International Journal of Stroke最新文献

{"title":"Fluoxetine and fractures after stroke: An individual patient data meta-analysis of three large randomized controlled trials of fluoxetine for stroke recovery.","authors":"Gillian Mead, Catriona Graham, Erik Lundström, Graeme J Hankey, Maree L Hackett, Laurent Billot, Per Näsman, John Forbes, Martin Dennis","doi":"10.1177/17474930251316164","DOIUrl":"10.1177/17474930251316164","url":null,"abstract":"<p><strong>Background: </strong>Observational studies have shown that selective serotonin reuptake inhibitors are associated with an increased risk of bone fractures, but the association can be confounded by indication and other sources of systematic bias that can be minimized in randomized controlled trials (RCTs).</p><p><strong>Aim: </strong>Our aim was to report the rate, site, context, and predictors of fractures after stroke, and whether the fractures modified the effect of fluoxetine on modified Rankin scale (mRS) at 6 months in an individual patient data meta-analysis of 5907 patients enrolled in three RCTs of fluoxetine (20 mg for 6 months) for stroke recovery.</p><p><strong>Methods: </strong>We classified fractures by treatment allocation, site (and thus likelihood of osteoporosis), and context, then performed multivariable analyses to explore the independent predictors of fractures. We explored whether the trend toward a poorer mRS at 6 months was explained by a fracture excess. Risk of bias was assessed using GRADE.</p><p><strong>Results: </strong>Among 5907 patients randomized at a mean of 6.6 days (SD 3.6) post-stroke onset and followed for 6 months, the number of fractures at 6 months was 93 (3.15%) in the fluoxetine group versus 41 (1.39%) in the control group (difference 1.76, 95% CI 0.10-2.51). However, 128 patients with fractures were suitable for further analyses. Of these, 102 (80%) were in sites typically affected by osteoporosis; 115 (90%) were associated with falls and 1 (1%) with a seizure. Independent fracture risk factors were female sex (hazard ratio (HR) 1.96; 95% CI 1.37-2.81, p = 0.0002), age > 70 years (HR 2.30, 95% CI 1.52-3.49, p < 0.001), previous fractures (HR 0.63 for no previous fractures, 95% CI 0.42-0.94, p = 0.0227), and randomized treatment (fluoxetine) (HR 2.39; 95% CI 1.64-3.49, p < 0.001). The common odds ratio for the effect of fluoxetine on mRS at 6 months was unchanged after excluding fracture patients. Risk of bias was high for imprecision.</p><p><strong>Conclusion: </strong>Fractures were more common in the fluoxetine group but the absolute risk of fractures was small and risk estimates were imprecise. Most fractures occurred with a fall, and in osteoporotic locations. Fractures did not modify the effect of fluoxetine on functional outcome.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"540-549"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between alcohol consumption and stroke in Nigeria and Ghana: A case-control study.","authors":"Innocent Ijezie Chukwuonye, Onoja Matthew Akpa, Osahon Jeffery Asowata, Adekunle Gregory Fakunle, Morenikeji A Komolafe, Joshua Akinyemi, Fred Stephen Sarfo, Albert Akpalu, Kolawole Wahab, Reginald Obiako, Lukman Owolabi, Godwin O Osaigbovo, Akinkunmi Paul Okekunle, Okechukwu Ogah, Hemant K Tiwari, Carolyn Jekins, Fawale B Michael, Donna Arnett, Benedict Calys-Tagoe, Abimbola Olalere, Oladimeji Adebayo, Wisdom Oguike, Philip Adebayo, Oyedunni Arulogun, Lambert Appiah, Philip O Ibinaiye, Sunday Adeniyi, Oladotun Olalusi, Olayemi Balogun, Rufus Akinyemi, Bruce Ovbiagele, Mayowa Ojo Owolabi","doi":"10.1177/17474930241308458","DOIUrl":"10.1177/17474930241308458","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to examine the association between alcohol consumption and stroke in Nigeria and Ghana.</p><p><strong>Methods: </strong>The study is a multicentre, case-control study. Cases included consenting adults 18 years of age and older with acute stroke and controls were age-and -gender -matched stroke -free adults. Alcohol consumption was self-reported. The participants were classified into three alcohol-drinking status, which included abstainers, former drinkers, and current drinkers. The current drinkers were further classified into different alcohol drinking levels, including infrequent, light, moderate, heavy, and binge drinkers. Conditional logistic regression was used to determine associations between the drinking status and stroke, and the association between the different levels of current alcohol consumption and stroke. Five models were evaluated. Model 1 was unadjusted. Model 2 was adjusted for demographic characteristics. Model 3 included Model 2, lifestyle and psychosocial characteristics. Model 4 included Model 3 and dietary characteristics. Model 5 included Model 4 and metabolic characteristics.