Is improvement in impaired cognition and depressive symptoms in post‐stroke patients associated with recovery in activities of daily living?

Background and purpose – Depression and cognitive impairment after stroke are associated with physical functional outcomes, but there are limited data on whether depressive symptoms and cognitive status and improvements independently influence functional status and recovery. Methods – In a 6‐month prospective cohort study of 141 post‐acute stroke patients, demographic and clinical data on admission, and neurological, cognitive, depressive symptoms and functional variables on admission and at 6 months after stroke were measured using the National Institute of Health Stroke Scale (NIHSS), Abbreviated Mental Test (AMT), Geriatric Depression Scale (GDS) and Barthel Index (BI). Results – On multivariate analysis, severe activities of daily living (ADL) dependence at 6 months was significantly less likely associated with higher baseline AMT score denoting better cognitive status (OR = 0.68, 95% CI 0.48–0.97 per score point) and with greater AMT change score denoting greater cognitive improvement (OR = 0.61, 95% CI 0.41–0.91 per change score point); it was also more likely with higher baseline NIHSS scores denoting severe neurological impairment, (OR = 1.74, 95% CI 1.13–2.63 per point score), NIHSS change score [denoting lesser neurological improvement (OR = 1.83, 95% CI 1.13–2.93 per unit change score)], but was not associated with baseline or change scores of GDS. Greater magnitudes of functional recovery [BI change score (standardized beta)] were associated with better baseline depressive symptoms (?0.21) and improvement (?0.31), but not with cognitive status or improvement, in the presence of other significant variables, neurological status (?0.89) and improvement (?0.65), lower baseline physical functional status (?0.85) and younger age (?0.23). Conclusions – These data suggest that improving depressive symptoms in stroke patients may accelerate functional recovery, but the level of physical functioning achieved post‐stroke is determined by neurological and cognitive factors, consistent with the evidence that improvement of depressive symptoms through therapeutic intervention is limited by cognitive impairment.     

Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The European Community Stroke Project

BACKGROUND: Information on determinants and prognosis of ischemic stroke subtypes is scarce. We aimed at evaluating risk factors, pathogenesis, treatment and outcome of different ischemic stroke subtypes. METHODS: In a European Concerted Action involving seven countries, ischemic stroke subtypes defined according to the Oxfordshire Community Stroke Project (OCSP) were evaluated for demographics, baseline risk factors, resource use, 3-month survival, disability (Barthel Index) and handicap (Rankin Scale). RESULTS: During the 12-month study period, cerebral infarction was diagnosed in 2740 patients with first-in-a-lifetime stroke (mean age 70.5+/-12.4 years, 53.4% males). OCSP classification was achieved in 2472 (90.2%). Of these, 26.7% were total anterior circulation infarctions (TACI), 29.9% partial anterior circulation infarctions (PACI), 16.7% posterior circulation infarctions (POCI) and 26.7% lacunar infarctions (LACI). In multivariate analysis, atrial fibrillation was predictive of TACI (odds ratio [OR], 1.61; 95% CI, 1.28-2.03), hypertension (OR, 1.38; 95% CI, 1.16-1.65) and myocardial infarction (OR, 1.42; 95% CI, 1.08-1.86) predictive of PACI, hypertension (OR, 1.25; 95% CI, 1.04-1.50) predictive of LACI. A negative association was observed between TACI and hypertension (OR, 0.51; 95% CI, 0.42-0.61). Discharge home was 50% less probable in TACI and PACI than in LACI patients. As compared to LACI, TACI significantly increased the risk of 3-month death (OR, 5.73; 95% CI, 3.91-8.41), disability (OR, 3.27; 95% CI, 2.30-4.66) and handicap (OR, 2.71; 95% CI, 1.91-3.85). CONCLUSIONS: Ischemic stroke subtypes have different risk factors profile, with consequences on pathogenesis and prognosis. Information on determinants of the clinical syndromes may impact on prevention and acute-phase interventions.     

