Heart failure and stroke.
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Brain Ischemia↗
Biomedical subjects
Peter Appelros
Publications and source records attributed to Peter Appelros.
Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences.
PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.
Activities of Daily Living↗
How to identify potential fallers in a stroke unit: validity indexes of 4 test methods.
OBJECTIVE: The aim of this study was to describe general characteristics of patients with stroke who have a tendency to fall and to determine whether certain test instruments can identify fallers. METHODS: Patients treated in a stroke unit during a 12-month period were included. At inclusion assessments were made with Berg Balance Scale Berg Balance Scale, Stops Walking When Talking, Timed Up & Go (TUG) and diffTUG. At follow-up 6 or 12 months later, patients who had fallen were identified. RESULTS: During the time from discharge to follow-up on 159 patients, 68 patients fell and 91 did not. Fallers fell more often during their initial hospital stay, used sedatives more often and were more visually impaired, compared with non-fallers. The Berg Balance Scale, Stops Walking When Talking and TUG results differed between fallers and non-fallers. The combined results of Berg Balance Scale and Stops Walking When Talking increased the possibility of identifying fallers. CONCLUSION: Berg Balance Scale, Stops Walking When Talking and TUG can be used to evaluate which patients have a tendency to fall in order to carry out preventive measures. Berg Balance Scale can be used in all patients. Stops Walking When Talking can give additional information if the patient is able to walk. TUG is a possible choice, but fewer patients can perform it.
Accidental Falls↗
Prevalence and predictors of pain and fatigue after stroke: a population-based study.
Pain and fatigue are two often overlooked symptoms after stroke. Their prevalence and determinants are not well understood. In this study patients with first-ever stroke (n=377) were examined at baseline and after 1 year. General characteristics of the patients, as well as stroke type, stroke severity and risk factors were registered at baseline. After 1 year survivors (n=253) were examined with respect to residual impairment, disability, cognition and depression. They were asked whether they had experienced pain and/or fatigue which had started after the stroke, and which the patient felt to be stroke related. Twenty-eight patients (11%) had stroke-associated pain and 135 (53%) had stroke-associated fatigue. Pain was associated with depression and different manifestations of stroke severity, especially degree of paresis at baseline. Fatigue was more associated with physical disability. In univariate analysis, fatigue was also associated with sleep disturbances. In conclusion, it is important to be aware of the occurrence of pain and fatigue after stroke, because these symptoms are common, they impair quality of life and they are potentially treatable. Post-stroke depression may coexist with pain and fatigue. The detection of one symptom should lead to consideration of the others. Follow-up and individual assessment of stroke patients is crucial.
Adult↗
Lacunar infarcts: functional and cognitive outcomes at five years in relation to MRI findings.
BACKGROUND: There are few long-term follow-up studies of patients with lacunar infarcts (LIs). The purpose of this 5-year follow-up study was to assess functional and cognitive outcome in relation to MRI findings. METHODS: 81 patients with a first-ever LI were followed for 5 years with respect to mortality, stroke recurrence, functional and cognitive outcome. T(2)-weighted MRI was performed at baseline and at 5 years. The presence of basal ganglia lesions and white matter lesions was scored according to the European Task Force rating scale. Functional outcome was assessed with the Oxford Handicap Scale (OHP). Cognition was assessed with the Mini Mental State Examination (MMSE). RESULTS: The 5-year mortality was 19%. Predictors for death were age (OR = 1.07, 95% CI 1.03-1.11), ischemic heart disease (OR = 2.1, 95% CI 1.1-4.1) and impairment score (OR = 1.16, 95% CI 1.02-1.32). 30% of the patients had a recurrent stroke. Predictors for recurrent stroke were diabetes mellitus (OR = 1.7, 95% CI 1.2-7.4) and amount of white matter lesions (OR = 1.7, 95% CI 1.2-2.7). 36% of the patients were functionally dependent (defined as OHP >2). Predictors for functional dependency were impairment score (OR = 1.71, 95% CI 1.12-2.59), MMSE (OR = 0.55, 95% CI 0.33-0.91) and stroke recurrence (OR = 84, 95% CI 9.4-745). 16% of the patients had cognitive impairment (defined as MMSE <24). Stroke recurrence and white matter score, but not basal ganglia score, were correlated to cognitive impairment. CONCLUSIONS: Many LI patients have a good functional outcome at 5 years. For older patients, for patients with an initial severe stroke, and with additional vascular risk factors, however, the prognosis is more severe, with an increased risk for mortality, stroke recurrence, and physical and cognitive decline.
Analysis of Variance↗
What causes increased stroke mortality in patients with prestroke dementia?