</p><p><strong>Results: </strong>A total of 7368 participants took part in the study. Half were stroke participants, and half were control participants. On the associations between drinking status and stroke, respectively, former drinkers showed no significant association with stroke. However, a significant association was observed between current drinkers and stroke in Models 1 and 2, with an odds ratio of 1.19 (95% CI: 1.04-1.38; p < 0.05) and 1.17 (95% CI: 1.01-1.36; p < 0.05), respectively. Regarding the various levels of current alcohol drinking and their association with stroke, no significant association was observed between light drinking and stroke in Model 5. In contrast, moderate drinkers, binge drinkers, and heavy drinkers showed a persistent and significant association with stroke respectively.</p><p><strong>Conclusion: </strong>There is a significant association between stroke and current alcohol consumption, especially among heavy, binge, and moderate drinkers.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"590-600"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and management of adult Moyamoya angiopathy: An overview of guideline recommendations and identification of future research directions.","authors":"Nicola Rifino, Dominique Hervè, Francesco Acerbi, Satoshi Kuroda, Giuseppe Lanzino, Peter Vajkoczy, Anna Bersano","doi":"10.1177/17474930241297031","DOIUrl":"10.1177/17474930241297031","url":null,"abstract":"<p><p>Despite the progress made in understanding the management and outcomes of Moyamoya angiopathy (MMA), several aspects of the disease remain largely unknown. In particular, evidence on the disease history and management of MMA is lacking, mainly due to methodological and selection biases in the available studies and the lack of large, randomized prospective studies. Therefore, the care of MMA patients remains limited to a few expert centers worldwide, and management is often based on local expertise and available resources. Over the years, recommendations or expert opinions have been written to provide guidance to physicians in the treatment of this condition with the goal of reducing the risk of stroke recurrence and long-term disability. However, there is no complete agreement between the available guidelines and recommendations due to differences in the articles addressed, methodologies, expertise, and validated approaches to literature review. This lack of consensus on the management of MMA may confuse clinicians and highlight some important issues and points. The aim of this comprehensive review article is to critically examine three recent guidelines and recommendations on MMA, discussing their differences and similarities and highlighting gaps in MMA care that need to be covered.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"512-523"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and risk factors of covert brain infarction: A community-based cross-sectional study.","authors":"Ruinan Zhang, Dongxiao Yao, Xueli Cai, Yanli Zhang, Yingying Yang, Shan Li, Jing Jing, Suying Wang, Yongjun Wang, Yuesong Pan, Yilong Wang","doi":"10.1177/17474930241313435","DOIUrl":"10.1177/17474930241313435","url":null,"abstract":"<p><strong>Background: </strong>Covert brain infarction (CBI) is common and poses a potential and non-negligible burden of disease worldwide. The prevalence and risk factors for CBI have been reported inconsistently in previous studies.</p><p><strong>Aims: </strong>This study aims to ascertain the prevalence and risk factors of CBI and its imaging phenotypes in community-dwelling adults.</p><p><strong>Methods: </strong>The study population was derived from the baseline survey of a population-based cohort from the Polyvascular Evaluation for Cognitive Impairment and Vascular Events study, involving adults aged 50-75 years from Lishui City, Southeast China. The 3.0T magnetic resonance imaging (MRI) was performed to access CBI and detect intracranial and extracranial vascular lesions. The prevalence rates of CBI and three imaging phenotypes were stratified separately by age, sex, atherosclerotic burden, and artery stenosis. The intracranial and extracranial atherosclerotic burden was graded by summing atherosclerosis scores. Multivariable logistic regression with a stepwise selection method was used to identify independent CBI risk factors.