Post-stroke fatigue and return to work: a 2-year follow-up

Andersen G, Christensen D, Kirkevold M, Johnsen SP. Post‐stroke fatigue and return to work: a 2‐year follow‐up.
Acta Neurol Scand: 2012: 125: 248–253.
© 2011 John Wiley & Sons A/S. Background – Post‐stroke fatigue may affect the ability to return to work but quantitative studies are lacking. Method – We included 83 first‐ever stroke patients <60 years and employed either full‐time (n = 77) or part‐time (n = 6) at baseline. The patients were recruited from stroke units at Aarhus University Hospital between 2003 and 2005 and were followed for 2 years. Fatigue was assessed by the Multidimensional Fatigue Inventory. Pathological fatigue was defined as a score ≥12 on the General Fatigue dimension. Return to paid work was defined as working at least 10 h per week. Data were analyzed using multivariable logistic regression. Results – A total of 58% of patients had returned to paid work after 2 years. The adjusted Odds Ratio (OR) for returning to paid work was 0.39 (95% confidence interval (CI) 0.16–1.08) for patients with a General Fatigue score ≥12 at baseline. Persisting pathological fatigue after 2 years of follow‐up was associated with a lower chance of returning to paid work [adjusted OR 0.29 (95% CI 0.11–0.74)]. Higher scores of General Fatigue at follow‐up also correlated negatively with the chance of returning to paid work when analyzing fatigue on a continuous scale (adjusted OR 0.87, 95% CI 0.80–0.94 for each point increase in General Fatigue). Conclusions – Post‐stroke fatigue appears to be an independent determinant of not being able to resume paid work following stroke.     

Depressive symptoms predispose females to metabolic syndrome: a 7‐year follow‐up study

Objective: To evaluate the risk for developing metabolic syndrome when having depressive symptoms. Method: The prevalence of depressive symptoms and metabolic syndrome at baseline, and after a 7‐year follow‐up as measured with Beck depression inventory (BDI), and using the modified National Cholesterol Education Program – Adult Treatment Panel III criteria for metabolic syndrome (MetS) were studied in a middle‐aged population‐based sample (n = 1294). Results: The logistic regression analysis showed a 2.5‐fold risk (95% CI: 1.2–5.2) for the females with depressive symptoms (BDI ≥10) at baseline to have MetS at the end of the follow‐up. The risk was highest in the subgroup with more melancholic symptoms evaluated with a summary score of the melancholic items in BDI (OR 6.81, 95% CI: 2.09–22.20). In men, there was no risk difference. Conclusion: The higher risks for MetS in females with depressive symptoms at baseline suggest that depression may be an important predisposing factor for the development of MetS.     

Recurrent falls and mortality in Parkinson’s disease: a prospective two‐year follow‐up study

Matinolli M, Korpelainen JT, Sotaniemi KA, Myllylä VV, Korpelainen R. Recurrent falls and mortality in Parkinson’s disease: a prospective two‐year follow‐up study.
Acta Neurol Scand: 2011: 123: 193–200.
© 2010 John Wiley & Sons A/S. Objectives – To evaluate the risk factors for recurrent falling and mortality in Parkinson’s disease (PD) in a prospective study design. Materials and methods – One hundred and twenty‐five PD patients were included in the study. Baseline medical data were collected, and patients were clinically tested for mobility and balance. Falls were prospectively recorded for 2 years. Mortality was documented 4 years after the baseline. Results – Seventy‐nine patients reported altogether 3125 falls during the follow‐up, and 59 patients were classified as recurrent fallers. Altogether 126 fall injuries including six fractures were reported. Eighteen patients had died by the time of the hospital chart review. History of falling (OR 3.02, 95% CI 1.23–7.44) and the Unified Parkinson’s Disease Rating Scale activities of daily living score (OR 1.13, 95% CI 1.04–1.22) were independent risk factors for recurrent falling in PD, whereas slow walking speed (OR 16.28, 95% CI 1.85–142.97) was an independent risk factor for mortality in PD. Conclusions – History of falling and disease severity indicate increased risk of recurrent falls in PD, while patients with slow walking speed may have an increased risk of mortality. Recurrent falling was not associated with increased risk of mortality in PD in this study.     

Post‐stroke depression: can we predict its development from the acute stroke phase?

