Originally published15 Aug 2018https://doi.org/10.1161/STROKEAHA.117.020607Stroke. 2018;49:2138–2146

Abstract

Background and Purpose―

We aimed to determine whether low-frequency electric field navigated repetitive transcranial magnetic stimulation to noninjured motor cortex versus sham repetitive transcranial magnetic stimulation avoiding motor cortex could improve arm motor function in hemiplegic stroke patients when combined with motor training.

Methods―

Twelve outpatient US rehabilitation centers enrolled participants between May 2014 and December 2015. We delivered 1 Hz active or sham repetitive transcranial magnetic stimulation to noninjured motor cortex before each of eighteen 60-minute therapy sessions over a 6-week period, with outcomes measured at 1 week and 1, 3, and 6 months after end of treatment. The primary end point was the percentage of participants improving ≥5 points on upper extremity Fugl-Meyer score 6 months after end of treatment. Secondary analyses assessed changes on the upper extremity Fugl-Meyer and Action Research Arm Test and Wolf Motor Function Test and safety.

Results―

Of 199 participants, 167 completed treatment and follow-up because of early discontinuation of data collection. Upper extremity Fugl-Meyer gains were significant for experimental (P<0.001) and sham groups (P<0.001). Sixty-seven percent of the experimental group (95% CI, 58%–75%) and 65% of sham group (95% CI, 52%–76%) improved ≥5 points on 6-month upper extremity Fugl-Meyer (P=0.76). There was also no difference between experimental and sham groups in the Action Research Arm Test (P=0.80) or the Wolf Motor Function Test (P=0.55). A total of 26 serious adverse events occurred in 18 participants, with none related to the study or device, and with no difference between groups.

Conclusions―

Among patients 3 to 12 months poststroke, goal-oriented motor rehabilitation improved motor function 6 months after end of treatment. There was no difference between the active and sham repetitive transcranial magnetic stimulation trial arms.

Clinical Trial Registration―

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02089464.

The use of hypnotherapy as treatment for functional stroke: A case series from a single center in the UK

Wrong title; it is treating functional neurological disorder NOT stroke.  You can read about actual hypnotherapy for stroke here:

• hypnotherapy (4 posts)

So functional neurological disorder is defined here: 

Functional neurological disorder (FND) is a medical condition in which there is a problem with the functioning of the nervous system and how the brain and body sends and/or receives signals, rather than a structural disease process such as multiple sclerosis or stroke. FND can encompass a wide variety of neurological symptoms, such as limb weakness or seizures.

The use of hypnotherapy as treatment for functional stroke: A case series from a single center in the UK

 

Show all authors

Ranjan Sanyal, Marko Raseta, Indira Natarajan, ...

First Published February 27, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/1747493021995590

Article information 

Abstract

Background

Functional neurological disorder is defined by symptoms not explained by the current model of disease and its pathophysiology. It is found in 8.4% of patients presenting as acute stroke. Treatment is difficult and recurrence rates are high. We introduced hypnotherapy as a therapeutic option in addition to standard stroke unit care.

Methods

This is an observational study of successive patients with functional neurological disorder presenting as acute stroke treated with hypnotherapy between 1 April 2014 and 1 February 2018. The diagnosis of functional neurological disorder was confirmed by clinical examination and computed tomography/magnetic resonance imaging. Hypnosis was delivered by a hypnotherapy trained stroke physician using imagery for induction. A positive response was defined as a National Institutes of Health Stroke score reduction to 0 or by ≥4 points posthypnotherapy. Costs were calculated as therapist time and benefits as reduction in disability/bed days.

Results

Sixty-eight patients (mean age 36.4 years, 52 (76%) females, mean baseline National Institutes of Health Stroke 5.0 (range 1–9)) were included. Two patients (3%) could not be hypnotized. Fifty-eight 58 (85%) responded, 47 (81%) required one treatment session, while 19% needed up to three sessions for symptomatic improvement. No adverse events were observed. Disability (modified Rankin Scale) reduced from a mean of 2.3 to 0.5 resulting in an average cost saving of £1,658 per patient. Most (n = 50, 86%) remained well without recurrence at six-month follow-up.

