Yang-Kun Chen

Cortical and frontal atrophy are associated with cognitive impairment in age-related confluent white-matter lesion

Objective Although age-related confluent white-matter lesion (WML) is an important substrate for cognitive impairment, the mechanisms whereby WML induces cognitive impairment are uncertain. The authors investigated cognitive predictors in patients with confluent WML. Methods Among 100 patients with ischaemic stroke with confluent WML on MRI, the authors assessed executive function and global cognition by the Mattis Dementia Rating Scale—Initiation/Perseveration Subscale (MDRS I/P) and Mini-Mental State Examination (MMSE), respectively. All volumetric measures were corrected for intracranial volume. The authors investigated the association between basic demography, vascular risk factors, APOE status, WML volume, infarct measures (volume, number, location), microbleed number, atrophy measures (global, central, regional) and cognitive performance. The authors also performed Pittsburgh Compound B (PIB) imaging among seven cognitive impaired patients with stroke. Results WML was no longer related to cognitive performance after adding atrophy into regression equations. Multivariate regression models showed that cortical grey matter volume independently accounted for performance on both the MDRS I/P (β=0.241, p=0.045) and MMSE (β=0.243, p=0.032). Models examining frontal subregions revealed that volumes of both left (β=0.424, p<0.001) and right (β=0.219, p=0.045) lateral frontal orbital gyri predicted MDRS I/P, whereas education (β=0.385, p<0.001) and left lateral frontal orbital gyrus (β=0.222, p=0.037) predicted MMSE. Volumes of WML and cognitively relevant brain regions were significantly associated. Seven patients with PIB imaging showed no uptake pattern typical of Alzheimers disease, suggesting a predominantly vascular aetiology for the cognitive impairment and brain changes in these patients. Conclusions Cognitive impairment in patients with confluent WML is mediated by global and frontal cortical atrophy.

Effect of the glycaemic index of pre-exercise carbohydrate meals on running performance

Abstract The aim of this study was to examine the effect of pre-exercise low and high glycaemic index (GI) carbohydrate meals on running performance. Eight endurance-trained male runners (mean age 33 years, s x =1.7; 63 ml · kg−1 · min−1, s x =1.8) completed two trials separated by at least 7 days in a counterbalanced design. Two hours before they were to run and after an overnight fast, each participant consumed an isocaloric meal containing either low (gi=37) or high (gi=77) GI carbohydrate foods (2.4 MJ; 65% carbohydrate; 15% protein; 20% fat) that provided 1.5 g carbohydrate per kilogram of body mass in random order. Each trial consisted of a 21-km performance run on a level treadmill. The participants were required to run at 70% during the first 5 km of the run. They subsequently completed the remaining 16 km in as short a time as possible. All participants achieved a faster performance time after the consumption of the low GI meal (low vs. high GI: 98.7 min, s x =2 vs. 101.5 min, s x =2; P<0.01). Blood glucose and serum free fatty acids concentrations were higher throughout the performance run in the low GI trial. Serum insulin concentrations were higher in the high GI trial during the postpandial resting period. However, there were no differences between trials in serum insulin or blood lactate concentrations throughout exercise. Compared with the high GI trial, carbohydrate oxidation was 9.5% lower and fat oxidation was 17.9% higher during exercise in the low GI trial. In conclusion, our results indicate that compared with an isocaloric high GI meal, the consumption of a low GI meal 2 h before a 21-km performance run is a more effective means of improving performance time.

Emotional incontinence and executive function in ischemic stroke: a case-controlled study.

Frontal and basal ganglia infarcts and executive dysfunction are thought to be involved in the pathophysiology of poststroke emotional incontinence (PSEI). The study examined whether patients with PSEI have more frontal and/or basal ganglia infarcts and impairment in executive function. A total of 516 Chinese patients with acute ischemic stroke consecutively admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were screened for PSEI 3 months after the index stroke. According to Kims criteria, 39 (7.6%) had PSEI. Thirty-nine stroke patients without PSEI served as matched control group. The PSEI group had significantly more frontal and/or basal ganglia infarcts, had lower Chinese Frontal Assessment Battery scores, required more time to complete the Stroop Test, and made more omission and commission errors in the Go-NoGo test. There was no significant correlation between frontal or basal ganglia infarcts and executive function. The correlation between frontal infarct and severity of PSEI was .420. Further follow-up and functional imaging studies are warranted to explore the relationship between PSEI, brain infarcts, and executive dysfunction. (JINS, 2009, 15, 62-68.).