Objectives – To identify possible predictive factors for post‐stroke depression (PSD) in the acute phase of stroke. Methods – The study design was prospective, observational cohort study of patients with acute cerebral infarction (CI). Neurological and neuropsychological evaluations were conducted within the first 10 days from the onset of stroke and repeated at the 3‐month follow‐up. DSM‐IV criteria were used to define PSD. Results – From a total of 85 patients with CI, 59 patients completed the 3‐month follow‐up and 17 of them (28.8 %) fulfilled PSD criteria at the 3‐month follow‐up. Melancholy index of the Hamilton Depression Rankin Scale (HDRS) was associated with a risk three times greater than that of PSD at the 3‐month follow‐up in the univariate analysis (OR 3.07; 95% CI 1.53–6.16; P = 0.002) with no significant influence of stroke severity or the location of brain infarction (right or left side). The receiver operating characteristic curves pointed to a melancholy index ≥1.5 as the optimal cut‐off level associated with the development of PSD at the 3‐month follow‐up. Conclusions – Melancholy index of the HDRS ≥1.5 could be a useful clinical tool to detect patients with acute stroke at high risk of developing PSD.     

tPA treatment for acute ischaemic stroke in patients with leukoaraiosis

Background and Purpose: Whether leukoaraiosis on baseline CT is associated with an increased risk of symptomatic intracerebral haemorrhage (sICH) or poor outcome following tissue plasminogen activator (tPA) treatment for acute ischaemic stroke is still a matter of debate. Objective: To investigate the relationship between the presence and severity of leukoaraiosis on baseline CT and the risk of sICH and functional outcome after tPA treatment for acute ischaemic stroke. Methods: A single‐center observational cohort study with a retrospective analysis on consecutive patients with ischaemic stroke treated with tPA in the period 2002–2008. Outcome measures were the occurrence of sICH and functional outcome at 3 months. Results: Of the 400 patients, 24% had leukoaraiosis on their baseline CT. Eleven patients (11%) with leukoaraiosis versus thirteen (4%) patients without leukoaraiosis had a sICH [odds ratio (OR) 2.85 95%‐CI 1.23–6.60, P = 0.02]. Multivariate analysis showed a non‐significant trend towards an association of leukoaraiosis and sICH (OR 1.9, 95%‐CI 0.78–4.68, P = 0.16). Leukoaraiosis was independently associated with poor functional outcome (OR 2.39, 95%‐CI 1.21–4.72, P = 0.01). No difference was observed in the outcome measures amongst patients with moderate or severe leukoaraiosis. Conclusion: Our study demonstrates that patients treated with tPA and leukoaraiosis on their baseline CT are at greater risk of sICH and have a worse functional outcome compared to patients without leukoaraiosis. It is important to note that these results should not lead to exclusion of patients with leukoaraiosis for tPA treatment.     

Hypertension and incident dementia in community-dwelling elderly Yoruba Nigerians

Ogunniyi A, Lane KA, Baiyewu O, Gao S, Gureje O, Unverzagt FW, Murrell JR, Smith‐Gamble V, Hall KS, Hendrie HC. Hypertension and incident dementia in community‐dwelling elderly Yoruba Nigerians.
Acta Neurol Scand: 2011: 124: 396–402.
© 2011 John Wiley & Sons A/S. Objectives – To investigate the relationship between hypertension and dementia incidence in community‐dwelling elderly Yoruba (aged 70 years and above) because of sparse information on dementia and its risk factors in developing countries. Materials and Methods – Community‐based, prospective study of consenting elderly Yoruba using two‐stage design. Blood pressure was measured during the baseline evaluation at 2001 and hypertension was defined as BP ≥ 140/90 mmHg. Diagnosis of dementia and normal cognition was by consensus using standard criteria. Non‐demented subjects from the 2001 evaluation wave were re‐evaluated during the 2004 and 2007 waves for dementia. Logistic regression was used to examine the association of baseline hypertension and incident dementia, after adjusting for age, gender, education, and histories of stroke and smoking. P‐values <0.05 were considered significant. Results – During the 6‐year follow‐up, 120 individuals developed dementia, while 1633 remained non‐demented. The frequency of hypertension in the demented group was significantly higher than in the non‐demented (70.0% vs 60.2%, P = 0.034). Baseline hypertension was a significant risk factor for dementia (OR = 1.52; 95% CI 1.01–2.30). Higher systolic, diastolic or pulse pressure was associated with increased risk (P < 0.05). Participants with diastolic BP ≥ 90 mmHg were at a significantly greater risk than those with readings below 70 mmHg (OR = 1.65; 95% CI 1.01–2.69). Conclusions – Hypertension was associated with increased risk of dementia in elderly Yoruba and its appropriate treatment may lower the risk.     

