Leukoaraiosis Predicts Short-term Cognitive But not Motor Recovery in Ischemic Stroke Patients During Rehabilitation

Background: Leukoaraiosis has been shown to impact functional outcomes after acute ischemic stroke. However, its association with domain specific recovery after ischemic stroke is uncertain. We sought to determine whether pre-existing leukoaraiosis is associated with short-term motor and cognitive recovery after stroke. Methods: We retrospectively studied ischemic stroke patients admitted to acute inpatient rehabilitation (AIR) between January 2013 and September 2015. Patient baseline characteristics, infarct volume, prestroke modified Rankin Scale, stroke cause, rehabilitation length of stay, and Functional Independence Measure (FIM) scores were recorded. Leukoaraiosis severity was graded on brain magnetic resonance imaging using the Fazekas scale. Multiple linear regression was used to determine factors independently associated with the total, cognitive, and motor FIM scores at AIR discharge, respectively. Results: Of 1600 ischemic stroke patients screened, 109 patients were included in the final analysis. After adjustment, the initial National Institute of Health Stroke Scale (β ?0.541, confidence interval [CI] ?0.993 to ?0.888; P = 0.020) and pre-existing leukoaraiosis severity (β ?1.448, CI ?2.861 to ?0.034; P = 0.045) independently predicted the total FIM score. Domain specific analysis showed that infarct volume (β ?0.012, CI ?0.019 to ?0.005; P = 0.002) and leukoaraiosis severity (β ?0.822, CI ?1.223 to ?0.410; P = 0.0001) independently predicted FIM cognitive scores at discharge from AIR. Leukoaraiosis did not predict FIM motor score (P = 0.17). Conclusions: Leukoaraiosis severity is an independent predictor of total and cognitive, but not motor FIM scores after AIR for acute ischemic stroke. This highlights that leukoaraiosis affects poststroke recovery in a domain specific fashion, information that may aid counseling of patients and families as well as tailor rehabilitative efforts.     

Factors Influencing Quality of Life in Stroke Patients: Focus on Eating Habits

Background: Adherence to healthy lifestyle factors has been shown to improve outcomes after stroke. This study aimed to identify lifestyle factors about eating habits that may affect the quality of life (QOL) in elderly stroke patients. Methods: Fifty elderly patients with a first-ever stroke were enrolled. QOL was assessed by the Stroke and Aphasia QOL Scale-39-J. Lifestyle factors about eating habits were collected using questionnaires (Questions 1-17) for the intake of salt, calcium, magnesium, potassium, taurine, fiber, and protein, and the frequency of breakfast. Results: QOL of physical, communication, and psychosocial subdomains was better in the low (healthy) tertile of poststroke eating habits (Questions 1-17) compared with the high tertile of post-troke eating habits (Questions 1-17). This relationship appeared in eating habits except for salt intake but not in eating habits of salt intake and directly measured salt intake. Compared with prestroke eating habits score, poststroke eating habits score was decreased (improved) in 36 patients concerning eating habits of salt intake, but only in 12 patients concerning eating habits except for salt intake (P < .05 by chi-square test). Poststroke eating habits of calcium and magnesium were associated with better psychosocial QOL and better physical or energy QOL, respectively. Conclusions: Poststroke eating habits of calcium and magnesium were associated with QOL in elderly patients with a first-ever stroke. Since eating habits except for salt intake was poorly improved after stroke, intensive interventions regarding eating habits might be important.     

Expanding Eligibility in Stroke Prevention Trials to Patients with Early Disability