BACKGROUND AND PURPOSE: In patients with dementia, the incidence of stroke is higher and strokes are more severe and lethal. The purpose of this population-based study was to describe in what way previous dementia affects mortality in stroke patients. METHODS: Subjects were all persons > or =65 years old who had a first-ever stroke during 1 year (n = 327). The prestroke dementia (PSD) diagnosis was made at the time of the stroke diagnosis using data from next of kin and from patient records. Patients were followed prospectively and causes of death were evaluated. RESULTS: The 28-day case fatality was 44% for PSD patients and 15% for non-PSD patients. Corresponding ratios at 1 year were 71 and 36%, respectively. Twenty-eight percent of the PSD patients had a new stroke during the first year, compared to 8% of the non-PSD patients. More patients in the PSD group died as a direct or indirect consequence of their stroke. Multivariate analysis showed that PSD, in addition to age, atrial fibrillation and stroke severity, was an independent predictor of mortality. CONCLUSIONS: The PSD patients more often had a stroke-related death, even when we adjusted for a number of other factors. The cause for this is most likely multifactorial, including an increased tendency to contract complications in the acute phase, and iatrogenic causes. The brain of the PSD patients may also be frailer and more susceptible to ischemic or hemorrhagic damage than the nondemented brain.
Aged↗
Lifeworld perspectives on assistive devices: lived experiences of spouses of persons with stroke.
The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses' perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples' homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses' perspective is vital for occupational therapists prescribing such devices.
Adult↗
Unilateral neglect: further validation of the baking tray task.
OBJECTIVE: The Baking Tray Task is a comprehensible, simple-to-perform test for use in assessing unilateral neglect. The aim of this study was to validate further its use with stroke patients. METHODS: The Baking Tray Task was compared with 2 versions of the Behaviour Inattention Test and a test for personal neglect. A total of 270 patients were subjected to a 3-item version of the Behaviour Inattention Test and 40 patients were subjected to an 8-item version of the Behaviour Inattention Test, besides the Baking Tray Task and the personal neglect test. RESULTS: The Baking Tray Task was more sensitive than the 3-item Behaviour Inattention Test, but the 8-item Behaviour Inattention Test was more sensitive than the Baking Tray Task. The best combination of any 3 tests was Baking Tray Task, Reading an article, and Figure copying; the 2 last-mentioned being a part of the 8-item Behaviour Inattention Test. CONCLUSION: Multi-item tests detect more cases of neglect than do single tests. However, it is tiresome for the patient to undergo a larger test battery than necessary. It is also time-consuming for the staff. Behavioural tests seem more appropriate when assessing neglect. The Baking Tray Task seems to be one of the most sensitive single tests, but its sensitivity can be further enhanced when it is used in combination with other tests.
Aged↗
Characteristics of the National Institute of Health Stroke Scale: results from a population-based stroke cohort at baseline and after one year.
BACKGROUND: The National Institute of Health Stroke Scale (NIHSS) results at baseline and after 1 year have never before been accounted for within an unselected population-based stroke sample. Neither has it been shown which individual items in the scale are the most important ones for the outcome in terms of death or dependency after 1 year. METHODS: The subjects were all patients within a municipality who had their first-ever non-subarachnoidal stroke during 1 year (n = 377). Impairment was evaluated at baseline (within 24-48 h) and after 1 year with the 15-item version of the NIHSS. At the 1-year follow-up, the Modified Rankin Scale was used in order to determine which patients were dependent. Predictors of death and dependency were analysed in logistic regression models. The different NIHSS items, age and gender were used as independent variables. RESULTS: The median NIHSS score was 6 (interquartile range 3-12) at baseline and 1 (interquartile range 0-3) at the 1-year follow-up, when 33% of the patients had died. Of patients scoring less than 4 on baseline NIHSS, 75% were functionally independent after 1 year. Seventeen per cent were functionally dependent and 8% were dead. Independent predictors of death were: age, questions, commands, gaze, alertness and sensation. Independent predictors of dependency were: age, commands, alertness and motor leg. CONCLUSIONS: Baseline NIHSS predicts the outcome after 1 year at the group level. Age and any reduction of the level of consciousness on arrival were associated with bad outcome after 1 year.
Aged↗
Prognosis for patients with neglect and anosognosia with special reference to cognitive impairment.
OBJECTIVE: To describe prognosis in patients with unilateral neglect, anosognosia, or both, within a community based stroke cohort. METHODS: Patients (n = 377) were evaluated at baseline for the presence of neglect and anosognosia. After 1 year, the level of disability was established in survivors. Predictors for death and dependency were examined in multivariate analysis. The following independent variables were used: age, consciousness, hemianopia, arm paresis, leg paresis, sensory disturbance, aphasia, neglect, anosognosia, diabetes mellitus, cardiovascular disease, pre- and post-stroke cognitive impairment. RESULTS: Age, consciousness and sensory disturbance predicted death. Post-stroke cognitive impairment, neglect, hemianopia, arm paresis and age predicted dependency. CONCLUSION: Neglect in the acute phase, which occurs in patients irrespective of pre-stroke cognitive level, negatively affects disability after 1 year. Anosognosia more often occurs in patients who are cognitively impaired before the stroke. These patients often are ADL-dependent already, or become dependent because of cognitive impairment, not because of anosognosia.