Depression after minor stroke: prevalence and predictors

Background and purpose: Post‐stroke depression (PSD) is one of the most frequent complications of stroke, with a prevalence ranging 20–60%. As PSD seems to be related to stroke severity, we hypothesized that the prevalence of PSD would be lower in patients with minor stroke. Methods: We investigated the prevalence and predictors of PSD over a 30‐month follow‐up period in a cohort of patients with minor ischaemic stroke (NIHSS ≤ 5). Results: We enrolled 105 patients (mean age 64.38 ± 11.2 years, M/F 69/36). PSD was diagnosed in 43 (41%) patients, 40 (93%) of whom had dysthymia; 22% of patients were already depressed at 1 month. The most frequent depressive symptoms (DSs) were working inhibition, indecisiveness, and fatigability. Patients who developed PSD were less educated (P = 0.044) and diabetic (P = 0.006). After excluding patients that were already depressed at 1 month, we performed a logistic regression model to detect predictors of PSD. Crying (P = 0.012, OR 1.067, CI 0.269–4.553) and guilt (P = 0.007, OR 0.037, CI 0.02ì03–0.401) at baseline were two DSs found to be significantly correlated with PSD. Higher educational level (P = 0.022, OR 0.084, CI 0.010–0.698) and diabetes (P = 0.007, OR 14.361, CI 2.040–101.108) were the risk factors significantly correlated with PSD. Conclusion: Post‐stroke depression is frequent even in patients with minor stroke. Early detection of DSs might help to predict long‐term development of PSD. No correlation was observed between lesion site or side and the development of PSD.     

Predictors for 5-year survival in a prospective cohort of elderly stroke patients

Whiting R, Shen Q, Hung WT, Cordato D, Chan DKY. Predictors for 5‐year survival in a prospective cohort of elderly stroke patients.
Acta Neurol Scand: 2011: 124: 309–316.
© 2011 John Wiley & Sons A/S. Objectives – To examine predictors for 5‐year survival in elderly stroke patients. Materials and Methods – Prospective cohort study of 186 consecutive acute stroke patients aged ≥65 years admitted to Bankstown‐Lidcombe Hospital, Australia 03/2002 to 03/2003. All subjects were followed up in 2007/8, at 5 years post‐stroke, for outcome measures. Logistic regression analysis was performed to predict 5‐year survival using covariables, including functional status, age, stroke type and severity and vascular risk factors. Patients lost to follow‐up (n = 20) were excluded from the analyses. Results – One hundred patients (60%) were dead at study end. Predictors for survival in final logistic regression model were as follows: Glasgow Coma Scale (GCS) on admission (OR 1.49, 95%CI 1.1–2.0, P = 0.01), preadmission functional independence measure (FIM) score (OR 1.04, 95%CI 1.0–1.1, P = 0.01), age (OR 0.93, 95%CI 0.87–0.98, P = 0.01) and atrial fibrillation (OR 0.43, 95% CI 0.19–0.95, P = 0.04). For 5‐year survivors, mean Modified Rankin Scale was 3.1 ± 1.5, total FIM score 85 ± 32, mini‐mental state examination (MMSE) 22 ± 8 and Hospital Anxiety and Depression (HAD) scores 5.4 ± 3.4 and 5.2 ± 3.9, respectively. FIM cognition score was significantly lower at 5 years when compared to baseline (24 ± 8 vs 29 ± 8, P < 0.05) (all scores expressed as mean ± SD). In contrast, MMSE, HAD and total FIM scores were not significantly different at 5 years when compared to baseline. Conclusions – The study identified lower GCS on admission, lower preadmission FIM score, age and atrial fibrillation as negative predictors for 5‐year survival following stroke.     

