| 61. |
- Kjellström, T., et al.
(författare)
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Helsingborg declaration 2006 on European stroke strategies
- 2007
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 23:2-3, s. 231-241
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Tidskriftsartikel (refereegranskat)abstract
- The Second Consensus Conference on Stroke Management took place from 22 to 24 March 2006 in Helsingborg, Sweden. The meeting was arranged by the International Stroke Society, endorsed by the European Stroke Council and International Stroke Society, and co-sponsored by the WHO Regional Office for Europe. It was arranged in collaboration with the European Region of the World Confederation for Physical Therapy and the European Association of Neuroscience Nurses. The patients' organization Stroke Alliance for Europe also participated. The meeting adopted the Helsingborg Declaration 2006 on European Stroke Strategies, a statement of the overall aims and goals of five aspects of stroke management ( organization of stroke services, management of acute stroke, prevention, rehabilitation, evaluation of stroke outcome and quality assessment) to be achieved by 2015.
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| 62. |
- Kreisel, S. H., et al.
(författare)
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Deterioration of Gait and Balance over Time: The Effects of Age-Related White Matter Change - The LADIS Study
- 2013
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 35:6, s. 544-553
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study investigates if the degree of prevalent ARWMC has a differential effect on lower body motor function as it changes over time, hypothesizing that individuals with more severe baseline white matter pathology experience greater clinical deterioration independent of potential confounders. This is of clinical relevance: given the increasing use of neuroimaging, incidental white matter pathology is common; being able to delineate natural trajectories of balance and gait function given ARWMC may improve patient advice and help optimize allocation of care. Methods: 639 non-disabled elderly individuals with prevalent ARWMC (grading of severity of ARWMC using the Fazekas scale) were followed up yearly for 3 years, as part of the Leukoaraiosis and Disability Study. The primary outcome variable, reflecting the temporal course of gait and balance function, was the change of scores on the Short Physical Performance Battery (SPPB) over time versus the severity of ARWMC. We used linear mixed modelling to analyse change over time. Explorative analysis was carried out investigating the effect of age on potential deterioration of gait and balance function. We used propensity scores to adjust for multiple confounders that affect both the exposure (i. e. ARWMC) and outcome. Results: Subjects' lower body motor function deteriorated by 2.6% per year. However, after adjustment for baseline motor impairment and potential confounders, only subjects with moderate [-0.22 points per year on the SPPB (equals -2.3%); 95% CI -0.35 to -0.09, p < 0.001] or severe [-0.46 points per year (equals -4.7%); 95% CI -0.63 to -0.28, p < 0.0001] ARWMC show a loss of function. Age shows differential effects: relatively younger elderly subjects have similar temporal dynamics in SPPB change independent of their individual degree of ARWMC severity; however, subjects with severe ARWMC and who are older than 75.9 years deteriorate significantly more rapidly than their counterparts with only mild or moderate white matter pathology. Conclusion: Only moderate and severe ARWMC is independently associated -on average -with a deterioration of gait and balance. Albeit the possibility of unmeasured confounding and other methodological constraints, there is nonetheless evidence of large interindividual variability: some subjects with moderate or severe ARWMC stay stable over time or even show improvement. Furthermore, there is explorative analysis showing that younger elderly subjects may be able to better compensate even severe ARWMC. These individuals' gait and balance function stays relatively stable over time, whereas their older counterparts deteriorate significantly. This may point towards a threshold effect given ARWMC.
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| 63. |
- Laska, AC, et al.