Background and Purpose: Early disability after stroke is common, though many patients improve. Stroke secondary prevention trials often prohibit the recruitment of nonambulatory patients, limiting their access to potential treatment options and impeding trial enrollment. We aimed to determine outcomes after early dependence around the time of transition from acute care to recovery. Methods: Data were obtained from a composite of patients enrolled in acute stroke clinical trials within the Virtual International Stroke Trials Archive (VISTA-Acute). Early disability was defined by the modified Rankin Scale (mRS) of 4 or 5 between days 3-10 after onset, representing the time of discharge or transition to a rehabilitation-focused care setting. We developed multivariable models to identify factors associated with recovery to independent ambulatory function and recurrent stroke during the 90 days after stroke. Results: 4965 patients were included, with 2905 (59%) having early disability. Patients with early dependence were older, more likely to be women, had higher baseline NIHSS scores, and had more atrial fibrillation and diabetes mellitus, compared with those who were initially ambulatory. Recovery to ambulatory function occurred in 58% with early mRS = 4, compared to only 16% with early mRS = 5. Of those with early mRS = 4, return to independent ambulatory status by 90 days was associated in multivariable analysis with age, diabetes, prior stroke, NIH motor and gaze subscores, and thrombolysis. Recurrent ischemic stroke through day 90 was reported in 126 of 2905 (4.3%) subjects with early dependence compared to 63 of 2060 (3.1%), which was not different after adjustment for age, sex, and risk factors (odds ratio 1.27; 95% confidence interval 0.92-1.73). Conclusions: Favorable outcomes are common among ischemic stroke patients previously enrolled in acute clinical trials despite early dependence (mRS = 4) after initial acute hospital care. Further, their risk of recurrent stroke is high in the short term. These patients likely benefit from aggressive poststroke care and should be actively recruited into secondary prevention trials.     

Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study

Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers.     

Transcutaneous Auricular Vagus Nerve Stimulation with Upper Limb Repetitive Task Practice May Improve Sensory Recovery in Chronic Stroke

Background: Sensory impairment is associated with reduced functional recovery in stroke survivors. Invasive vagus nerve stimulation (VNS) paired with rehabilitative interventions improves motor recovery in chronic stroke. Noninvasive approaches, for example, transcutaneous auricular VNS (taVNS) are safe, well-tolerated and may also improve motor function in those with residual weakness. We report the impact of taVNS paired with a motor intervention, repetitive task practice, on sensory recovery in a cohort of patients with chronic stroke. Methods: Twelve participants who were more than 3 months postischemic stroke with residual upper limb weakness received 18 × 1 hour sessions over 6 weeks with an average of at least 300 repetitions of functional arm movements per session concurrently with taVNS at maximum tolerated intensity. Light touch and proprioception were scored as part of the Upper Limb Fugl-Meyer (UFM) assessment at baseline and postintervention (score range for sensation 0-12). Results: Eleven participants (92%) had sensory impairment at baseline of whom 7 (64%) regained some sensation (proprioception n = 6 participants, light touch n = 2, both modalities n = 1) postintervention. The maximal increase in UFM sensation score (3 points) was seen in the patient with the greatest improvement in motor function. Conclusions: taVNS paired with motor rehabilitation may improve sensory recovery in chronic stroke patients. The relative contribution of motor and sensory rehabilitation to overall functional recovery in chronic stroke needs further characterization in a larger, phase 2 study.     

Examining the Inter-relations of Depression,Physical Function,and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis

Goal: Stroke survivors commonly experience depression as well as deficits in physical and cognition function. Emerging evidence also suggests sleep quality is compromised poststroke. Our primary objective was to examine the association of subjective sleep parameters (ie, total PSQI score) with depression, health related quality of life, physical function, and cognition among stroke survivors. Materials and Methods: Cross-sectional analysis of 72 older adults with chronic stroke (≥6 months postischemic stroke) enrolled in a randomized controlled trial of exercise or cognitive enrichment. Subjective sleep parameters were assessed using the Pittsburgh Sleep Quality Index (PSQI). We report total PSQI score and specific PSQI parameter scores (ie, PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, PSQI-habitual sleep efficiency, PSQI-sleep disturbances, PSQI-use of sleep medication, and PSQI-daytime dysfunction). Bivariate correlations and multivariate linear regression assessed associations between subjective sleep parameters and depression/health related quality of life, physical function, and cognition. Findings: For bivariate correlations, depression was significantly associated with global PSQI, PSQI-subjective sleep quality, PSQI-habitual sleep efficiency, and PSQI-daytime dysfunction. Health related quality of life was significantly associated with PSQI-sleep medication. Physical function and health was significantly associated with PSQI-subjective sleep quality, PSQI-sleep latency, PSQI-sleep duration, and PSQI-daytime dysfunction. Multivariate linear regression demonstrated that PSQI-daytime dysfunction predicted depression and physical function; PSQI-subjective sleep quality predicted depression. No significant associations between global PSQI subjective sleep parameters with cognition were observed. Conclusion: Poor subjective sleep parameters and PSQI-subjective sleep quality among stroke survivors were associated with depression; PSQI-daytime dysfunction was associated with physical function. Thus, sleep should be considered in the management of those who have suffered a stroke to optimize poststroke rehabilitation outcomes.     