Conclusions

In this case series, hypnotherapy was associated with rapid and sustained recovery of symptoms. A prospective randomized controlled study is required to confirm the findings and establish generalizability of the results.

UBC(University of British Columbia) study finds high life satisfaction linked to better overall health

 Except for the lack of use of the left arm/hand and the inability to run I have high life satisfaction.

UBC(University of British Columbia) study finds high life satisfaction linked to better overall health

(info at bottom) New research from UBC finds that higher life satisfaction is associated with better physical, psychological and behavioural health. The research, published recently in The Milbank Quarterly, found that higher life satisfaction is linked to 21 positive health and well-being outcomes including:

a 26 per cent reduced risk of mortality

a 46 per cent reduced risk of depression 

a 25 per cent reduced risk of physical functioning limitations(I already have this.)
a 12 per cent reduced risk of chronic pain 

a 14 per cent reduced risk of sleep problem onset 

an eight per cent higher likelihood of frequent physical activity 

better psychological well-being on several indicators including higher: positive affect, optimism, purpose in life, and mastery—as well as lower: hopelessness, negative affect, perceived constraints, and loneliness Dr. Eric Kim and his team examined data from a nationally representative sample of 12,998 U.S. adults over age 50, in which participants were asked to self-evaluate their life satisfaction and health. This study is the first to see whether a positive change in life satisfaction is associated with better outcomes on a wide range of physical, behavioural and psychosocial health and well-being indicators over a four-year period. “Life satisfaction is a person’s evaluation of his or her own life based on factors that they deem most relevant,” says Dr. Kim, an assistant professor in UBC’s psychology department and lead author of the study. “While life satisfaction is shaped by genetics, social factors and changing life circumstances, it can also be improved on both the Enhancing life satisfaction at the policy levelDr. Kim says in recent years, intergovernmental organizations such as the United Nations (UN) and the World Health Organization have urged countries to use well-being indicators in addition to traditional economic indicators, like GDP, when making policy decisions. “The results of this study suggest that life satisfaction is a valuable target for policymakers to consider when enhancing physical, psychological and behavioural health outcomes at the policy level,” says Dr. Kim. The researchers decided to examine a four-year time period as there is emerging evidence that indicates changing levels of life satisfaction is an important determinant of voting behaviour. Further, election cycles happen approximately every four years in many countries. “It is in the interest of policymakers’ election and reelection campaigns to consider how life satisfaction can be improved,” says Dr. Kim. “But more importantly understanding what the downstream health and well-being effects of altering life satisfaction might be for populations over a four-year period is critical to evaluate, and this is precisely the kind of question we tried to answer in our study.”Dr. Kim says policy-makers who are interested in looking for practical ideas on how to improve life satisfaction at the policy level can look to the Global Happiness and Well-Being Policy Report, which is generated out of a broader UN initiative co-led by UBC economics professor emeritus Dr. John Helliwell and Columbia University professor Dr. Jeffrey Sachs. “As our nations pause and reevaluate our priorities in light of the widespread change caused by COVID-19, our policymakers have a rare and excellent opportunity to pursue well-being for all in the post-pandemic world.”Permalink:


Contact:

Wan Yee Lok
UBC Media Relations
Tel: 604.822.4549
wanyee.lok@ubc.ca

Scientists inch closer to explaining the mysterious 'brain fog' symptom of COVID-19

You already had brain fog from your stroke, make damn sure your doctor has EXACT PROTOCOLS to prevent this result from COVID-19. If we had a great stroke association with approachable leaders we could ask them for research on whether this brain fog is more common among stroke survivors.  But no, we have fucking failures of stroke associations  instead.

Scientists inch closer to explaining the mysterious 'brain fog' symptom of COVID-19

As larger numbers of people recover from COVID-19, researchers are learning more about "brain fog" in those affected by the virus.

