Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke
Schirmer, Markus D
Bonkhoff, Anna K
Dalca, Adrian V
Regenhardt, Robert W
Etherton, Mark R
Donahue, Kathleen L
Mocking, Steven J T
McIntosh, Elissa C
Benavente, Oscar R
Cole, John W
Griessenauer, Christoph J
Kittner, Steven J
Levi, Christopher R
McDonough, Caitrin W
Meschia, James F
Sacco, Ralph L
Stanne, Tara M
McArdle, Patrick F
Worrall, Bradford B
Lindgren, Arne G
Rost, Natalia S
JournalFrontiers in Neurology
PublisherFrontiers Media S.A.
MetadataShow full item record
AbstractObjective: To personalize the prognostication of post-stroke outcome using MRI-detected cerebrovascular pathology, we sought to investigate the association between the excessive white matter hyperintensity (WMH) burden unaccounted for by the traditional stroke risk profile of individual patients and their long-term functional outcomes after a stroke. Methods: We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) study, for whom data on vascular risk factors (VRFs), including age, sex, atrial fibrillation, diabetes mellitus, hypertension, coronary artery disease, smoking, prior stroke history, as well as acute stroke severity, 3- to-6-month modified Rankin Scale score (mRS), WMH, and brain volumes, were available. We defined the unaccounted WMH (uWMH) burden via modeling of expected WMH burden based on the VRF profile of each individual patient. The association of uWMH and mRS score was analyzed by linear regression analysis. The odds ratios of patients who achieved full functional independence (mRS < 2) in between trichotomized uWMH burden groups were calculated by pair-wise comparisons. Results: The expected WMH volume was estimated with respect to known VRFs. The uWMH burden was associated with a long-term functional outcome (β = 0.104, p < 0.01). Excessive uWMH burden significantly reduced the odds of achieving full functional independence after a stroke compared to the low and average uWMH burden [OR = 0.4, 95% CI: (0.25, 0.63), p < 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p < 0.01, respectively]. Conclusion: The excessive amount of uWMH burden unaccounted for by the traditional VRF profile was associated with worse post-stroke functional outcomes. Further studies are needed to evaluate a lifetime brain injury reflected in WMH unrelated to the VRF profile of a patient as an important factor for stroke recovery and a plausible indicator of brain health.
Rights/TermsCopyright © 2021 Hong, Giese, Schirmer, Bonkhoff, Bretzner, Rist, Dalca, Regenhardt, Etherton, Donahue, Nardin, Mocking, McIntosh, Attia, Benavente, Cole, Donatti, Griessenauer, Heitsch, Holmegaard, Jood, Jimenez-Conde, Roquer, Kittner, Lemmens, Levi, McDonough, Meschia, Phuah, Rolfs, Ropele, Rosand, Rundek, Sacco, Schmidt, Enzinger, Sharma, Slowik, Sousa, Stanne, Strbian, Tatlisumak, Thijs, Vagal, Wasselius, Woo, Zand, McArdle, Worrall, Wu, Jern, Lindgren, Maguire, Tomppo, Golland, Rost and the MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium.
Keywordacute ischemic stroke
functional outcome after acute stroke
white matter hyperintensity
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/16739
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- Authors: Giese AK, Schirmer MD, Dalca AV, Sridharan R, Donahue KL, Nardin M, Irie R, McIntosh EC, Mocking SJT, Xu H, Cole JW, Giralt-Steinhauer E, Jimenez-Conde J, Jern C, Kleindorfer DO, Lemmens R, Wasselius J, Lindgren A, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Thijs V, Worrall BB, Woo D, Kittner SJ, McArdle PF, Mitchell BD, Rosand J, Meschia JF, Wu O, Golland P, Rost NS, International Stroke Genetics Consortium and the MRI-GENIE Investigators.
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Anxiety, Apathy, and Depression in First-Time Stroke Survivors with Aphasia in the Post-Stroke PeriodJackson, Maranda Christine; Thomas, Sue Ann, 1947- (2013)Emotional disorders specifically, anxiety, apathy and depression, in the post-stroke period are prevalent, long lasting and detrimental. Aphasia, an acquired communication disorder, is experienced by 40% of all stroke survivors. As the leading cause for disability, stroke affects multiple aspects of the stroke survivors life. Moreover, physical disability, social isolation, and emotional distress further complicate stroke rehabilitation compromising recovery and increasing mortality. Seventy-one percent of stroke studies exclude stroke survivors with aphasia. Thus, the impact of emotional distress in aphasic stroke survivors remains a gap within the stroke literature. This study examined emotional distress in first-time stroke survivors with aphasia in the post-stroke period. A descriptive, cross-sectional study design using non-probability sampling was used. Participants were recruited from rehabilitation hospitals, the community and a stroke database. Using primary data collection a sample size of 16 stroke survivors was obtained. A battery of instruments assessing aphasia, physiological, sociological, and neuropsychological aspects of stroke recovery were administered in a 2-hour interview session. Within this sample of stroke survivors with aphasia, 68.8% reported anxiety, 100% reported apathy, and 43.8% reported depression. With the majority of the population reporting apathy mixed disorders were identified. Sixty-eight percent of stroke survivors screened for anxiety and apathy and 66.7% reported depression and apathy. The mean stroke severity score was 2.2. Forty-three percent were functionally independent, 93.8% had below average neuropsychological scores, and 62.5% had left hemisphere lesions. Ethnicity and gender was associated with depression. Chi square analysis (p = .041, Fishers exact test) and Mann Whitney U associate non-blacks (n=8, Mdn=6.0) with higher depression scores than blacks (n=8, Mdn=2.5) (U= 12.000, z= -2.11, p=, 03). Emotional distress is a pervasive in stroke survivors with aphasia. Thoughtful selection of instruments modified for this stroke population may effectively detect post-stroke emotions. Despite the small sample size, this study contributes to the body of research by screening for social isolation, apathy, and neuropsychological status within this stroke sub-population. Going forward, incorporation of social, neuropsychological and psychological screening as standard of care in facilities serving the stroke population, will improve stroke outcomes in the stroke survivor with aphasia.
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