Timing of Direct Enteral Tube Placement and Outcomes after Acute Stroke

Background: Direct enteral feeding tube (DET) placement for dysphagia after stroke is associated with poor outcomes. However, the relationship between timing of DET placement and poststroke mortality and disability is unknown. We sought to determine the risk of mortality and severe disability in patients who receive DET at different times after stroke. Methods: We used the Ontario Stroke Registry and linked administrative databases to identify patients with acute ischemic stroke or intracerebral hemorrhage between 2003 and 2013 who received DET (gastrostomy or jejunostomy) during their hospital admission. We grouped patients by week of DET placement and evaluated mortality at 30 days and 6 months after DET insertion, and disability at discharge. We used Cox proportional hazard models and multiple logistic regression to determine the association between time from admission to DET placement and outcomes, adjusting for patient and hospital factors. Results: In the study sample of 1367 patients, the median time from admission to DET placement was 17 days. After adjustment, each week of delay to DET placement was associated with lower mortality at 30 days (adjusted hazard ratio [aHR] .88, 95% confidence interval [CI] .79-.98), but not at 6 months (aHR .98, 95% CI .91- 1.05), and a higher likelihood of severe disability at discharge (adjusted odds ratio 1.35, 95% CI 1.13- 1.60). Conclusions: Later DET placement after stroke was associated with lower 30-day mortality but higher severe disability at discharge. Further research is needed to understand the reasons for these observations and to optimize patient selection and timing of DET.     

The Effect of Poststroke Depression on Recovery from Stroke

Background : Stroke is a major health problem and poststroke depression is known to be one of the frequent and severe psychiatric complications following stroke.
Methods : Based on the results of structured psychiatric mental state exams and DSM diagnostic criteria, the prevalence of poststroke depression has been examined in numerous study populations throughout the world. Longitudinal examinations have documented the effect of poststroke depression on recovery from stroke.
Results : The mean prevalence of poststroke major depression was 21.1 % and minor depression was 17.1% among hospitalized or outpatient samples. Community samples showed a slightly lower rate of 14.1% and 9.1%, respectively. Furthermore, the existence of poststroke depression leads to poorer physical recovery, greater cognitive impairment, and worse recovery in activities of daily living compared with non-depressed patients. Several studies have also found that poststroke depression is associated with increased mortality compared with non-depressed patients who had comparable strokes and similar premorbid risk factors. Finally, several studies have found that successful treatment of poststroke depression improves both cognitive and physical recovery and decreases mortality.
Conclusion : The current review documents the beneficial effect of identifying and treating poststroke depression on both recovery and survival following stroke.     

Stroke patients in south Madrid: function and motor recovery, resource utilization, and family support

BACKGROUND AND PURPOSE: The purpose of the present study was to describe the epidemiology of stroke disability and the use of health resources in South Madrid. METHODS: Among a population of 665 168 residents in South Madrid, patients with an acute stroke of clinical onset during March to July 1996 who were seen at a general hospital or at 1 of 3 primary care centers were evaluated at baseline (n=147) and at 3 months (n=110) and 6 months (n=112) after stroke. We assessed the frequencies of stroke and stroke-related residual disability per population unit, as well as the impairment, disability, secondary complications, use of health resources, and impact on quality of life. RESULTS: In patients > or =60 years old, the incidence of stroke with severe residual disability after 6 months was 75 per 10 000, was higher in men, and increased with age; the proportion of survivors among those examined at baseline was 20%. The use of hospital days per population unit was similar to that of reported European data, but the use of other health care resources was less. Patients frequently used bladder and nasal catheters and presented with shoulder pain. Social activities were infrequent and decreased after stroke. Access to technical aids was limited, and home adaptations were exceptional. The impact of stroke on health-related quality of life among patients and main caregivers was modest. CONCLUSIONS: The study shows that in South Madrid, (1) the use of health resources after stroke is low; (2) patients with stroke register low activities of daily living scores with a comparatively small impact on quality of life; and (3) relative to need, the use of rehabilitation, aids, and home adaptations and services was low.     

