Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment

He, Minqiang; Wang, Jine; Liu, Na; Xiao, Xiao; Geng, Shan; Meng, Pin; Ji, Ningfei; Sun, Ying; Xu, Yingda; Zhou, Xinyu; Zhang, Guanghui; He, Xu; Cai, Zenglin; Li, Zaipo; Wang, Bei; Xu, Biao; Hui, Rutai; Wang, Yibo

doi:10.1161/strokeaha.118.020827

Cited by 28 publications

(27 citation statements)

References 37 publications

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“…Research on the impacts of different etiologic stroke subtypes on the prevalence and severity of PSCI could provide new insights into the underlying mechanisms for the development and course of PSCI and, thereby, on its prevention and treatment. In agreement with several studies but in contrast to others, we found better outcomes among SVD patients than among the other stroke subtypes, as attention was most impaired in relation to cortical infarcts (CE and LAD) (17,23). We used the TOAST classification (22) to assess the etiologic subtype of ischemic stroke, which, to a small extent, reflects the severity and localization of the stroke and is known to be important for cognitive function (6,17,18,22).…”

Section: Discussionsupporting

confidence: 84%

“…LAD and CE strokes are often cortical strokes of large volume, while SVD strokes are subcortical and of small volume ( 22 ). Cognitive impairment has been shown to be less common in the early post-stroke period in SVD compared to other stroke subtypes, but SVD is associated with cognitive decline long after a stroke ( 16 , 17 , 23 , 24 ). However, in their review and meta-analyses, Makin et al found similar proportions to have PSCI in lacunar vs. non-lacunar stroke [OR 0.75 (95% CI 0.47–1.20)] ( 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

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Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

et al. 2020

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Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51-0.66) and 0.51 (0.52-0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language Aam et al. Post-stroke Cognitive Impairment improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

et al. 2020

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“…While there is little evidence to support a specific BP threshold, there is a precedent for pre-activity BP screening criteria. A recent study in 708 post-ischemic stroke patients demonstrated increased odds of cognitive impairment at 3 months for patients in the lowest and highest systolic BP (SBP) quintiles within 7 days of stroke (Q1, 102–127 mmHg and Q5, 171–215 mmHg), relative to the middle quintile (Q3, 143–158 mmHg) after adjustment (55). Similarly, better outcomes were observed for patients in the middle quintile of diastolic BP (DBP) (Q3, 93–102 mmHg).…”

Section: Peripheral and Cerebral Circulatory Considerations For Exercmentioning

confidence: 99%

“…◦ People with tightly controlled blood pressure (e.g., SBP below 120 mmHg and/or DBP below 80 mmHg in ischemic stroke) (55). Refer to Guideline 1.0 for lower blood pressure limits prior to commencing early mobilization/exercise prescription.…”

Section: Mobilization and Aerobic Exercise In The Hyper-acute And Acumentioning

confidence: 99%

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations

Marzolini

Robertson

et al. 2019

Front. Neurol.

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Knowledge gaps exist in how we implement aerobic exercise programs during the early phases post-stroke. Therefore, the objective of this review was to provide evidence-based guidelines for pre-participation screening, mobilization, and aerobic exercise training in the hyper-acute and acute phases post-stroke. In reviewing the literature to determine safe timelines of when to initiate exercise and mobilization we considered the following factors: arterial blood pressure dysregulation, cardiac complications, blood-brain barrier disruption, hemorrhagic stroke transformation, and ischemic penumbra viability. These stroke-related impairments could intensify with inappropriate mobilization/aerobic exercise, hence we deemed the integrity of cerebral autoregulation to be an essential physiological consideration to protect the brain when progressing exercise intensity. Pre-participation screening criteria are proposed and countermeasures to protect the brain from potentially adverse circulatory effects before, during, and following mobilization/exercise sessions are introduced. For example, prolonged periods of standing and static postures before and after mobilization/aerobic exercise may elicit blood pooling and/or trigger coagulation cascades and/or cerebral hypoperfusion. Countermeasures such as avoiding prolonged standing or incorporating periodic lower limb movement to activate the venous muscle pump could counteract blood pooling after an exercise session, minimize activation of the coagulation cascade, and mitigate potential cerebral hypoperfusion. We discuss patient safety in light of the complex nature of stroke presentations (i.e., type, severity, and etiology), medical history, comorbidities such as diabetes, cardiac manifestations, medications, and complications such as anemia and dehydration. The guidelines are easily incorporated into the care model, are low-risk, and use minimal resources. These and other strategies represent opportunities for improving the safety of the activity regimen offered to those in the early phases post-stroke. The timeline for initiating and progressing exercise/mobilization parameters are contingent on recovery stages both from neurobiological and cardiovascular perspectives, which to this point have not been specifically considered in practice. This review includes tailored exercise and mobilization prescription strategies and precautions that are not resource intensive and prioritize safety in stroke recovery.

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“…Actually, some randomized controlled trials of blood pressure lowering in hypertension have yielded to an improvement of cognitive decline [18–20]. Increased blood pressure at the acute phase of stroke has been reported to increase the probability and severity of poststroke dementia [21], while the impact of chronic hypertension is still a matter of debate [22, 23].…”

Section: Introductionmentioning

confidence: 99%

Hypertension and Its Impact on Stroke Recovery: From a Vascular to a Parenchymal Overview

Maïer

Kubis

2019

Neural Plasticity

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Hypertension is the first modifiable vascular risk factor accounting for 10.4 million deaths worldwide; it is strongly and independently associated with the risk of stroke and is related to worse prognosis. In addition, hypertension seems to be a key player in the implementation of vascular cognitive impairment. Long-term hypertension, complicated or not by the occurrence of ischemic stroke, is often reviewed on its vascular side, and parenchymal consequences are put aside. Here, we sought to review the impact of isolated hypertension or hypertension associated to stroke on brain atrophy, neuron connectivity and neurogenesis, and phenotype modification of microglia and astrocytes. Finally, we discuss the impact of antihypertensive therapies on cell responses to hypertension and functional recovery. This attractive topic remains a focus of continued investigation and stresses the relevance of including this vascular risk factor in preclinical investigations of stroke outcome.

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Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment

Abstract: URL: https://www.chictr.org. Unique identifier: ChiCTR-TRC-14004804.

Cited by 28 publications

References 37 publications

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study

Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations

Hypertension and Its Impact on Stroke Recovery: From a Vascular to a Parenchymal Overview

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