Global stroke statistics 2022

Thayabaranathan, Tharshanah; Kim, Joosup; Cadilhac, Dominique A.; Thrift, Amanda G.; Donnan, Geoffrey A.; Howard, George; Howard, Virginia J.; Rothwell, Peter M.; Feigin, Valery L.; Norrving, Bo; Owolabi, Mayowa; Pandian, Jeyaraj Durai; Liu, Liping; Olaiya, Muideen T.

doi:10.1177/17474930221123175

Cited by 143 publications

(80 citation statements)

References 60 publications

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“…Epidemiological data show wide geographical variations in stroke incidence with a particular burden in low- and middle-income countries (LMICs), 4 but there is much less data looking at individual stroke subtypes, including lacunar stroke. Talking to colleagues from many LMICs, our impression is that the burden of SVD in these countries is high, but there has been little published data to support this view.…”

Section: The Global Burden Of Svdmentioning

confidence: 99%

Cerebral small vessel disease: Recent advances and future directions

Markus

Leeuw

2022

International Journal of Stroke

150

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Cerebral small vessel disease (SVD) causes lacunar stroke and intracerebral hemorrhage, and is the most common pathology underlying vascular cognitive impairment. Increasingly, the importance of other clinical features of SVD is being recognized including motor impairment, (vascular) parkinsonism, impaired balance, falls, and behavioral symptoms, such as depression, apathy, and personality change. Epidemiological data show a high prevalence of the characteristic magnetic resonance imaging (MRI) features of white matter hyperintensities and lacunar infarcts in community studies, and recent data suggest that it is also a major health burden in low- and middle-income countries. In this review, we cover advances in diagnosis, imaging, clinical presentations, pathogenesis, and treatment. The two most common pathologies underlying SVD are arteriolosclerosis caused by aging, hypertension, and other conventional vascular risk factors, and cerebral amyloid angiopathy (CAA) caused by vascular deposition of β-amyloid. We discuss the revised Boston criteria of CAA based on MRI features, which have been recently validated. Imaging is providing important insights into pathogenesis, including improved detection of tissue damage using diffusion tensor imaging (DTI) leading to its use to monitor progression and surrogate endpoints in clinical trials. Advanced MRI techniques can demonstrate functional or dynamic abnormalities of the blood vessels, while the high spatial resolution provided by ultrahigh field MRI at 7 T allows imaging of individual perforating arteries for the first time, and the measurement of flow velocity and pulsatility within these arteries. DTI and structural network analysis have highlighted the importance of network disruption in mediating the effect of different SVD pathologies in causing a number of symptoms, including cognitive impairment, apathy, and gait disturbance. Despite the public health importance of SVD, there are few proven treatments. We review the evidence for primary prevention, and recent data showing how intensive blood pressure lowering reduces white matter hyperintensities (WMH) progression and delays the onset of cognitive impairment. There are few treatments for secondary prevention, but a number of trials are currently evaluating novel treatment approaches. Recent advances have implicated molecular processes related to endothelial dysfunction, nitric oxide synthesis, blood–brain barrier integrity, maintenance and repair of the extracellular matrix, and inflammation. Novel treatment approaches are being developed to a number of these targets. Finally, we highlight the importance of large International collaborative initiatives in SVD to address important research questions and cover a number which have recently been established.

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Section: The Global Burden Of Svdmentioning

confidence: 99%

Cerebral small vessel disease: Recent advances and future directions

Markus

Leeuw

2022

International Journal of Stroke

150

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“…Stroke is the most common cause of death and disability worldwide (Feigin et al, 2017; GBD 2019 Stroke Collaborators, 2021; Thayabaranathan et al, 2022). About 80% of stroke survivors have upper limb motor impairment (4), which seriously affects their activities of daily living and quality of life (Pollock et al, 2014;Stinear et al, 2020;Schindel et al, 2021;Yuliana et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

WITHDRAWN: Task-oriented mirrored upper-limb robotic training in subacute patients after stroke: a case control study