Meta-analysis of the cardiovascular benefits of intensive lipid lowering with statins

Chan DKY, O’Rourke F, Shen Q, Mak JCS, Hung WT. Meta‐analysis of the cardiovascular benefits of intensive lipid lowering with statins.
Acta Neurol Scand: 2011: 124: 188–195.
© 2010 John Wiley & Sons A/S. Objective – To evaluate the efficacy of intensive lipid lowering with higher‐dose statins. Methods – Meta‐analysis of seven randomized controlled trials comprising 50,972 participants. Results – Mean follow‐up was 3.1 years with mean age 63 years. Final LDL‐C levels in intensive lipid‐lowering group were 1.42–2.07 mmol/l compared to 2.1–3.5 mmol/l in the less intensive or control group. The intensive arm had significantly lower risks for stroke OR 0.80 (95% CI 0.71–0.89); major coronary events OR 0.74 (95% CI 0.65–0.83); cardiovascular disease (CVD) or coronary heart disease (CHD) deaths OR 0.84 (95% CI 0.74–0.95). Significantly higher liver enzyme abnormalities occurred in intensive group* (OR 3.96; 95% CI 2.08–7.53), but it was not associated with drug discontinuations (OR 1.20; 95% CI 0.88–1.64). Conclusion – In those at high risk of cardiovascular events, intensive lipid lowering with statins to LDL‐C level <2.1 mmol/l significantly reduces risk of stroke, major coronary events and CVD or CHD deaths compared to LDL‐C level ≥2.1 mmol/l. [*Correction added on 11 January 2011 after first online publication on 27 October 2010. The phrase, “Significantly higher liver enzyme abnormalities occurred in less intensive group”, was amended to “Significantly higher liver enzyme abnormalities occurred in intensive group”.]     

Blood Pressure, smoking and oral contraceptive control after cryptogenic stroke in young adults in the PFO-ASA Study

BACKGROUND: Management of vascular risk factors is not optimal in stroke patients. We assessed the control of hypertension, smoking and stopping of oral contraceptive in 581 consecutive young cryptogenic ischemic stroke patients followed in the PFO-ASA study and we identified factors associated with inadequate management. METHODS: At each follow-up visit, blood pressure (BP), smoking and use of oral contraceptive were recorded. Data were analyzed at 6 months, 1 and 2 years. Hypertension was defined as systolic BP > or = 140 or diastolic BP > or = 90 mm Hg, recorded in at least two follow-up visits. Current smoking was defined as more than one cigarette per day reported during at least one follow-up visit. RESULTS: During follow-up, 36% of patients were hypertensive and 30% were smokers. Among the 90 hypertensive patients at baseline, 60-68% remained with high BP and among the 278 patients who were current smokers at baseline, 54-58% still smoked during follow-up. Age (OR = 1.05, 95% CI 1.02-1.08), male sex (OR = 1.42, 95% CI 0.93-2.18), body mass index > or = 27 (OR = 2, 95% CI 1.27-3.17) and known hypertension (OR = 3.08, 95% CI 1.80-5.28) were significantly associated with hypertension during follow-up. Tobacco consumption at baseline (OR = 35.2, 95% CI, 19.3-64.2), alcohol consumption at baseline (OR = 2.7, 95% CI 1.4-5.2) and Rankin < or = 2 (OR = 2.6, 95% CI 1.4-4.9) were independently associated with persistent smoking. Among the 114 women who were using combined estrogen-progesterone pills at baseline, 96.5% stopped. CONCLUSIONS: Major risk factors for stroke are poorly controlled after stroke, even in the context of a prospective clinical study in young adults.     

Perinatal, maternal, and fetal characteristics of children diagnosed with attention-deficit-hyperactivity disorder: results from a population-based study utilizing the Swedish Medical Birth Register

