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The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after strokeThe goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided. Copyright 2020 The Authors.
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Anxiety, Apathy, and Depression in First-Time Stroke Survivors with Aphasia in the Post-Stroke PeriodEmotional 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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Alternate approach to stroke phenotyping identifies a genetic risk locus for small vessel strokeIschemic stroke (IS), caused by obstruction of cerebral blood flow, is one of the leading causes of death. While neurologists agree on delineation of IS into three subtypes (cardioembolic stroke (CES), large artery stroke (LAS), and small vessel stroke (SVS)), several subtyping systems exist. The most commonly used systems are TOAST (Trial of Org 10172 in Acute Stroke Treatment) and CCS (Causative Classification System for Stroke), but agreement is only moderate. We have compared two approaches to combining the existing subtyping systems for a phenotype suited for a genome-wide association study (GWAS). We used the NINDS Stroke Genetics Network dataset (SiGN, 11,477 cases with CCS and TOAST subtypes and 28,026 controls). We defined two new phenotypes: the intersect, for which an individual must be assigned the same subtype by CCS and TOAST; and the union, for which an individual must be assigned a subtype by either CCS or TOAST. The union yields the largest sample size while the intersect yields a phenotype with less potential misclassification. We performed GWAS for all subtypes, using the original subtyping systems, the intersect, and the union as phenotypes. In each subtype, heritability was higher for the intersect compared with the other phenotypes. We observed stronger effects at known IS variants with the intersect compared with the other phenotypes. With the intersect, we identify rs10029218:G>A as an associated variant with SVS. We conclude that this approach increases the likelihood to detect genetic associations in ischemic stroke. Copyright 2020, The Author(s).