(författare)
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Long-term antidepressant treatment with moclobemide for aphasia in acute stroke patients: a randomised, double-blind, placebo-controlled study
- 2005
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 19:2, s. 125-132
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background and Purpose:</i> Pharmacotherapy aimed at stroke rehabilitation through direct central nervous effects may be assumed to work in a similar way for language recovery and sensory-motor recovery. Some data suggest that antidepressant drugs could be beneficial also for functional improvement. This prompted us to investigate whether regression from aphasia after acute stroke could be enhanced by antidepressive drug therapy. <i>Methods:</i> We randomised 90 acute stroke patients with aphasia to either 600 mg moclobemide or placebo daily for 6 months, within 3 weeks of the onset of stroke. Aphasia was assessed prior to treatment and at 6 months, using Reinvang’s ‘Grunntest for afasi’ and the Amsterdam-Nijmegen-Everyday-Language-Test (ANELT). <i>Result:</i> The degree of aphasia decreased significantly at 6 months, with no difference between the moclobemide- and the placebo-treated groups. Multivariate regression analysis including treatment group, activities of daily living, aetiology of stroke, ANELT, and Reinvang’s coefficient at baseline, and neurological deficit confirmed these results. In all, 13 in the moclobemide and 10 in the placebo group stopped taking the study medication. No further change was found in the 56 aphasic patients followed up for another 6 months with no medication. <i>Conclusions:</i> Compared to placebo, treatment with moclobemide for 6 months did not enhance the regression of aphasia following an acute stroke.
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| 64. |
- Laska, AC, et al.
(författare)
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Recognition of depression in aphasic stroke patients
- 2007
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 24:1, s. 74-79
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Data on post-stroke depression in aphasia are scarce. <i>Methods:</i> Eighty-nine acute stroke patients with aphasia of all types were followed for 6 months to investigate if depression can be reliably diagnosed (DSM-IV criteria) and validly assessed by the verbal Montgomery-Åsberg Depression Rating Scale (MADRS) and a global technique (Clinical Global Impressions Rating Scale for Severity). A standard aphasia test was performed. <i>Results:</i> In 60 patients (67%) at baseline and in 100% at 6 months, comprehension allowed a reliable DSM-IV diagnosis. Among these patients MADRS was feasible in 95% at baseline and in 100% at 6 months. The assistance of relatives and staff increases the feasibility and decreases the validity. Depression was identified in 24% during the 6 months. <i>Conclusion:</i> Depression diagnosis and severity rating can reliably be made in the acute phase in at least two thirds of aphasic patients, and feasibility increases over time.
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| 65. |
- Leoo, T, et al.
(författare)
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Risk factors and treatment at recurrent stroke onset: Results from the recurrent stroke quality and epidemiology (RESQUE) study
- 2008
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 25:3, s. 254-260
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Much effort has been made to study first-ever stroke patients. However, recurrent stroke has not been investigated as extensively. It is unclear which risk factors dominate, and whether adequate secondary prevention has been provided to patients who suffer from recurrent stroke. Also, the different types of recurrent stroke need further evaluation. <i>Methods:</i> The study included patients with recurrent stroke admitted to twenty-three Swedish stroke centers. The type of previous and recurrent stroke was determined, as well as evaluation (when applicable) of recurrent ischemic stroke according to the TOAST classification. Presence of vascular risk factors was registered and compared to the type of stroke. Also assessed was ongoing secondary prevention treatment at recurrent stroke onset. <i>Results:</i> A total of 889 patients with recurrent stroke (mean age 77) were included in the study. Of these, 805 (91%) had ischemic stroke, 78 (9%) had intracerebral hemorrhage and 6 (<1%) stroke of unknown origin. The most frequent vascular risk factors were hypertension (75%) and hyperlipidemia (56%). Among the 889 patients, 29% had atrial fibrillation. Of the patients in the ischemic group with cardiac embolism, only 21% were on anticoagulation treatment. The majority of the patients (75%) had their most recent previous stroke >12 months before admission. <i>Conclusions:</i> Few patients had a recurrent stroke shortly after the previous stroke in this study. This indicates that it is meaningful to prevent a second event with an adequate long-term treatment strategy for secondary prevention after first-ever stroke. There also seems to be a clear potential for improving secondary prevention after stroke.
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| 66. |
- Li, Cairu, et al.
(författare)
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Incidence of Ischemic Stroke in Relation to Asymptomatic Carotid Artery Atherosclerosis in Subjects with Normal Blood Pressure. A Prospective Cohort Study.