Validation of the ABCD2 Score to Identify the Patients With High Risk of Late Stroke After a Transient Ischemic Attack or Minor Ischemic Stroke

Background and Purpose— The ABCD2 score is able to predict the short-term risk of stroke after a transient ischemic attack/minor stroke. We aimed to explore its predictive value for long-term recurrent stroke. Methods— Consecutive patients with a transient ischemic attack/minor stroke, hospitalized during a 2-year period, were followed up to document any further stroke and death stratified by a 7-point ABCD2 score. Result— A total of 490 patients were followed for an average of 40.5 months (SD, 10.7 months). Further stroke were identified in 76 (15.5%) patients and 62 (12.7%) patients died during follow-up. Multivariate Cox regression analysis showed that an ABCD2 score >4 was found to be an independent risk factor for further stroke (hazard ratio, 2.27; 95% CI, 1.36 to 3.80) and for death (hazard ratio, 1.68; 95% CI, 0.99 to 2.85). Conclusions— In addition to predicting short-term stroke risk, ABCD2 score is a useful tool to predict long-term stroke risk after a transient ischemic attack or minor ischemic stroke.

Effects of glycemic index meal and CHO-electrolyte drink on cytokine response and run performance in endurance athletes.

OBJECTIVEnTo examine the effect of the glycemic index (GI) of a pre-exercise (PRE-ex) meal on plasma cytokine responses and endurance performance when carbohydrate-electrolyte (CHO-E) drink was consumed during exercise.nnnMETHODSnEight endurance-trained male runners (age: 28.6+/-2.7 years; body mass: 61.9+/-1.71 kg; V O(2max): 58.5+/-1.6 ml kg(-1)min(-1)) completed three trials in a randomized order. The pre-exercise meal consisted of either high-GI (HGI) (GI=83), low-GI (LGI) foods (GI=36) or control (CON) (low energy sugar-free jelly) was given to the participant 2h before a 21-km performance run on a level treadmill. During each trial, 2 ml kg(-1) BM of 6.6% CHO-E solution was consumed immediately before exercise and every 2.5-km afterward. Blood samples were collected before (pre-meal), and 120 min after ingestion the meal (120 min), immediately (POST), and 60 min (POST-60 min) after exercise.nnnRESULTSnNo difference was found in time to complete the 21-km run between LGI and HGI. The interleukin-6 (IL-6) level increased by more than 100 times immediately after exercise in the three trials and returned to the basal level only on LGI at POST-60 min. In contrast, interleukin-2 (IL-2) level showed a transitory decrease at POST on CON (p<0.001). Glucose concentrations did not recover to the pre-meal level by POST-60 min on HGI only. Cortisol concentrations increased throughout the exercise and were lower on LGI when compared with CON (p<0.05) at POST-60 min.nnnCONCLUSIONSnHGI and LGI demonstrated similar performance when CHO-E solution was consumed during a 21-km run. However, pre-exercise LGI meal attenuated the increases in cortisol and quickened the recovery of the increased IL-6 value.

Clinical and radiologic correlates of insomnia symptoms in ischemic stroke patients

Insomnia is a common complaint in stroke survivors. The purpose of this study was to investigate the clinical and magnetic resonance imaging (MRI) correlates of insomnia symptoms in Chinese ischemic stroke survivors.