</p><p><strong>Results: </strong>A total of 2947 participants (mean age of 61.1 ± 6.6 years, 53.8% women) were included. CBI prevalence among study subjects was 9.6%, and the most common subtype was other chronic infarction (5.6%), followed by cavitatory lesions (4.6%) and acute cerebral infarction (0.5%). In multivariable analysis, older age (odds ratio (OR): 1.59, 95% confidence interval (CI): 1.40-1.83), hypertension (OR: 1.45, 95% CI: 1.08-1.94), higher levels of low-density lipoprotein cholesterol (LDL-C) (OR: 1.17, 95% CI: 1.04-1.32), homocysteine (OR: 1.12, 95% CI: 1.01-1.23) and diastolic blood pressure (DBP) (OR: 1.22, 95% CI: 1.06-1.41), intracranial artery plaque (OR: 1.56, 95% CI: 1.16-2.10), and severe extracranial atherosclerotic burden (OR: 6.57, 95% CI: 1.67-25.79) were associated with a higher CBI odds. There is a linear relationship between age, DBP, LDL-C, and CBI odds, while homocysteine shows a nonlinear relevancy. Age, DBP, homocysteine, and LDL-C elevation increase CBI risk.</p><p><strong>Conclusion: </strong>CBI prevalence in this Chinese community-based population was not low. Age, hypertension, intracranial artery plaque, extracranial atherosclerotic burden, homocysteine, LDL-C, and DBP were found to be the risk factors of CBI.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"611-622"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An exploration of serious falls after stroke using a large international stroke rehabilitation database.","authors":"Julian Wang, Julie Bernhardt, Hannah Johns, Leonid Churilov, Catherine Said, Natalie A Fini, Frances Batchelor, Janice Collier, Fiona Ellery, Kelly J Bower","doi":"10.1177/17474930251314330","DOIUrl":"10.1177/17474930251314330","url":null,"abstract":"<p><strong>Background: </strong>Falls are common after stroke and can have serious consequences such as hip fracture. Prior research shows around half of individuals will fall within the 12 months post stroke, and these falls are more likely to cause serious injury compared to people without stroke. However, there is limited research on risk factors collected in the immediate post-stroke period that may relate to falls risk. Furthermore, the circumstances and consequences surrounding falls resulting in serious adverse events (serious falls) is underexplored.</p><p><strong>Aims: </strong>Using longitudinal cohort data from A Very Early Rehabilitation Trial (AVERT), we aimed to describe the occurrence, consequences, and circumstances of serious falls over 12 months post stroke and examine potential risk factors associated with these serious falls.</p><p><strong>Methods: </strong>Data from participants included in the AVERT trial (n = 2104; recruited from 56 stroke units across five countries) were analyzed. Serious falls were defined as those resulting in death, were life threatening, or required/prolonged hospitalization. Baseline variables included: demographics, pre-morbid function, stroke severity, hemi-neglect, functional independence, and mobility. Statistical analysis included Wilcoxon-Mann-Whitney tests, Fisher's tests, and Firth's logistic regressions (adjusting for age, stroke severity, and AVERT intervention group).</p><p><strong>Results: </strong>Of the 2104 participants, 85 (4%) experienced at least one serious fall (mean age 78.1 years, 45 male), with 91 individual falls. Fifty-five (60%) serious falls resulted in fracture, with 23 (42%) being hip fractures. Two (2%) falls resulted in death. Serious falls were most common during the day (26 of 38 reported), at home (30 of 63 reported) and while ambulating (22 of 42 reported). More serious falls were experienced by participants who were older, had worse pre-morbid mobility, were unable to walk 10 m independently in the first 24 hours post stroke, or required longer than 14 days to walk 50 m unassisted.