Aim The aim of this study was to evaluate the impact of pre‐ and perinatal factors on the risk of developing attention‐deficit–hyperactivity disorder (ADHD). Method We investigated the medical history of 237 children (206 male; 31 female) from Malmö, Sweden born between 1986 and 1996 and in whom a diagnosis of ADHD (Diagnostic and Statistical Manual of Mental Disorders‐IIIR or IV) was subsequently made at the Department of Child and Adolescent Psychiatry, Lund University, and a reference group of 31 775 typically developing children from Malmö using data from the Swedish Medical Birth Register. Results The results of multiple logistic regression analysis revealed that ADHD was significantly associated with a young maternal age (odds ratio [OR] for 5y increase 0.87; 95% confidence interval [CI] 0.76–0.99), maternal smoking (OR 1.35; 95% CI 1.14–1.60), maternal birthplace in Sweden (OR 2.04; 95% CI 1.45–2.94), and preterm birth <32 weeks (OR 3.05; 95% CI 1.39–6.71), and a male predominance (OR 6.38; 95% CI 4.37–9.32). Apgar scores at 5 minutes below 7 were significantly associated with ADHD in the univariable analysis (OR 2.60; 95% CI 1.15–5.90). The population‐attributable fraction of ADHD caused by the perinatal factors studied was estimated to be 2.8%. Interpretation The results indicate that the studied factors constitute weak risk factors for developing ADHD.     

Female reproductive factors,menopausal hormone use,and Parkinson's disease

The objective of this study was to examine the associations of reproductive factors and exogenous hormone use with risk of Parkinson's disease (PD) among postmenopausal women. The study comprised 119,166 postmenopausal women aged 50 to 71 years in the NIH‐AARP Diet and Health Study, who completed a baseline questionnaire in 1995–1996 and a follow‐up survey in 2004–2006. A total of 410 self‐reported PD diagnoses were identified between 1995 and 2006. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression models. PD risk was not significantly associated with female reproductive factors including age at menarche, age at first live birth, parity, and age at menopause. For example, compared with women with natural menopause at age 50 to 54 years, the ORs were 1.18, (95% CI, 0.78‐1.79) for women with natural menopause aged <45, 1.19 (95% CI, 0.88‐1.61) for those aged 45 to 49, and 1.33 (95% CI, 0.91‐1.93) for those aged 55 or older. We found that oral contraceptive use for ≥10 years (vs. never used) was associated with lower PD risk (OR, 0.59; 95% CI, 0.38‐0.92), but shorter use showed no association. Use of menopausal hormone therapy showed inconsistent results. Compared with non–hormone users at baseline, current hormone users for <5 years showed a higher risk of PD (OR, 1.52; 95% CI, 1.11‐2.08). However, no associations were observed for past hormone users or current users of ≥5 years. Overall, this large prospective study provides little support for an association between female reproductive factors and PD risk. Our findings on long‐term oral contraceptive use and current hormone therapy warrant further investigations. © 2013 International Parkinson and Movement Disorder Society     

Impaired Nocturnal Melatonin in Acute Phase of Ischaemic Stroke: Cross-Sectional Matched Case–Control Analysis

Quantitative data on melatonin in stroke patients are scarce. A gender‐ and age‐matched cross‐sectional case–control study in 33 patients with ischaemic stroke was performed and associations between nocturnal melatonin and other factors (e.g. cortisol) were evaluated. Clinical and laboratory (e.g. melatonin and cortisol) measurements (03.00 h and 08.00 h) with statistical techniques [e.g. multifactorial regressions, receiver operating characteristic (ROC) curve and curvilinear estimations] were used. We identified mean value and 95% confidence interval (CI) (69.70 pg/ml; 95% CI = 53.86–85.54) for control levels of nocturnal melatonin in healthy subjects. The patients with stroke had lower melatonin (48.1 ± 35.9 pg/ml) and higher cortisol (297.3 ± 157.8 nmol/l) at 03.00 h (P < 0.05) but not at 08.00 h (P > 0.05). Stroke was the strongest factor of disturbed nocturnal cortisol (P < 0.001), whereas decreased melatonin depended on stroke (P = 0.010) and gender (P = 0.018). At the same time, vice versa, only nocturnal measures were associated with an increased probability of the presence of stroke (accuracy > 75%, P_model < 0.001). Thus, a hypothesis that a decrease of melatonin with 1.0 pg/ml might be associated with > 2% increase in the probability of the presence of stroke [adjusted odds ratio (OR) = 1.020; 95% CI = 1.002–1.037] was also suggested. The ROC curve (0.67, P = 0.0119) and optimisation techniques indicated that a novel best cut‐off < 51.5 pg/ml for decreased nocturnal melatonin in the view of the presence of stroke (OR = 3.12, P = 0.0463) might exist. The classification performance of such a cut‐off might be confirmed by existing nocturnal melatonin and cortisol differences between the sub‐groups; potential differences in diurnal melatonin were also suggested. In conclusion, a novel melatonin cut‐off of 51.5 pg/ml may be associated with the presence of ischaemic stroke. As a single marker (84% sensitivity, 74% specificity), it is hypothesised that modelling performance was independent of age, gender and cortisol. These new results, including the suggested hypothesis, might be further tested in follow‐up (cohort), longitudinal studies and be applied to explore melatonin disturbances as targets in high‐risk pre‐stroke and post‐stroke patients.     

