Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label cognitive impairment. Show all posts
Showing posts with label cognitive impairment. Show all posts

Monday, November 21, 2022

Researchers find connection between gut and stroke-induced cognitive impairment

 FYI. Hope your doctor can extrapolate this before research is totally proven out. 

Your doctor has had over a decade to come up with solutions to this problem.  Or are you letting your doctor skate by being out-of-date on all things stroke?

 

 

 

Researchers find connection between gut and stroke-induced cognitive impairment

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Texas [US], November 21(ANI): A major contributor to dementia, substantial long-term impairment, and mortality is stroke. The American Heart Association revealed that stroke patients are more likely to experience depression, which has a detrimental effect on functional and cognitive restoration.

The Texas A&M team investigated the novel idea of whether transplant of intestinal epithelial stem cells (IESCs) from healthy donors could repair the intestinal barrier after stroke and improve stroke outcomes. Results from their preclinical study, published in the journal Brain, Behavior, and Immunity, indicate that IESC transplantation reduced stroke-induced mortality, decreased the volume of dead tissue and gut leakiness, and prevented stroke-induced cognitive impairment.

The only recombinant tissue plasminogen activator licenced by the Food and Drug Administration (FDA) for the treatment of strokes has a limited track record and must be administered quickly after the onset of the stroke. Researchers at the Texas A&M University School of Medicine are leading research on the relationship between stroke-induced intestinal permeability, or leakiness, and cognitive impairment with the goal of improving stroke outcomes.

Two-thirds of stroke patients will develop cognitive impairment, while one-third of all stroke patients will go on to develop dementia, according to recent research, so there is a critical need for more effective stroke therapies that preserve cognitive function after acute stroke and that remain protective in the weeks following.

Although conventional stroke treatment research focuses on the brain, the gut responds early and rapidly to stroke with changes that may precede many of the inflammatory events associated with stroke-induced disease. These changes in the gut, such as increased permeability, likely result in the movement of products that are synthesized in the gut into the blood stream. Many of these products are toxic and therefore in a position to increase inflammation and exacerbate stroke-induced brain injury.

Evidence from a variety of studies demonstrates that IESCs repair the gut and reduce gut permeability. After a stroke, these repair processes may be critical to preserving cognitive function. “It is clear that the gut-brain axis is involved in injury following stroke,” said Farida Sohrabji, PhD, Regents Professor, department head for Neuroscience and Experimental Therapeutics and senior author of the study. “Factoring in the effects of gut health on the brain following stroke may allow us to more effectively advance stroke therapies.”

With that in mind, Sohrabji and her team transplanted primary IESCs from healthy donors after stroke in a preclinical model. IESCs from young donors repaired gut architecture and decreased gut permeability and consequently decreasing blood levels of proteins and other molecules that are toxic to brain cells. IESC transplantation also prevented depressive-like behaviors and cognitive impairment in the weeks following the stroke. IESC transplantation from older donors did not improve stroke outcomes, indicating that successful transplantation depends on the age of the donor.

Still at the preclinical stage, this research highlights the importance of early therapeutic intervention after stroke and will guide future directions of the work. “Future studies will investigate refinement of the dosing and timing of the protocol,” Sohrabji said. “A systematic study of aging stem cells would also be important to explain why older patients experience more severe strokes.”

Sohrabji, a neuroscientist with significant contributions to the literature on stroke pathogenesis, explained that this preclinical study was spearheaded by Kathiresh Kumar Mani, PhD, an associate research scientist in her lab. Mani, who is trained in gut biology, received a postdoctoral grant from the American Heart Association in support of this project. Combining their expertise has allowed them to move stroke therapy research into new territory with exciting results. They also received a generous grant from the WoodNext Foundation that is facilitating their innovative research.

“Ultimately, this research is expected to advance development of novel therapies that target and repair the intestinal epithelium to help mitigate stroke disability,” Sohrabji said, “but the premise–that gut stem cells might be therapeutically valuable outside of the gut–could be considered for a much greater variety of neurological diseases.” (ANI)

  

Sunday, October 2, 2022

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

Are your mentors and senior researchers that clueless that they don't know that predicting cognitive impairment is totally fucking useless for survivors?  If we had ANY KIND OF STROKE STRATEGY AT ALL, every piece of stroke research would lead directly to creation of stroke protocols that fix stroke problems.  I'd fire you all for doing a complete waste.

Predictors of post-stroke cognitive impairment using acute structural MRI neuroimaging: A systematic review and meta-analysis

Abstract

Background:

Stroke survivors are at an increased risk of developing post-stroke cognitive impairment and post-stroke dementia; those at risk could be identified by brain imaging routinely performed at stroke onset.