</p><p><strong>Conclusion: </strong>This large international prospective study found 1 in 25 stroke survivors experienced serious falls in the first year after stroke. Fractures were a common outcome of these falls, but the true post-stroke fracture rate is likely to be underestimated due to our study methods, such as the exclusion of individuals with poor pre-morbid mobility and the absence of data on fractures not relating to falls or leading to an inpatient hospital admission. Clear associations between older age, impaired pre- and early post-stroke mobility and heightened risk of serious falls were found. Integrating these factors into post-stroke screening tools could improve identification of individuals at greater risk of serious falls and lead to more focused rehabilitation and injury prevention.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"550-558"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of ruptured intracranial aneurysms with parent artery flow diverter devices: A comprehensive systematic review and meta-analysis.","authors":"Henrique L Lepine, Gabriel Semione, Fernanda M Llata, Bernardo Vieira Nogueira, Ana Clara Pinto Galvão Pereira, Davi Neves Coelho, Rafael Reis de Oliveira, Fabrício Ferreira Lipi, Henrique Garcia Maia, Anthony Hong, Luan Cavalcante Vilaça Lima, Savio Batista, Raphael Bertani, Bipin Chaurasia, João de Deus, Nirav Patel, Eberval Gadelha Figueiredo","doi":"10.1177/17474930241307114","DOIUrl":"10.1177/17474930241307114","url":null,"abstract":"<p><strong>Background: </strong>Surgical clipping and endovascular coiling are well-established treatments for acutely ruptured intracranial aneurysms leading to acute subarachnoid hemorrhage (aSAH). However, these modalities have limitations, particularly in cases involving wide-necked, bifurcating, or dissecting aneurysms. Flow diverter (FD) devices, initially used for unruptured aneurysms, have emerged as an alternative treatment for ruptured aneurysms despite concerns about hemorrhagic complications.</p><p><strong>Aims: </strong>This study aimed to perform a comprehensive systematic review and meta-analysis to assess the efficacy and safety of parental artery FD devices in treating ruptured intracranial aneurysms.</p><p><strong>Methods: </strong>A systematic search was conducted in Medline, Embase, and Cochrane databases from inception to July 2024. The inclusion criteria focused on studies involving patients with acutely ruptured aneurysms treated with parental artery FDs, with or without adjunctive coiling. Studies were required to report clear, stratified data specific to the population of interest, and include more than five patients. Exclusion criteria included studies on non-ruptured aneurysms, intrasaccular flow diversion devices, or previously clipped aneurysms treated with FD. Data extraction was performed independently by two authors, and statistical analysis included single proportion analysis with 95% confidence intervals under a random-effects model, using R Studio. The primary outcome was the rate of aneurysm occlusion at follow-up.</p><p><strong>Summary of review: </strong>A total of 60 studies encompassing 1300 patients were included. The primary outcome analysis revealed a 90% (95% CI: 87-92%; <i>I</i>² = 51%) rate of total occlusion at follow-up. Subgroup analysis indicated an occlusion rate of 89% for anterior circulation aneurysms and 96% for posterior circulation aneurysms. Intraoperative complications occurred in 6% of cases, while postoperative complications were observed in 13%. Rebleeding rates were low at 1%, with a 2% need for retreatment. Good functional outcomes (mRS ⩽ 2) were achieved in 82% of patients, and the overall mortality rate was 4%.</p><p><strong>Conclusions: </strong>FD devices demonstrated high rates of aneurysm occlusion and favorable functional outcomes in patients with acutely ruptured intracranial aneurysms. However, the low mortality rate and favorable outcomes observed may reflect selection bias toward patients with less severe SAH. Despite a modest complication rate, the overall safety and efficacy of FD devices suggest they may be a viable alternative to traditional treatments for specific aneurysm types. Further studies, including a broader spectrum of SAH severities, are warranted to optimize their use in clinical practice.