Utility of Dynamic Balance Measurements in Discriminating Community Ambulation Levels Among Individuals with Stroke: A Cross-sectional Study

Objective: To examine the association between dynamic balance measurements and community ambulation levels among individuals with chronic stroke. Methods: This cross-sectional study was performed in 2-day care facilities for older adults located in urban areas. Forty-seven community-dwelling poststroke adults who could walk independently were participated. Community ambulation performance was assessed using the Functional Ambulation Classification of the Hospital at Sagunto (FACHS). Dynamic balance and mobility were measured with the Mini-Balance Evaluation Systems Test (Mini-BESTest), the Timed Up and Go (TUG) test, and 10 m maximum walking speed. Results: Participants were classified into 3 groups according to FACHS scores: household (n = 15), neighborhood (n = 19), and community walkers (n = 13). Neighborhood and community walkers scored significantly higher on the Mini-BESTest and had a shorter TUG test time than household walkers. Community walkers had a significantly faster walking speed than household walkers, whereas neighborhood walkers did not have a faster walking speed than household walkers. Ordinal logistic regression analyses revealed the Mini-BESTest score (odds ratio [OR] 1.24; 95% confidence interval [CI]: 1.07-1.44) and the TUG test time (OR .91; 95% CI: .85-.98) were significantly associated with ambulation levels after adjusting for confounders. Conclusions: Dynamic balance measurement tools may have better responsiveness in detecting community ambulation levels among individuals with chronic stroke than walking speed.     

Barriers to metabolic care for adults with serious mental illness: provider perspectives

This study assessed barriers to metabolic care for persons with serious mental illness (SMI) by surveying experienced healthcare providers. Sixty-eight medical, mental health, and other stakeholders who care for patients with SMI attended a CME conference focused on medical management of SMI patients in 2007. They completed a 27-item survey assessing barriers to and systemic responsibility for metabolic care. The top three ranked barriers were: "separate mental health and primary care systems," "patient's lack of resources," and "[mental health] providers are not trained to do basic primary care." Results indicated that ratings of CMHC responsibility for SMI metabolic care (M = 5.2, SD = 1.5) were significantly lower than ratings of public health (M = 5.7, SD = 1.4), t(66) = 2.3, p = 0.027, and primary care providers (M = 6.3, SD = 1.1), t(67) = 4.7,p <0.001. Experienced providers identified a lack of integrated care and patient characteristics as important barriers to metabolic care and concluded that the primary care and public health systems are primarily responsible for metabolic treatment.     

A Therapeutic International Normalized Ratio Results in Smaller Infarcts and Better Outcomes for Patients with Ischemic Stroke

Background: Prior studies have shown that warfarin is effective for both primary and secondary stroke prevention in individuals with atrial fibrillation. It is also known that those on warfarin with atrial fibrillation often have poorer long-term poststroke outcomes, possibly because cardioembolic strokes tend to be larger and more severe. Less is known regarding the direct effect of the international normalized ratio (INR) value at the time of stroke on severity or long-term functional status. Methods: We prospectively followed a consecutive series of 112 patients presenting to our institution with acute ischemic stroke between 2013 and 2018 who were on warfarin. Along with INR on admission, data were collected regarding patient demographics, vascular risk factors, stroke characteristics, and functional outcomes. Patients were stratified by INR into “therapeutic” and “subtherapeutic” groups. Stroke severity (NIH Stroke Scale), infarct volume, and outcome (modified Rankin Scale) were assessed on admission, discharge, and follow-up (3 months poststroke). Differences were calculated using Student's t-tests and regression analyses. Results: The average INR on admission was 1.6 for the entire cohort. Seventy six percent were subtherapeutic on admission (INR < 2.0). Therapeutic patients had lower National Institutes of Health Stroke Scale scores on admission (5.9 versus 9.5, P = .033), significantly smaller stroke volumes (19.5 cc versus 49.2 cc, P = .036), and were more likely to show more than 1 digit improvement on follow-up mRS than subtherapeutic patients. Conclusions: Stroke size and severity is significantly reduced in patients with ischemic strokes who present therapeutic on warfarin. The greater volume of brain saved may ultimately lead to better functional recovery.     