Huang

Deng

et al. 2022

Preprint

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Objective People with stroke often have upper limb motor impairment, which has an impact on their activities of daily living and quality of life. Robotic-assisted training devices are used for upper limb rehabilitation, but their effectiveness in enhancing activities of daily living is not satisfactory yet. In this study, we combined task-oriented training and mirror training to an upper limb robot, created a task-oriented mirrored upper limb robot (Wisebot X5), and investigated the feasibility and safety of task-oriented mirror robot training for subacute stroke patients and observed its effects on upper limb motor function and activities of daily living. Methods Based on case-control principles, 32 patients with subacute stroke were assigned to receive task-oriented mirrored upper limb rehabilitation robot training for 30 minutes each time, 5 times per week for 4 weeks, or to receive the equivalent duration of conventional occupational therapy training. The primary outcome was the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and secondary outcomes were the Modified Barthel Index (MBI), the Stroke Self-Efficacy Scale (SSEQ), the System Usability Scale (SUS), and the Chinese version of the Quebec User Evaluation With Assistive Technology(C-QUEST). Statistical analysis was performed with paired-samples t-test. Results Thirty-two patients participated and completed the study. After the 4-week intervention, for FMA-UE, the experimental group was better than the control group in terms of the change score from the baseline to post intervention (P༜0.05). For MBI and SSEQ, both the experimental and control groups showed significant increases after the intervention(P༜0.05). However, there was no statistical difference between the groups in terms of the change score from the baseline to post intervention(P༞0.05). The usability assessment reported a high level of satisfaction: mean SUS score is 74.84% (SD = 11.64), mean QUEST scale is 4.42 (SD = 0.31). Conclusions Task-oriented mirrored upper-limb robotic training is feasible and safe for patients with subacute stroke. It is beneficial in promoting the recovery of upper limb function and activities of daily living.

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“…43,44 Rates of stroke in China are higher than in many other HICs, such as in North America, Australia, and Europe, but are similar to India. 1,11,39,45,46 Our results provide further evidence of a downward trend in deaths from stroke, but these are still much higher in China than in other HICs, further highlighting a potential gap of stroke care between LMICs and HICs. 39,40,41,47…”

Section: Discussionmentioning

confidence: 56%

Increasing burden of stroke in China: A systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality

Zhao

Hua

Ren

et al. 2022

International Journal of Stroke

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Background: The epidemiology of stroke is evolving in China as the population undergoes demographic, lifestyle, and economic transitions. An updated review is pertinent to providing feedback on current, and in planning future, prevention and management strategies. Aims: To identify high-quality epidemiological studies for quantifying the prevalence, incidence, mortality, and case fatality for stroke in China. Methods: A search was undertaken across a range of bibliographic databases on 30 November 2021 without time limitation. Assessments were made of the risk of bias of the included studies. The outcomes were synthesized using a random-effects model. Subgroup analysis and meta-regression models were used to define the source of heterogeneity. Results: Of 9,407 identified records, 26 population-based studies were included. Due to significant heterogeneity across the studies, the original range for crude rates of indices was wide. The pooled annual prevalence was 1,329.5/100,000 (95% confidence interval [CI] 713.6 to 2131.9, p<0.001), incidence 442.1/100,000 (327.6 to 573.8, p<0.001), mortality 154.1/100,000 (52.6 to 308.8, I2 =100%, p<0.001), and case-fatality 35.8% (26.1% to 46.1%, I2 =97%, p<0.001). The prevalence and incidence of stroke have increased, but stroke-related case fatality has declined, in China over recent decades. There are significant regional and rural-urban differences in incidence rates. Conclusions: Despite improved public health policies and healthcare delivery, the burden of stroke remains high in China. Further coordinated efforts are required in prevention and community care to offset the likelihood of further expansion in the absolute number of stroke cases in this large population.

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Global stroke statistics 2022

Cited by 143 publications

References 60 publications

Cerebral small vessel disease: Recent advances and future directions

Cerebral small vessel disease: Recent advances and future directions

WITHDRAWN: Task-oriented mirrored upper-limb robotic training in subacute patients after stroke: a case control study

Increasing burden of stroke in China: A systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality

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