What characteristics of primary anxiety disorders predict subsequent major depressive disorder?

OBJECTIVE: The goal of this study was to examine the associations between specific anxiety disorders and the risk of major depressive disorder and to explore the role of various clinical characteristics of anxiety disorders in these relationships using a prospective, longitudinal design. METHOD: The data are from a 4-year prospective, longitudinal community study, which included both baseline and follow-up survey data on 2548 adolescents and young adults aged 14 to 24 years at baseline. DSM-IV diagnoses were made using the Munich-Composite International Diagnostic Interview. RESULTS: The presence at baseline of any anxiety disorder (odds ratio [OR] = 2.2 [95% CI = 1.6 to 3.2]) and each of the anxiety disorders (specific phobia, OR = 1.9 [95% CI = 1.3 to 2.8]; social phobia, OR = 2.9 [95% CI = 1.7 to 4.8]; agoraphobia, OR = 3.1 [95% CI = 1.4 to 6.7]; panic disorder, OR = 3.4 [95% CI = 1.2 to 9.0]; generalized anxiety disorder, OR = 4.5 [95% CI = 1.9 to 10.3]) was associated with a significantly (p <.05) increased risk of first onset of major depressive disorder. These associations remained significant after we adjusted for mental disorders occurring prior to the onset of the anxiety disorder, with the exception of the panic disorder association. The following clinical characteristics of anxiety disorders were associated with a significantly (p <.05) increased risk of developing major depressive disorder: more than 1 anxiety disorder, severe impairment due to the anxiety disorder, and comorbid panic attacks. In the final model, which included all clinical characteristics, severe impairment remained the only clinical characteristic that was an independent predictor of the development of major depressive disorder (OR = 2.2 [95% CI = 1.0 to 4.4]). CONCLUSION: Our findings suggest that anxiety disorders are risk factors for the first onset of major depressive disorder. Although a number of clinical characteristics of anxiety disorders appear to play a role in the association between anxiety disorders and depression, severe impairment is the strongest predictor of major depressive disorder.     

Patent foramen ovale is not associated with an increased risk of stroke recurrence

Background and Purpose: Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast‐enhanced transcranial Doppler ultrasonography (c‐TCD) and recurrent stroke in an unselected population sample. Methods: We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD‐based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow‐up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow‐up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause. Results: Follow‐up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt‐carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41–1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41–3.29]) Conclusion: Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.     

Slowed Information Processing Speed at Four Years Poststroke: Evidence and Predictors from a Population-Based Follow-up Study

Background and PurposeSlowed Information Processing Speed (IPS) is a commonly reported cognitive deficit following stroke, affecting up to 50% to 70 % of stroke survivors. IPS has a major influence on poststroke cognitive dysfunction, affecting quality of life and increasing dependence on others. Few studies have examined predictors of slow IPS after stroke, and there is a paucity of data in terms of long-term prevalence. This study examined baseline predictors associated with long-term slow IPS in a population-based stroke incidence cohort, 4 years after stroke onset.MethodsAdults with stroke (n = 133, m = 71.1 ± 13.5 years) completed the Symbol Digit Modalities Test (SDMT) at 4 years poststroke. Baseline predictors were obtained within 2 weeks of the acute event. Multivariate regression linear and logistic models were used to identify baseline predictors (reported as OR with 95%CI) and prevalence of impaired IPS at 4-years.Results51% of people with stroke had low scores on the SDMT as indicated by a score of −1.0 SD to −2.5 SD (ranging from low to very low respectively). There were significant associations between slow IPS at 4-years after controlling for age and education level and the following baseline factors: older age (>75 years) (OR 3.03, 95% CI .9-9.3,P = .05), previous stroke (OR 2.74, 95% CI 1.0-7.4,P = .05), high cholesterol (OR 2.72, 95% CI 1.3-5.4,p = .01), hypertension (OR 1.82, 95% CI 0.9-3.6,p = .05), and presence of coronary artery disease (OR 3.35, 95% CI 1.6-9.6,P = .01), or arrhythmia (OR 4.40, 95% CI 1.5-12.4,P = .01).ConclusionsEven after 4-years poststroke, slowed IPS is highly prevalent, with comorbid vascular risk factors significantly contributing to persistent impaired IPS. Early identification of adults who are at higher risk of deficits in IPS is vital to targeting the timely delivery of cognitive rehabilitation interventions, improving overall outcomes.     