Absence of cerebral microbleeds predicts reversion of vascular ‘cognitive impairment no dementia’ in stroke

Background Cerebral microbleeds may contribute to cognitive deficits in stroke. Cognitive impairment that does not meet the criteria for dementia (cognitive impairment no dementia) is common in stroke, and patients with such impairment can revert to normal cognition. Aims and hypothesis This study examined the association between cerebral microbleeds and the reversion of cognitive impairment no dementia. Method A total of 328 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. All subjects were assessed for cognitive impairment no dementia with a neuropsychological test battery at three- and 15 months following the index stroke. Of the 180 patients with cognitive impairment no dementia at three-months poststroke, 143 (79·4%) attended the 15-month follow-up. Twenty-nine subjects had reverted from cognitive impairment no dementia to normal cognitive status (reverters), 98 were nonreverters and 16 had progressed to dementia. Results In univariate analysis, the reverters were found to be younger, less likely to have hypertension and cerebral microbleeds, and to have smaller white matter hyperintensity volumes. In multivariate analysis, the absence of cerebral microbleeds remained an independent predictor of reversion with an odds ratio of 4·3. Absence of deep cerebral microbleeds predicted the reversion of the language domain, whereas the absence of lobar cerebral microbleeds predicted the reversion of the visuomotor speed domain. Conclusions The results suggest that the absence of cerebral microbleeds may be associated with a higher likelihood of a reversible cognitive impairment in stroke patients. The mechanism of how this occurs is not well understood.

Health-Related Quality of Life in the Family Caregivers of Stroke Survivors.