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"524-539"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White matter hyperintensities are independently associated with systemic vascular aging and cerebrovascular dysfunction.","authors":"Alastair Js Webb, Karolina Feakins, Amy Lawson, Catriona Stewart, James Thomas, Osian Llwyd","doi":"10.1177/17474930241306987","DOIUrl":"10.1177/17474930241306987","url":null,"abstract":"<p><strong>Background: </strong>In the Oxford Haemodynamic Adaptation to Reduce Pulsatility trial (OxHARP), sildenafil increased cerebrovascular reactivity but did not reduce cerebral pulsatility, a marker of vascular aging. This analysis of OxHARP tested whether these potentially causative mechanisms were independently associated with the severity of white matter hyperintensities (WMHs).</p><p><strong>Aims: </strong>The aims were to determine independence of the relationship between severity of WMHs with both cerebral pulsatility and cerebrovascular reactivity in the same population.</p><p><strong>Methods: </strong>OxHARP was a double-blind, randomized, placebo-controlled, crossover trial of phosphodiesterase inhibitors in patients with mild-to-moderate WMH and previous minor cerebrovascular events. It determined effects on cerebrovascular pulsatility and reactivity on transcranial ultrasound and reactivity on magnetic resonance imaging (MRI). Associations were determined between baseline ultrasound measures, and averaged MRI measures across follow-up, with the severity of WMH on clinical imaging (Fazekas or modified Blennow scores) and WMH volume in the MRI substudy, by ordinal and linear regression.</p><p><strong>Results: </strong>In 75/75 patients (median 70 years, 78% male), cerebral pulsatility was associated with age (p < 0.001) whereas reactivity on ultrasound was not (p = 0.29). Severity of WMH in all participants was independently associated with decreased cerebrovascular reactivity and increased cerebral pulsatility (pulsatility p = 0.016; reactivity p = 0.03), with a trend to a synergistic interaction (p = 0.075). Reactivity on ultrasound was still associated with WMH after further adjustment for age (p = 0.017), but pulsatility was not (p = 0.31). Volume of WMH in the MRI substudy was also independently associated with both markers on ultrasound (pulsatility p = 0.005; reactivity p = 0.029) and was associated with reduced cerebrovascular reactivity within WMH on MRI (p < 0.0001).</p><p><strong>Conclusion: </strong>WMHs are independently associated with cerebral pulsatility and reactivity, representing complementary potential disease mechanisms and treatment targets.</p><p><strong>Trial registration: </strong>clinicaltrials.org: https://classic.</p><p><strong>Clinicaltrials: </strong>gov/ct2/show/NCT03855332.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"581-589"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moya-Moya angiopathy, falls after stroke, post-stroke dementia, and infection as a trigger for stroke.","authors":"Hugh S Markus","doi":"10.1177/17474930251340763","DOIUrl":"https://doi.org/10.1177/17474930251340763","url":null,"abstract":"","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":"20 5","pages":"510-511"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How tube feeding modes influence anxiety in patients with dysphagia after ischemic stroke: A propensity score-matched, longitudinal study.","authors":"Hongji Zeng, Weijia Zhao, Jing Zeng, Rui Wang, Hong Luo, Changming Wen, Yanbo Liu, Dongjian Li, Xi Zeng","doi":"10.1177/17474930241306916","DOIUrl":"10.1177/17474930241306916","url":null,"abstract":"<p><strong>Background: </strong>Although tube feeding modes have been shown to influence psychological status, the specific mechanism of action and differences between intermittent oro-esophageal tube feeding (IOE) and nasogastric tube feeding (NGT) have yet to be uncovered. This study explored the effect of IOE versus NGT on anxiety in patients with dysphagia after ischemic stroke.</p><p><strong>Methods: </strong>This longitudinal observational study included patients with dysphagia after ischemic stroke who were treated in the Department of Rehabilitation Medicine between February 2022 and June 2024. Questionnaires, scales, and medical records were used to collect data regarding anxiety symptoms, basic information, treatment details, and self-perception on the 1st and 10th day of hospitalization. Propensity Score Matching (PSM) was used to balance potential confounding factors and analyze the association between IOE versus NGT and anxiety symptoms. Path analysis was conducted to explore the specific mechanisms of action.