Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes

Toyoda, Kazunori; Yoshimura, Sohei; Nakai, Michikazu; Koga, Masatoshi; Sasahara, Yusuke; Sonoda, Kazutaka; Kamiyama, Kenji; Yazawa, Yukako; Kawada, Sanami; Sasaki, Masahiro; Terasaki, Tadashi; Miwa, Kaori; Koge, Junpei; Ishigami, Akiko; Wada, Shinichi; Iwanaga, Yoshitaka; Miyamoto, Yoshihiro; Minematsu, Kazuo; Kobayashi, Shotai; Iihara, Koji; Itabashi, Ryo; Kitazono, Takanari; Ogasawara, Kuniaki; Nogawa, Shigeru; Uno, Masaaki; Ikawa, Fusao; Yamaguchi, Shûhei; Ito, Ai

doi:10.1001/jamaneurol.2021.4346

Cited by 148 publications

(91 citation statements)

References 45 publications

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“…1,2 The development of effective acute treatments has resulted in global trends showing improvement in stroke outcomes. 3–5 Yet, poststroke cognitive impairment and dementia (PSCID) remain highly prevalent and disabling. 6–10 Cognitive deficits are present in over 70% of stroke survivors, depending on stroke type, definition, and time point of assessment, 8,11 (Table 1) and are associated with disability, 12,13 dependency, 14 and morbidity 15,16 ; thus, posing a major burden to patients, caregivers, and health care systems.…”

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confidence: 99%

Post-Stroke Cognitive Impairment and Dementia

Rost

Brodtmann

Pase

et al. 2022

Circulation Research

360

194

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Poststroke cognitive impairment and dementia (PSCID) is a major source of morbidity and mortality after stroke worldwide. PSCID occurs as a consequence of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage. Cognitive impairment and dementia manifesting after a clinical stroke is categorized as vascular even in people with comorbid neurodegenerative pathology, which is common in elderly individuals and can contribute to the clinical expression of PSCID. Manifestations of cerebral small vessel disease, such as covert brain infarcts, white matter lesions, microbleeds, and cortical microinfarcts, are also common in patients with stroke and likewise contribute to cognitive outcomes. Although studies of PSCID historically varied in the approach to timing and methods of diagnosis, most of them demonstrate that older age, lower educational status, socioeconomic disparities, premorbid cognitive or functional decline, life-course exposure to vascular risk factors, and a history of prior stroke increase risk of PSCID. Stroke characteristics, in particular stroke severity, lesion volume, lesion location, multiplicity and recurrence, also influence PSCID risk. Understanding the complex interaction between an acute stroke event and preexisting brain pathology remains a priority and will be critical for developing strategies for personalized prediction, prevention, targeted interventions, and rehabilitation. Current challenges in the field relate to a lack of harmonization of definition and classification of PSCID, timing of diagnosis, approaches to neurocognitive assessment, and duration of follow-up after stroke. However, evolving knowledge on pathophysiology, neuroimaging, and biomarkers offers potential for clinical applications and may inform clinical trials. Preventing stroke and PSCID remains a cornerstone of any strategy to achieve optimal brain health. We summarize recent developments in the field and discuss future directions closing with a call for action to systematically include cognitive outcome assessment into any clinical studies of poststroke outcome.

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confidence: 99%

Post-Stroke Cognitive Impairment and Dementia

Rost

Brodtmann

Pase

et al. 2022

Circulation Research

360

194

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“…An established therapeutic strategy for acute ICH analogous to reperfusion therapy for acute ischemic stroke has not been established. In the nationwide registry of the Japan Stroke Data Bank, functional outcomes improved for ischemic stroke patients over the past 20 years after age adjustment but did not improve for ICH patients [ 5 ]. The lack of an established strategy might be an essential reason for the difference.…”

Section: Introduction: Before the Samurai-ich Studymentioning

confidence: 99%

Controlling blood pressure soon after intracerebral hemorrhage: The SAMURAI-ICH Study and its successors

Toyoda

Koga

2022

Hypertens Res

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The impact of acute therapy for intracerebral hemorrhage (ICH) lags far behind that for acute ischemic stroke. Intensive blood pressure lowering is a promising therapeutic strategy for acute ICH, especially for East Asian patients whose etiological mechanism is more commonly hypertension than that of patients in the Western population. A multicenter, prospective, observational study named the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-IntraCerebral Hemorrhage (SAMURAI-ICH) study, involving 211 patients from ten Japanese stroke centers, was performed to elucidate the safety and feasibility of blood pressure lowering to 160 mmHg or less in acute ICH patients using intravenous nicardipine. When we started the study, intravenous nicardipine was not officially approved for hyperacute ICH patients in Japan. The SAMURAI-ICH study was also a pilot study to judge the feasibility of participation by many Japanese investigators in an international, randomized, controlled trial named the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH)−2 trial. The SAMURAI-ICH study, ATACH-2 trial, and their combined individual participant data meta-analysis produced several new interesting findings on how to control blood pressure levels in acute ICH patients. Some of the findings are introduced in the present review article.

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“…Indeed, it has to be considered that there are substantial differences between AIS and ICH cohorts, with regard to neurological severity and stroke recovery. In fact, was reported in a recent analysis on more than 180,000 acute stroke patients that the short-term, functional outcomes of hospital admission were improved mainly in AIS patients, presumably due to the efficacy of reperfusion therapy, while they were almost absent in ICH group [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Circulating miRNA-195-5p and -451a in Patients with Acute Hemorrhagic Stroke in Emergency Department

Giordano

Trotta

Ciarambino

et al. 2022

Life

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(1) Background: In our previous study, acute ischemic stroke (AIS) patients showed increased levels of circulating miRNAs (-195-5p and -451a) involved in vascular endothelial growth factor A (VEGF-A) regulation. Here, we evaluated, for the first time, both circulating miRNAs in acute intracerebral hemorrhagic (ICH) patients. (2) Methods: Circulating miRNAs and serum VEGF-A were assessed by real-time PCR and ELISA in 20 acute ICH, 21 AIS patients, and 21 controls. These were evaluated at hospital admission (T0) and after 96 h (T96) from admission. (3) Results: At T0, circulating miRNAs were five-times up-regulated in AIS patients, tending to decrease at T96. By contrast, in the acute ICH group, circulating miRNAs were significantly increased at both T0 and T96. Moreover, a significant decrease was observed in serum VEGF-A levels at T0 in AIS patients, tending to increase at T96. Conversely, in acute ICH patients, the levels of VEGF-A were significantly decreased at both T0 and T96. (4) Conclusions: The absence of a reduction in circulating miRNAs (195-5p and -451a), reported in acute ICH subjects after 96 h from hospital admission, together with the absence of increment of serum VEGF-A, may represent useful biomarkers indicating the severe brain damage status that characterizes acute ICH patients.

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Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes

Abstract: This cohort study assesses secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population.

Cited by 148 publications

References 45 publications

Post-Stroke Cognitive Impairment and Dementia

Post-Stroke Cognitive Impairment and Dementia

Controlling blood pressure soon after intracerebral hemorrhage: The SAMURAI-ICH Study and its successors

Circulating miRNA-195-5p and -451a in Patients with Acute Hemorrhagic Stroke in Emergency Department

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