The objective of this cross-sectional study was to identify the factors associated with health-related quality of life (HRQOL) of family caregivers of Chinese stroke patients. One hundred and twenty-three stroke patients consecutively admitted to a stroke clinic and their 123 family caregivers were recruited. The caregivers HRQOLs were assessed with the Short Form 36 (SF-36). Two subscores of the SF-36, the Physical Component Summary and the Mental Component Summary Scores served as the dependent variables. Independent variables comprised patients and caregivers demographic data and physical and psychological conditions in relation to caregivers HRQOL. The severity of coexisting illnesses of both the patients and their caregivers was assessed using the Cumulative Illness Rating Scale. The Geriatric Depression Scale (GDS) was administered to rate both the patients and their caregivers depressive symptoms. The extent of the patients functional disability was assessed using the Barthel Index and the Instrumental Activities of Daily Living. Global cognition of the patients was measured using the Mini Mental State Examination. The level of social support and recent life events of the caregivers were rated using Lubben Social Network Scale and the Modified Life Event Scale, respectively. The multiple linear regression revealed caregivers Cumulative Illness Rating Scale and GDS score were associated with Physical Component Summary Score of SF-36. The patients and caregivers GDS score were associated with Mental Component Summary Score of SF-36. Severity of depressive symptoms in Chinese stroke patients and their caregivers is an important factor associated with the caregivers HRQOL. Further studies evaluating interventions on caregivers HRQOL should include the assessment and management of mood disorders. Das Ziel der vorliegenden Querschnittsstudie war die Ermittlung von Faktoren im Zusammenhang mit der gesundheitsbezogenen Lebensqualität (HRQOL) von familiären Betreuungspersonen von chinesischen Schlaganfallpatienten. Insgesamt wurden 123 Schlaganfallpatienten konsekutiv in einer Rehaklinik für Schlaganfallpatienten aufgenommen; ihre 123 Betreuer aus der jeweils eigenen Familie wurden rekrutiert. Die HRQOL der Betreuungspersonen wurde anhand der Kurzform 36 (SF-36) bewertet. Zwei Subscores des SF-36, die körperliche Summenskala (Physical Component Summary Score) und die psychische Summenskala (Mental Component Summary Score), wurden als abhängige Variablen herangezogen. Unabhängige Variablen waren die demographischen Daten sowie der körperliche und psychische Zustand der Patienten und Betreuer mit Bezug auf die HRQOL der Betreuungspersonen. Der Schweregrad der gleichzeitig bestehenden Krankheiten der Patienten sowie der ihrer Betreuungspersonen wurde mit Hilfe des Cumulative Illness Rating Scale (CIRS) bewertet. Die geriatrische Depressionsskala (GDS) wurde zur Beurteilung der depressiven Symptome der Patienten sowie der ihrer Betreuungspersonen angewandt. Das Ausmaß der funktionalen Behinderung der Patienten wurde mit Hilfe des Barthel-Indexes und der Skala zur Einschätzung instrumenteller Aktivitäten des täglichen Lebens (IADL) erfasst. Die globale Kognition der Patienten wurde anhand der Mini Mental State Examination (MMSE) gemessen. Der Umfang der sozialen Unterstützung und die jüngsten Lebensereignisse der Betreuungspersonen wurden anhand der Lubben Social Network Scale bzw. der Modified Life Event Scale erfasst. Die multiple lineare Regression ergab, dass die Cumulative Illness Rating Scale (CIRS) der Betreuer und die GDS mit der körperlichen Summenskala (Physical Component Summary Score) des SF-36 verbunden waren. Der GDS-Score der Patienten und Betreuer war mit der psychischen Summenskala (Mental Component Summary Score) des SF-36 verbunden. Der Schweregrad der depressiven Symptome von chinesischen Schlaganfallpatienten sowie der ihrer Betreuungspersonen ist ein wichtiger Faktor, der mit dem HRQOL der Betreuungspersonen verbunden ist. Weitere Studien bzgl. der Evaluierung der Interventionen mit Bezug auf die HRQOL der Betreuungspersonen sollten die Beurteilung und das Management von affektiven Psychosen umfassen. El objetivo de este estudio transversal fue identificar los factores relativos a la calidad de vida asociada al estado de salud (CDVAES) de los familiares cuidadores de pacientes que han padecido un accidente cerebrovascular, en China. En el estudio se incluyeron a 123 pacientes que han padecido un accidente cerebrovascular y que han sido ingresados en una clínica especializada para el tratamiento de este tipo de pacientes, y 123 familiares cuidadores de estos. Como variables independientes se utilizaron dos componentes del formulario SF-36: el componente físico y el componente emocional. Como variables independientes se utilizaron los datos demográficos de los pacientes y de sus cuidadores, y las condiciones físicas y psicológicas asociadas la CDVAES de los cuidadores. Se valoró la gravedad de las enfermedades concurrentes de los pacientes y de los cuidadores mediante el índice acumulativo de enfermedad. Se empleó la escala de depresión para personas de edad geriátrica (EDPG) para explorar la presencia de síntomas de depresión en los pacientes y en sus cuidadores. La magnitud de la discapacidad funcional de los pacientes se valoró mediante el índice de Barthel y la escala de valoración de actividades de la vida diaria. El nivel cognitivo general de los pacientes se determinó mediante la miniexploración del estado mental. El grado de apoyo social y los sucesos recientes ocurridos a los cuidadores se valoraron mediante la escala de Lubben de la red de apoyo social y la escala modificada de acontecimientos personales, respectivamente. El análisis de regresión lineal múltiple reveló que los resultados del índice acumulativo de enfermedad y de la EDPG se asociaron a los resultados obtenidos en la valoración del componente físico del formulario SF-36. Los resultados de la EDPG en los pacientes y sus cuidadores se asociaron a los resultados de la valoración del componente emocional del formulario SF-36. La gravedad de los síntomas de depresión de estos pacientes chinos que han padecido un accidente cerebrovascular y de sus cuidadores es un factor importante asociado a la CDVAES de los cuidadores. Los futuros estudios destinados a valorar la CDVAES de los cuidadores deben incluir la valoración y el manejo de las alteraciones emocionales. Cette étude transversale avait pour objet didentifier les facteurs associés à la qualité de vie liée à la santé (QVLS) des soignants familiaux de patients chinois victimes daccidents cardio-vasculaires. Cent vingt-trois patients victimes daccidents cardio-vasculaires ont été consécutivement admis dans une clinique dAVC, et leurs 123 soignants familiaux ont été recrutés. La QVLS des soignants a été évaluée avec le formulaire court 36 (SF-36). Deux sous-scores du questionnaire SF-36, les scores récapitulatifs de composant physique et de composant mental, ont servi de variables dépendantes. Les variables indépendantes consistaient dans les données démographiques des patients et des soignants et les conditions physiques et psychologiques par rapport à la QVLS des soignants. La sévérité des maladies coexistant chez les patients et leurs soignants a été évaluée en utilisant léchelle cumulative de classement des maladies. Léchelle de dépression gériatrique (GDS) a été administrée pour évaluer les symptômes dépressifs des patients comme de leurs soignants. Létendue de lincapacité fonctionnelle des patients a été évaluée en utilisant lindice de Barthel et les activités instrumentales de la vie quotidienne. La cognition globale des patients a été mesurée en utilisant le mini-examen de létat mental. Le niveau de soutien social et les événements récents de la vie des soignants ont été évalués en utilisant respectivement léchelle de Lubben du réseau social et léchelle modifiée des événements de vie. La régression linéaire multiple a révélé que le score sur léchelle cumulative de classement des maladies et le score GDS des soignants étaient associés avec le score récapitulatif des composants physiques du SF-36. Les scores GDS des patients et des soignants étaient associés avec le score récapitulatif des composants mentaux du SF-36. La gravité des symptômes dépressifs chez les patients chinois victimes dAVC et les soignants est un facteur important associé à la QVLS des soignants. Des études complémentaires dévaluation des interventions sur la QVLS des soignants devront inclure lévaluation et la gestion des troubles de lhumeur.