Outcome of intracerebral haemorrhage patients pre‐treated with statins

Background: Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin‐treated animals have better outcome than non‐treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre‐treatment. Methods: Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis. Results: We included 269 patients (age 71.9 ± 12.4, mean ± SD, 152 males). Thirty‐four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre‐treated groups and the group without statin pre‐treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92–0.97), ICH volume (OR: 0.96; CI 0.94–0.98), GCS (OR: 1.55; CI 1.21–1.98), pre‐treatment with statins (OR: 4.21; CI 1.47–12.17; P = 0.008), and good outcome at 3 months. Conclusions: Statins pre‐treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.     

A cross-sectional study on the mental health of patients with COVID-19 1 year after discharge in Huanggang,China

Objective

This study is aimed to investigate the mental health status of COVID-19 survivors 1 year after discharge from hospital and reveal the related risk factors.

Methods

From April 11 to May 11, 2021, 566 COVID-19 survivors in Huanggang city were recruited through their primary doctors. A total of 535 participants (94.5%) admitted to participate in the survey and completed the questionnaires. Five scales were applied including 7-Items Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and Fatigue Scale-14. The chi-square and the Fisher’s exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of sleep quality, fatigue, anxiety, depression, and post-traumatic stress disorder (PTSD).

Results

One year after being discharged, of the 535 COVID-19 survivors, 252 (47.1%) had poor sleep quality; 157 (29.3%) had the symptoms of fatigue; 84 (15.7%),112 (20.9%), and 130 (24.3%) suffered from symptoms of anxiety, depression, and PTSD, respectively. The logistic regression analysis showed that history of chronic disease was risk factor for poor sleep quality (OR 2.501; 95% CI, 1.618–3.866), fatigue (OR 3.284; 95% CI 2.143–5.033), PTSD (OR 2.323; 95% CI 1.431–3.773) and depression (OR 1.950; 95% CI 1.106–3.436) in COVID-19 survivors. Smoking contributed to the poor sleep quality (OR 2.005; 95% CI 1.044–3.850), anxiety (OR 4.491; 95% CI 2.276–8.861) and depression (OR 5.459; 95% CI 2.651–11.239) in survivors. Drinking influenced fatigue (OR 2.783; 95% CI 1.331–5.819) and PTSD (OR 4.419; 95% CI 1.990–9.814) in survivors. Compared with college-educated survivors, survivors with high school education were at higher risk for poor sleep quality (OR 1.828; 95% CI 1.050–3.181) and PTSD (OR 2.521; 95% CI 1.316–4.830), and survivors with junior high school education were at higher risk for PTSD (OR 2.078; 95% CI 1.039–4.155). Compared with overweight survivors (BMI ≥ 23.0), survivors with normal BMI (18.5–22.9) (OR 0.600; 95% CI 0.405–0.889) were at lower risk for fatigue. While being housewife (OR 0.390; 95% CI 0.189–0.803) was protective factor for fatigue and having more family members was protective factor for PTSD (OR 0.404 95% CI 0.250–0.653) in survivors.

Conclusions

One year after infection, poor sleep quality, fatigue, anxiety, depression, and PTSD, still existed in a relatively high proportion of COVID-19 survivors. Chronic disease history was an independent risk factor for poor sleep quality, fatigue, depression, and PTSD. Participants with low education levels were more likely to have mental problems than the others. We should focus on the long-term psychological impact of COVID-19 on survivors, and the government should apply appropriate mental health services to offer psychiatric support.