- 2008
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 26:3, s. 297-303
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Tidskriftsartikel (refereegranskat)abstract
- Background:Approximately 10-20% of stroke cases have normal blood pressure (BP). The objective of this study was to explore whether the risk of ischemic stroke is related to the carotid intima-media thickness (CIMT) and atherosclerotic lesions in a cohort of subjects with normal BP. Methods:Common CIMT and the presence of carotid plaque were determined by B-mode ultrasound in 6,103 subjects, randomly recruited between 1991 and 1994 from the 'Malmo Diet and Cancer' study. Normal BP was defined as BP <140/90 mm Hg, without pharmacological treatment for hypertension. Carotid artery atherosclerosis (CAA) was defined as CIMT >/=0.81 mm or/and the presence of plaque (i.e. focal CIMT >1.2 mm). The incidence of ischemic stroke was followed over a mean period of 10.7 years. Results:A total of 2,228 subjects (791 men and 1,437 women) had normal BP. During the follow-up, 34 patients suffered a first-ever ischemic stroke (crude incidence: 1.51/1,000 person-years). The Prevalences of CAA in subjects with and without stroke were 68.6 and 39.0%, respectively. It was estimated that the subjects with CAA had a 3-fold higher risk of ischemic stroke (RR: 3.33, 1.37-8.14), independent of other cardiovascular risk factors. Each increase of 1 standard deviation (0.13 mm) in CIMT increased the stroke risk by 43% (RR: 1.43, 1.002-2.02). Several factors were found to have a notable relation with CAA, including age, male sex, smoking, diabetes, systolic BP, HbA1c (glycosylated hemoglobin) and cholesterol. Conclusions: CIMT and atherosclerotic lesions are independent clinical markers for ischemic stroke among normotensive individuals.
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| 67. |
- Li, Cairu, et al.
(författare)
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Long-Term Stroke Prognosis in Relation to Medical Prevention and Lifestyle Factors. A Prospective Population-Based Study.
- 2008
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 25:6, s. 526-532
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies have focused on the quality of secondary prevention among long-term stroke survivors. This study explores the intensity of medical intervention and the impact of lifestyle and other risk factors on the long-term stroke prognosis in a population-based setting of Swedish individuals with a history of stroke. Methods: A population-based cohort (n = 28,449) in Malmo, Sweden, was recruited during 1991-1996. Of them, 394 had a history of stroke, according to self-reported physician diagnosis and record linkage with the Stroke Register in Malmo. Information on medical intervention and lifestyle factors was collected from the questionnaire. The incidence of a cardiac event (CE) or recurrent stroke was followed for 7.5 years after the baseline examination. Results: The prevalence of hypertension was 79.4% in patients with a history of stroke. Only half of them received blood-pressure (BP)-lowering medication, and 11.5% of them achieved a BP <140/90 mm Hg. Most patients with hypercholesterolemia did not receive lipid-lowering medication. Antithrombotic agents were used by 38%. Nearly one third were still smoking, and two thirds were overweight or obese. Compared to subjects without a history of stroke, the risk of cardiovascular disease (CVD, i.e. CE or recurrent stroke) was significantly higher in stroke survivors. The increased CVD risk was significantly associated with elevated BP levels. No significant relationship was found between CVD risk and lifestyle risk factors reported at the time of baseline examination. Conclusions: There was a large gap between recommended secondary preventive measures and their implementation in subjects with a history of stroke. Achieving recommended hypertension control may prevent a substantial proportion of the CE and recurrent strokes in this group.
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| 68. |
- Lindgren, Arne, et al.
(författare)
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Prevalence of Stroke and Vascular Risk Factors among First-Degree Relatives of Stroke Patients and Control Subjects.