Age Factors↗
Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year.
BACKGROUND AND PURPOSE: The purpose of this study was to define predictors of poor outcome after a first-ever stroke. We studied risk factors and stroke severity at baseline in relationship to death, dependency, and stroke recurrence within a year after the event. METHODS: The study included a community-based cohort of first-ever stroke patients. Subarachnoid hemorrhage was not included. All patients (n=377) were subjected to investigations regarding risk factors. Stroke severity was evaluated with the National Institutes of Health Stroke Scale, and dependency was defined according to the modified Rankin Scale. Multivariate regression models were used to analyze predictors of survival, dependency, and stroke recurrence. The following independent variables were used: age, sex, cohabitation status, cigarette smoking, dementia, hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transitory ischemic attack, peripheral atherosclerosis, and stroke severity. RESULTS: The 1-year mortality was 33%. After 1 year, 37% of the survivors were dependent; 9% of survivors had a recurrent stroke within a year. Dementia, age, stroke severity, and atrial fibrillation were associated with death within a year. Dependency was associated with age, stroke severity, and heart failure. Stroke recurrence was predicted by age and dementia. CONCLUSIONS: In addition to age and stroke severity, heart diseases and dementia before the stroke seem to have an impact on mortality and recurrence after 1 year. Finding and, when possible, treating these prestroke conditions may affect stroke morbidity and mortality favorably.
Adult↗
Neglect and anosognosia after first-ever stroke: incidence and relationship to disability.
Neglect and anosognosia are serious consequences of stroke. Authors have found great variations in their incidence and their relationship to disability has been unclear. We studied the incidence of neglect and anosognosia within the scope of a population-based stroke-incidence study, and also evaluated their impact on disability. Four tests of visuo-spatial neglect, four tests of personal neglect, and an anosognosia questionnaire were used. Sixty-two patients (23%) of the study group had visuo-spatial neglect according to our definition, 21 patients (8%) had personal neglect, and 48 (17%) showed signs of anosognosia. Using a multiple logistic regression model, we found that both neglect and anosognosia influenced disability. To ascertain the true incidence of neglect and anosognosia after stroke, it is necessary to use a community-based study design, where cases treated outside the hospital are included. Some of the variability found in previous incidence studies is likely to be explained by not using such a design.
Aged↗
High incidence rates of stroke in Orebro, Sweden: Further support for regional incidence differences within Scandinavia.
BACKGROUND AND PURPOSE: As a basis for comparison of differences in stroke incidence in Scandinavian countries, a community-based stroke register was established in Orebro in the centre of Sweden. METHODS: All first-ever cases of stroke were registered during a 12-month period 1999-2000. The study population was 123,503. The WHO definition of stroke was used. Cases were searched inside as well as outside hospital. Multiple overlapping sources and 'hot pursuit' technique were used in the process of case ascertainment. RESULTS: 388 cases of first-ever stroke were found, corresponding to a crude incidence rate of 314 (95% CI, 283-348) per 100,000 per year, 337 (95% CI, 294-386) for females, and 289 (95% CI, 248-336) for males. Adjusted to the European population, the corresponding rates were 254 (95% CI, 227-284) per 100,000 per year, 273 (95% CI, 238-311) for females and 232 (95% CI, 206-261) for males. The overall 28-day case-fatality rate was 19% (95% CI, 15-23). The case-fatality rates for the different subtypes of stroke were as follows: brain infarction, 10%; intracerebral haemorrhage, 20%; subarachnoidal haemorrhage 45%, and undetermined pathological type 56%. CONCLUSIONS: The present study as well as other studies in northern and middle Scandinavia show significantly higher incidence rates than studies from other regions. The crude incidence rate, reflecting the age distribution of the population, is even higher, indicating a burden to the community that is rather increasing than decreasing.
Adult↗
Predictors of severe stroke: influence of preexisting dementia and cardiac disorders.
BACKGROUND AND PURPOSE: There is little research into the impact of prestroke dementia on stroke severity and short-term mortality. We included prestroke dementia, along with other risk factors, to determine independent predictors of stroke severity and early death in a community-based stroke study. METHODS: All patients (n=377) with a first-ever stroke were evaluated in terms of risk factors. Registration took place over a 12-month period. Stroke severity was evaluated with the National Institutes of Health Stroke Scale. Predictors of severe stroke and early death were analyzed in logistic regression models. The following independent variables were used: age, sex, living alone, arterial hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transient ischemic attack, cigarette smoking, peripheral atherosclerosis, and dementia. RESULTS: Risk factors for stroke were found in 82% of the patients. Heart failure, atrial fibrillation, and dementia were associated with more severe strokes. Dementia, atrial fibrillation, heart failure, and living alone were associated with death within 28 days of the event. CONCLUSIONS: These results raise the question of whether certain high-risk patients, ie, patients with atrial fibrillation, heart failure, and dementia, can benefit from more aggressive primary and secondary stroke prevention measures.
Aged↗