Aim:

This systematic review aimed to identify features which are associated with post-stroke cognitive impairment (including dementia) on magnetic resonance imaging (MRI) performed at stroke diagnosis.

Summary of review:

We searched the literature from inception to January 2022 and identified 10,284 records. We included studies that performed MRI at the time of stroke (0–30 days after a stroke) and assessed cognitive outcome at least 3 months after stroke. We synthesized findings from 26 papers, comprising 27 stroke-populations (N = 13,114, average age range = 40–80 years, 19–62% female). When data were available, we pooled unadjusted (ORu) and adjusted (ORa) odds ratios.
We found associations between cognitive outcomes and presence of cerebral atrophy (three studies, N = 453, ORu = 2.48, 95% CI = 1.15–4.62), presence of microbleeds (two studies, N = 9151, ORa = 1.36, 95% CI = 1.08–1.70), and increasing severity of white matter hyperintensities (three studies, N = 704, ORa = 1.26, 95% CI = 1.06–1.49). Increasing cerebral small vessel disease score was associated with cognitive outcome following unadjusted analysis only (two studies, N = 499, ORu = 1.34, 95%CI = 1.12–1.61; three studies, N = 950, ORa = 1.23, 95% CI = 0.96–1.57). Associations remained after controlling for pre-stroke cognitive impairment. We did not find associations between other stroke features and cognitive outcome, or there were insufficient data.

Conclusion:

Acute stroke MRI features may enable healthcare professionals to identify patients at risk of post-stroke cognitive problems. However, there is still substantial uncertainty about the prognostic utility of acute MRI for this.

Introduction

Cognitive problems after stroke are of major concern to stroke survivors and their families.1(Yep, AND YOU'RE DOING NOTHING TO SOLVE THEM!) Identifying who is at risk at the time of stroke may enable healthcare professionals to arrange appropriate follow-up, inform patients and their carers, and plan for possible future health outcomes. Individuals at risk of post-stroke cognitive problems could also be targeted for clinical trials with cognitive endpoints.
The cognitive consequences of stroke are conventionally described as post-stroke cognitive impairment (PSCI—impaired performance on a structured cognitive assessment) and the subcategory of post-stroke dementia (PSD—a clinical diagnosis of a cognitive change sufficient to interfere with daily life).
International guidelines for PSCI highlight that there are currently no prediction tools suitable for clinical practice.2 A survey of 60 UK healthcare professionals reported that respondents were aware that imaging features could predict PSCI, but they did not use these features in clinical practice.3 Acute stroke neuroimaging could help healthcare professionals to identify who is at risk of PSCI.
Acute stroke computed tomography (CT) brain imaging is routinely performed in clinical practice to determine the cause of stroke. CT brain imaging is inexpensive and quick to perform but has lower resolution than magnetic resonance imaging (MRI). Recently, MRI has become more available for stroke diagnosis in clinical practice. MRI also allows the identification of neuroimaging features such as cerebral microbleeds (CMB) that are rarely visible on CT brain scans. MRI may help identify neuroimaging features associated with post-stroke cognitive problems.
Cerebral small vessel disease (cSVD) is commonly associated with stroke and dementia.4 Neuroimaging features include white matter hyperintensities (WMH), CMB, lacunes, perivascular spaces (PVS), recent small subcortical infarcts, and cerebral atrophy.5 Three systematic reviews have described the associations between neuroimaging features and PSD/PSCI.68 One review found that stroke survivors with moderate to severe WMH had a two-to-three-fold increased risk in PSD/PSCI.7 Another review reported that medial temporal lobe atrophy (MTLA) and global atrophy were associated with increased risk of PSCI,6 and the third review highlighted an association between MTLA, WMH, and PSCI.8 These reviews included studies that performed brain imaging up to several months after a stroke, which does not reflect what happens in clinical practice. Only one review performed a sensitivity analysis comparing the association between severity of WMH and PSD when identified on CT versus MRI.7 The reviews did not report the association between acute stroke lesions and post-stroke cognitive outcome. However, a multicohort study of 2950 stroke survivors reported that infarcts in the left thalamus, left frontotemporal lobes, and right parietal lobe were associated with PSCI.9 Our previous systematic review focused on the prognostic utility of acute stroke CT finding that presence of atrophy, WMH, and pre-existing stroke lesions were associated with a two-to-three-fold increase in risk of PSD, and WMH was associated with a three-fold increased risk in PSCI.10 MRI is increasingly being used in clinical practice and is recommended for suspected TIA.11 A similar review focusing on MRI was needed.
 
More at link.