</p><p><strong>Results: </strong>Totally, 2459 participants (55.51% IOE users) were recruited. The IOE users had significantly lower moderate-to-severe anxiety rates than the NGT users (25.88% and 44.42%, <i>p</i> < 0.001). PSM analysis revealed an 8.56% difference in moderate-to-severe anxiety rates between IOE and NGT users. Self-perception of comfort, reflux, dietary schedule, social activity, self-esteem, and daily exercise showed significance as intermediate variables between tube feeding modes and anxiety symptoms in path analysis (all <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>Compared to NGT, IOE can alleviate anxiety symptoms in patients with dysphagia after ischemic stroke who were treated in the Department of Rehabilitation Medicine. The relationship between tube feeding modes and anxiety symptoms was mediated by the self-perception of comfort, reflux, dietary schedule, social activity, self-esteem, and daily exercise.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"572-580"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of long-term post-stroke dementia using a linked dataset of patients with ischemic stroke without a history of dementia.","authors":"Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Soo-Hyun Park, Kyungbok Lee, Kyung-Ho Yu, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko","doi":"10.1177/17474930241310730","DOIUrl":"10.1177/17474930241310730","url":null,"abstract":"<p><strong>Background: </strong>Post-stroke dementia (PSD) is a common and disabling sequela of stroke. However, the long-term incidence of PSD after an ischemic stroke and factors which predict its occurrence are incompletely understood. Linkage of large health datasets is being increasing used to study long-term outcomes after disease. We used large-scale linked data from Korea to determine the long-term incidence of PSD after ischemic stroke, and identify which factors predicted its occurrence.</p><p><strong>Methods: </strong>From January 2008 to December 2014, patients with ischemic stroke (<i>n</i> = 37,553) without a history of dementia were included in a linked dataset comprising the claims database of the Health Insurance Review and Assessment Service and the Clinical Research Center for Stroke registry data. The outcome measure was PSD after ischemic stroke. Clinical factors evaluated included vascular risk factors, acute stroke management including reperfusion therapy, antithrombotics, and statins, stroke severity, and educational levels, were evaluated.</p><p><strong>Results: </strong>Among 37,553 patients with ischemic stroke without a history of dementia (mean age: 64.9 years; 61.9% males), 6052 (16.1%) experienced PSD during a median follow-up period of 5 (interquartile range, 3.4-7.0) years. The 10-year estimated cumulative incidence of dementia was 23.5%. Age (hazard ratio (HR) 1.82 per 10 years, 95% confidence interval (CI) 1.75-1.88) and a lower educational level (illiteracy or no education HR 1.65 (CI = 1.44-1.88), 0-3 years 1.53 (CI = 1.31-1.79), 4-6 years 1.60 (CI = 1.43-1.80), 7-9 years 1.32 (CI = 1.16-1.49), 10-12 years 1.17 (CI = 1.04-1.32)) were independently associated with an elevated risk of PSD. Male sex was associated with a significantly lower risk of PSD (HR 0.86, CI = 0.79-0.92). Diabetes mellitus (HR 1.21, CI = 1.14-1.29), a history of stroke before index stroke (HR 1.31, CI = 1.21-1.41), and initial National Institutes of Health Stroke Scale (HR 1.03, CI = 1.03-1.04) were independent risk factors for PSD. Regarding medications, the use of anticoagulation and antipsychotic medications after stroke appeared to be associated with increased PSD risk, whereas statin therapy was associated with a reduced risk.</p><p><strong>Conclusions: </strong>PSD is common with a 5- and 10-year incidence in patients with ischemic stroke without a history of dementia of 16.1% and 23.5%, respectively. Factors associated with PSD include age, female sex, lower educational level, diabetes mellitus, initial stroke severity, antipsychotics, and anticoagulants. Further studies are required to determine whether reducing those risk factors which are treatable reduces the incidence of PSD.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"601-610"},"PeriodicalIF":6.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142836626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}