- 2005
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 20:5, s. 381-387
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background:</i> Genetic and environmental factors may be of importance for stroke risk. We assessed the prevalence of stroke and vascular risk factors among first-degree relatives and spouses of stroke patients and control subjects. <i>Methods:</i> As a part of the Lund Stroke Register study, we asked 925 consecutive patients with first-ever stroke and 286 control subjects to complete a questionnaire about all their first-degree relatives and spouses. The questionnaires addressed whether these relatives had been affected by stroke or TIA, hypertension, heart disease, diabetes mellitus, and if they were smokers. <i>Results:</i> A total of 606 patients and 261 control subjects returned the questionnaire, providing information on 4,972 first-degree relatives and 738 spouses. The prevalence of stroke or TIA was 12.3% among first-degree relatives of patients and 7.5% among first-degree relatives of control subjects (OR 1.74, 95% CI 1.36–2.22). Corresponding results for hypertension were 21.0 and 16.7% (OR 1.33, 95% CI 1.10–1.60). The prevalences of heart disease, diabetes mellitus and smoking did not differ significantly between first-degree relatives of patients and control subjects. Spouses of patients and control subjects had similar prevalences of stroke or TIA and vascular risk factors. <i>Conclusions:</i> The prevalences of stroke or TIA and hypertension are higher among first-degree relatives of stroke patients than among first-degree relatives of control subjects. This, and the lack of differences between spouses of patients and control subjects, indicates that an increased risk of stroke may in part be explained by heritability of hypertension.
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| 69. |
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| 70. |
- Lu, M, et al.
(författare)
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Stroke incidence in women under 60 years of age related to alcohol intake and smoking habit
- 2008
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Ingår i: Cerebrovascular diseases (Basel, Switzerland). - : S. Karger AG. - 1421-9786 .- 1015-9770. ; 25:6, s. 517-525
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Tidskriftsartikel (refereegranskat)abstract
- <i>Background and Purpose:</i> The association between alcohol intake, cigarette smoking and risk of stroke amongst women remains unclear, especially in young women. <i>Methods:</i> This prospective cohort study included 45,449 Swedish women aged 30–50 years free of stroke and heart diseases at enrolment in 1991 and 1992. Information on drinking and smoking habits at enrolment was collected using a questionnaire. Incident stroke cases were identified through cross-linkage to the Swedish Inpatient Register. Cox proportional hazards regression models were used to calculate relative risks (RR) and their corresponding 95% confidence intervals (CIs). <i>Results:</i> During an average of 11 years of follow-up, 170 incident stroke cases, of which 111 ischemic and 47 hemorrhagic, were identified. Compared to abstainers, risk of stroke was reduced among women consuming less than 20 g (RR = 0.7, 95% CI 0.5–1.0) or 20–69.9 g (RR = 0.5, 95% CI 0.3–0.7) of alcohol per week, whilst women who consumed ≧70 g of alcohol per week had a nonsignificant reduced relative risk (RR = 0.7, 95% CI 0.4–1.3). We found no difference in stroke risk according to the types of alcoholic beverage consumed. Compared with never smokers, there was an increased risk of all strokes among current smokers of 1–9 cigarettes/day (RR = 2.3, 95% CI 1.5–3.7) or ≧10 cigarettes/day (RR = 2.6, 95% CI 1.7–4.1). The observed smoking-related excess risks were confined mainly to ischemic stroke. Former smokers had a 50–60% increase in RRs of both ischemic and hemorrhagic stroke. In stratified analyses, current smokers had a 4-fold excess risk if they were nondrinkers (RR = 4.2; 95% CI 2.2–7.8) but a lower risk (RR = 1.5; 95% CI 0.8–2.4) if they drank in moderation. Compared to never drinkers and never smokers, women who drank in moderation were also at reduced risk (RR = 0.6; 95% CI 0.3–1.1). These interactions were statistically significant (p = 0.001). <i>Conclusions:</i> Light to moderate alcohol intake, regardless of type of alcoholic beverage, reduces risk of stroke among women under 60 years of age, in particular those women who were never smokers. Smoking increases the risk of stroke, especially ischemic stroke.
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