Stroke Mimics: An Important Source of Bias in Acute Ischemic Stroke Research

Study Objective: Stroke mimics may be difficult distinguish from acute ischemic strokes and are often treated with alteplase though not by intent. We report the characteristics, frequency, and outcomes of stroke mimics treated at our institution. Using our data, we then explore how the inclusion of stroke mimics in stroke outcomes research may be an important source of bias. Methods: We retrospectively identified all patients treated with alteplase in our emergency department from August 2013 to December 2017 for suspected acute ischemic stroke. We collected the following variables: gender, age, risk factors (hypertension, diabetes, and atrial fibrillation), admission glucose, admission National Institute of Health Stroke Scale, admission mean arterial pressure, onset-to-treatment time, adverse events, discharge diagnosis, length of stay, discharge NIHSS, discharge destination, and 3 month modified Rankin score. Results: One hundred and eighteen patients were treated with alteplase for suspected acute ischemic stroke of which 33 (27.9%) were stroke mimics. Compared to ischemic strokes, stroke mimics were younger (median age 53 versus 69; P < .0003); were less likely to have vascular risk factors (hypertension [51.5% versus 78.8%; P < .005] diabetes (9.1% versus 32.9%; P < .007), and atrial fibrillation (3.0% versus 23.5%; P < .006). The most common stroke mimic was transient ischemic attack (33.3%). Stroke mimics were significantly more likely to be discharged home (75.8% versus 41.2%; P < .002). Outcomes unadjusted for stroke mimics led to artificial inflation of a favorable discharge destination. Conclusions: Inclusion of stroke mimics led to an artificial inflation of a favorable discharge destination for our entire cohort. Our study highlights the potential for bias in reporting favorable outcomes if appropriate adjustment accounting for stroke mimics does not occur.     

Collagen-Induced Platelet Aggregates,Diabetes, and Aspirin Therapy Predict Clinical Outcomes in Acute Ischemic Stroke

Background: Aggregation of platelets is a trigger for additional development of larger thrombi. This study aimed to identify factors that may affect platelet aggregability and their role in clinical outcomes in acute ischemic stroke. Methods: Consecutive acute ischemic stroke patients (n = 352) who were transferred within 24 hours after its onset were enrolled. Peripheral venous blood was sampled to measure platelet aggregability and other parameters. Results: Mean values of spontaneous small-sized platelet aggregates and collagen- or adenosine diphosphate (ADP)-induced large-sized aggregates were elevated in acute ischemic stroke. In atherothrombotic stroke (n = 178), collagen and ADP-induced large-sized aggregates were positively correlated with HbA1c, respectively. High incidence of the modified Rankin Scales (mRS) 5-6 at discharge was associated with diabetes complication (odds ratio [OR] 8.77, 95% confidence interval [CI] 1.32-57.56). The proportion of patients who were functionally independent (the mRS 0-2) at discharge was lower in the middle tertile of collagen and ADP-induced large-sized aggregates than their low tertile (OR 2.46, 95% CI 1.09-5.58; OR 2.43, 95% CI 1.05-5.59, respectively). Prestroke administration of aspirin recovered the proportion of independence at discharge (OR 0.25, 95% CI 0.06-0.99), and ameliorated incidence of the mRS 5-6. On logistic regression analysis, diabetes, HbA1c, collagen-induced large-sized aggregates, and prestroke administration of aspirin remained independent predictors of clinical outcomes in atherothrombotic stroke. In cardioembolic and lacunar stroke, no relations with clinical outcomes were found. Conclusions: High plasma level of HbA1c is involved in enhanced platelet aggregability in acute atherothrombotic stroke patients, and prestroke administration of aspirin may be beneficial to clinical outcomes.     

Caregiver role strain: the contribution of multiple roles and available resources in African-American women

While the roles of spouse, parent, and employee are normative for middle-aged adults, strain associated with each role may increase when the role of caregiver is added. The objectives of the present study were to determine: (1). what is the relationship between the caregiver's other roles (marital, parental, employee), specific combinations of these roles, and role strain; and (2). what is the relationship between available resources (economic, social, and personal) and role strain? The study participants were 148 African-American females who provided care to elderly family members. A model using multiple linear regression was analyzed. Caregivers with higher depressive symptomatology were more strained. However, neither additional multiple roles, nor a combination of roles were significantly related to role strain. African-American caregivers experienced a wide range of caregiver role strain. It would be a disservice to African-American caregivers to operate under the assumption that they provide care with little emotional cost. Continued within group analyses are needed to understand differential outcomes of these caregivers.     