For months, doctors and researchers have been aware of a range of longer-term symptoms afflicting people after recovering from an active COVID-19 infection. One such symptom, generally referred to as "brain fog," can take the shape of confusion, difficulty thinking and concentrating, short-term memory loss, and in severe cases, has even been reported to cause delirium and psychosis.

While scientists still don't know for sure what causes brain fog, they're zeroing in on a few theories. Mainly, scientists increasingly believe brain fog happens when cells that are involved in response to an infection make their way to atypical places, such as the brain.

MORE: Biden says there will be enough vaccine for American adults by end of May

A key finding emerged when researchers autopsied brains of COVID victims, discovering certain cells that shouldn't have been there. These large cells, known as megakaryocytes, might be taking up precious space, leaving less room for blood to pass to the brain.

This phenomenon might be unique to COVID, according to David Nauen, MD, PH.D, a professor of pathology at the Johns Hopkins University School of Medicine.

PHOTO: TOPSHOT - A medic watches a Covid-19 patient hospitalised at the Covid-19 Intensive Care Unit of the Pulmonology department of the Hospital Ruzinov in Bratislava, Slovakia on February 24, 2021. (Vladimir Simicek/AFP via Getty Images)

"To have megakaryocytes in the brain has never been seen before, I couldn't find any reference in my search this past summer with megakaryocytes noted in human brain capillaries. This is very new for COVID that they are doing this," Nauen told ABC News. "This could help us bring up a better picture of what's going on."

MORE: How falling levels of COVID-19 tests could threaten pandemic fight

If these massive cells are indeed blocking blood flow to the brain, it would starve the brain of enough oxygen and nutrients to work at full capacity.

"The brain cortex is richly vascularized with capillaries, if some proportion of capillaries are blocked or occluded by these cells, it blocks some level of blood flow. An alteration in flow of blood in a system that is so precisely delivering oxygen based on time and need could be leading to impaired cognitive function, like a brain fog picture," said Nauen, who led the research into the topic, which was published in the Journal of American Medical Association Neurology.

In fact, the cells seen were not in small number, "the findings on autopsy suggest that the burden could be significant," Nauen said.

The next question Nauen said is about how these megakaryocytes are getting there and what sort of communication the cells are using in the process.

Other scientists have theories, which may add to Nauen's findings.

According to Adrienne A. Boire, MD, PhD, a Neuro-Oncologist & Neurologist at Memorial Sloan Kettering Cancer Center, people who experience brain fog may have inflammation in the brain evidenced by a protein called 'cytokines' swirling around the tissue that surrounds the brain and spinal cord.

These proteins are usually associated with the immune system, which leads to inflammation and can damage vital organs. Now, researchers like Boire say they're finding these proteins in cerebrospinal fluid, or CSF.

"We did find a large influx of cytokines in the CSF. Cytokines are small proteins that cells use to communicate with each other," Boire told ABC News.

PHOTO: LODI, ITALY - FEBRUARY 11: Doctor Annalisa Malara (L), wearing PPE (Personal Protective Equipment), talks to her colleague Doctor Alessia Crespi as they stand next to a patient in the COVID-19 Intensive Care Unit of the Ospedale Maggiore di Lodi. (Emanuele Cremaschi/Getty Images)

Severe COVID infections are known to cause inflammation in the body. It's possible that this process causing inflammation in the brain can cause the brain to not function normally.

For now, these new findings lead to more .

>MORE: Texas, Mississippi to end mask mandates, allow businesses to reopen at full capacity

For Boire, people who recover from COVID without any lingering problems may hold the key to unlocking the mystery of why some people develop "brain fog."

"The question of how this finding affects patients without severe disease is still an open question," Nauen said.

"These 'unaffected' patients are key to understanding why some people avoid “brain fog” and why others are disabled by them," Boire said.

Nasir Malim, D.O., M.P.H., an internal medicine resident with Montefiore Medical Center in New York City, is a contributor to the ABC News Medical Unit.

Scientists inch closer to explaining the mysterious 'brain fog' symptom of COVID-19 originally appeared on abcnews.go.com