Poststroke depression in patients with small subcortical infarcts

OBJECTIVESnSmall subcortical infarcts (SSIs) can result from small vessel disease (SVD) and intracranial and extracranial large artery disease (LAD). No study has explored poststroke depression (PSD) in different etiological types of SSIs.nnnMETHODSnPatients with SSIs resulting from LAD and SVD were included in the study. Poststroke depression was evaluated with the 15-item version of the geriatric depression scale (GDS) 3 months after stroke.nnnRESULTSnOf the 127 patients with SSIs, 44 had LAD and 83 had SVD. The LAD group had a significantly higher mean GDS score and higher frequency of PSD (p<0.05). The etiological type LAD was a significant independent risk factor for PSD.nnnCONCLUSIONnPSD is more common in patients with SSIs resulting from LAD. This suggests that cerebral blood perfusion may play an important role in the development of PSD.

Poststroke fatigue: risk factors and its effect on functional status and health-related quality of life.

Background Fatigue is a common problem in ischemic stroke survivors. The mechanisms of poststroke fatigue are uncertain yet. The effects of it on functional status have rarely been studied. Aims The aim of this study was to investigate the risk factors of poststroke fatigue and its effect on activities of daily living and health-related quality of life in Chinese patients with ischemic stroke. Methods Two hundred and eighteen patients with ischemic stroke formed the study sample. A comprehensive assessment, including the Fatigue Severity Scale, Hamilton Depression Rating Scale, Lawton activities of daily living scale, and the stroke-specific quality of life scale, was conducted three-months after stroke. Magnetic resonance imaging scans focused on the evaluation of infarctions, white matter lesions, and brain atrophy. Results In the whole sample, with Fatigue Severity Scale as the dependent variable in a linear regression model, Hamilton Depression Rating Scale, prestroke fatigue, and the National Institutes of Health Stroke Scale score at admission were significant correlates of Fatigue Severity Scale, accounting for 36% of the variance of it. When subjects with depression (Hamilton Depression Rating Scale ≥ 20 or current usage of antidepressants) were excluded, only Hamilton Depression Rating Scale and prestroke fatigue remained significant correlates of Fatigue Severity Scale, accounting for 33% of the variance of Fatigue Severity Scale. No magnetic resonance imaging variables correlated with Fatigue Severity Scale. In bivariate correlation analyses, Fatigue Severity Scale was significantly correlated with both activities of daily living and stroke-specific quality of life. In linear regression models, Fatigue Severity Scale independently contributed to activities of daily living accounting for 27% of the variance. Fatigue Severity Scale was also a significant contributor to stroke-specific quality of life accounting for 39% of the variance. Conclusion Depressive symptoms and prestroke fatigue are major correlates of poststroke fatigue while more severe post-stroke fatigue is associated with poorer activities of daily living and health-related quality of life.