Initial National Institute of Health Stroke Scale to Early Predict the Improvement of Swallowing in Patients with Acute Ischemic Stroke

Objectives: To study the applicability of National Institutes of Health Stroke Scale (NIHSS) in early predicting the prognosis of poststroke dysphagia in an acute ward. Methods: This is an observational retrospective cohort study including adult patients with ischemic stroke. Patients with various factors affecting swallowing were excluded to obtain a representative sample of 165 patients. The main outcome measure was the improvements of oral intake function. Results: The scores of facial palsy (NIHSS item 4) (odds ratio [OR]: 0.484, 95% confidence interval [CI]: 0.279-0.838, P = .0096] and language/aphasia (NIHSS item 9) (OR: 0.562, 95% CI: 0.321-0.982, P = .0430) demonstrated significantly negative effects on the early improvement of dysphagia. Moreover, the improved patients had a 4.14-fold (95% CI: 2.53-11.23, P = .005) increased odds of returning home compared with nonimproved patients. Conclusions: Our findings provide evidence that early improvement of poststroke dysphagia was significantly associated with a favorable discharge destination and NIHSS items of facial palsy and language/aphasia can be used at the onset of stroke to identify dysphagic patients at risk of achieving limited improvement. These findings provide valuable prognostic indicators for clinicians to make a precise outcome prediction at very early stage.     

Serum Retinoic Acid Level and The Risk of Poststroke Cognitive Impairment in Ischemic Stroke Patients

Background: Retinoic acid (RA), an active metabolite of vitamin A, possesses enormous protective effects on vascular systems. It may also be positively related to good functional outcome after ischemic stroke. However, whether circulating RA concentration is associated with poststroke cognitive impairment (PSCI) remains unclear. This study aimed to detect the association between RA level and PSCI among patients with first-ever acute ischemic stroke. Methods: Two hundred and 61 consecutive patients were prospectively recruited during March 2018 and March 2019. Serum RA concentration was measured at admission for all patients. We also performed cognitive function examination using the Montreal Cognitive Assessment (MoCA) at admission and at every follow-up visit. Patients with MoCA score less than 26 were identified as developing PSCI. Results: The median serum RA level was 2.0 ng/mL (interquartile range, 1.1-3.2 ng/mL) after admission. Patients diagnosed as PSCI at admission, 1-month and 3-month were 53 (20.3%), 91 (34.6%), and 141 (54.0%), respectively. Univariate analysis showed that reduced RA level was correlated with PSCI at 3-month (P = .003), but not at admission (P = .416) and 1-month poststroke (P = .117). After adjusting for all potential confounders, the odds ratio for the lowest tertile of RA, compared with the highest tertile, was 1.97 (95% confidence interval, 1.01-3.83, P = .046) for PSCI at 3 months. Furthermore, multiple-adjusted spline regression model further confirmed the dose-response relationships between RA level and 3-month PSCI (P < .001). Conclusions: Decreasing serum RA level might be associated with 3-month PSCI in ischemic stroke patients.     

Educating Stroke/TIA Patients about Obstructive Sleep Apnea after Stroke: A Randomized Feasibility Study

BackgroundObstructive sleep apnea (OSA) occurs in about 70% of stroke and transient ischemic attack (TIA) patients and is associated with poor function and recurrent vascular events. Continuous Positive Airway Pressure (CPAP) has been shown to improve poststroke/TIA outcomes but adherence is generally poor. This study aimed to develop and conduct a preliminary assessment of educational materials for poststroke/TIA OSA.MethodsThis blinded pilot study involved the randomization of stroke/TIA patients to either an intervention group (who viewed an educational pamphlet and slideshow) or a control group (standard of care). Patient ratings were used to evaluate the educational materials. Changes in knowledge, daytime sleepiness, functional outcomes of sleep, and CPAP use were assessed at baseline and 6 months.ResultsTotal 93% of eligible patients consented to participate. Forty-eight participants were randomized to the control group (n = 23) or intervention group (n = 25). In the intervention group, all patients agreed or strongly agreed that the information in the educational materials was useful and that the wording was easy to understand. There were no significant changes in knowledge, daytime sleepiness, and functional outcomes of sleep between both groups at 6 months. In those who used CPAP, there was no significant difference in mean hours of CPAP use at the 6-month follow-up.ConclusionsThe educational program was feasible and easy to understand amongst stroke/TIA patients but did not lead to a significant change in outcomes or CPAP use. The lessons learned can be used to facilitate future development of educational materials and plan an adequately-powered trial.