Welcome to the WSC 2022 Interactive Program

Background and Aims

In Fylde Coast, England, acknowledging the significant mental health challenges faced by people affected by stroke, a collaboration emerged between the local long term conditions Improving Access to Psychological Therapies (IAPT) services and the Stroke Association, focused on developing and testing a group-based emotional wellbeing and support programme for people affected by stroke.

Methods

This was a pilot project, with evaluation built in. The intervention comprised an 8 week online programme. Prospective participants were identified and referred by Stroke Association Coordinators, with referrals made to Mindmatters or Supporting Minds. Those referred, received a welcome call and the referral was accepted subject to eligibility criteria (mild to moderate anxiety or depression). The number of participants was capped at 10. A mixed methods approach to evaluation was adopted. Clinical outcome measures – PHQ-9 and GAD-8 were gathered at each contact. Patient experience forms were used to capture how participants experienced the programme and verbal feedback captured on an ongoing basis.

Results

Programme attended by 7 participants. Some declined group-based support despite being eligible, as they were seeking 1:1 support.

Eighty percent successfully achieved clinical recovery, as reflected in PHQ9 and GAD7 outcome measures.

Qualitative data gave insight into how this translated into participants’ everyday life and how outcomes may have been brought about by the programme.

Conclusions

While a small scale pilot, this evaluation demonstrated that an Emotional Wellbeing Programme, delivered in collaboration between IAPT services and the Stroke Association, has the potential to make a meaningful difference to the lives of stroke survivors.

Background and Aims

Falls is a common complication in stroke patient due to hemiparesis, poor balance or spasticity. This causes bony fracture that leads to morbidity and mortality. It is estimated that hip fracture in stroke patient is fourfold that of the general population. We aim to identify the incidence of low-impact fracture within 1 year after stroke in BNSRC

Methods

Retrospective casenote review of patients admitted with stroke (ischemic or haemorrhagic) in Brunei Neuroscience Stroke and Rehabilitation Centre (BNSRC) from September 2019 to December 2019 to identify low-impact fracture within 1 year of stroke diagnosis. Low-impact fracture is identified through case review of the national database BruHIM for visit to any orthopedic clinic nationwide.

Results

Within 3 months there were 110 patients admitted with stroke i.e. male 78 (78%), female 32 (29%), mean age 60 (range 30-90), median age 56. 83 had ischemic stroke (75%) and 27 had haemorrhagic stroke (25%). Only 1 patient had a low-impact fracture within 1 year of stroke diagnosis.

Conclusions

Surprisingly only 1 patient had a low-impact fracture within 1 year of stroke diagnosis. This is likely due to several reasons. The population of Brunei Darussalam enjoys good year round sunshine with high standard of living including adequate nutritional intake. Moreover bone remodelling takes time to demineralize thus fracture risk might increase in the subsequent year. Stroke physician should anticipate and pre-empt low-impact fractures in stroke patients by emphasizing on stroke rehabilitation and osteoporosis prevention. Further study can look at vitamin D level in post stroke patient and fracture risk in subsequent years.

Background and Aims

Few studies on poststroke depression (PSD) have been done in Singapore. This is the largest and most comprehensive study done to date.

Aim: Characterisation of the phenomenology and the clinical correlates of poststroke depression in the hospital and community settings, with subgroup analysis of ischemic and haemorrhagic strokes.

Methods

Data was extracted from a database from inception in 2010 to 30 November 2021. This database stores real-world clinical data from stroke patients who were screened for PSD from the time of hospitalisation and followed-up at least once after discharge up to 12 months poststroke.

The Hospital Anxiety and Depression Scale (both Anxiety HADS-A and Depression HADS-D subscales and Total HADS-T) and the Patient Health Questionnaire (PHQ2-item and 9-item) were used. A positive case of PSD is defined as HADS-A ≥7 or HADS-D ≥7 or HADS-T ≥10 or PHQ-2 ≥2 or PHQ-9 ≥8.

T0 refers to the screening done during the stroke hospitalization and T1 refers to any follow-up screening done after hospital discharge.

Results

The prevalence of PSD was 19.24% in ischemic stroke and 24.59% in haemorrhagic at T0 (n=1732), and 6.42% for ischemic stroke, 3.52% for haemorrhagic stroke at T1 (n=547). Right-sided strokes were associated with PSD only in ischemic strokes in the hospital setting. Stroke characteristics were not associated with PSD in the community setting. The core symptoms of hospital-setting PSD are the feeling of sadness, anxious distress, and trouble sleeping.

Conclusions

Specific characteristics and symptom profile of PSD have been found in a representative Singapore stroke sample, potentially changing local clinical practice.

Background and Aims

Poststroke depression (PSD) and poststroke cognitive impairment (PSCI) have thus far been studied in silo and little is known about comorbid PSD and PSCI.

We aim to examine the differences in profiles and characteristics between those with PSCI and PSD and those with only PSCI.

Methods

Data was extracted from a stroke rehabilitation database containing real-world clinical data of hospitalised stroke patients who were screened for PSCI and PSD.

The Hospital Anxiety and Depression Scale (both Anxiety HADS-A and Depression HADS-D subscales and Total HADS-T) and the Patient Health Questionnaire (PHQ2-item and 9-item) were used. A positive case of PSD is defined as HADS-A ≥7 or HADS-D ≥7 or HADS-T ≥10 or PHQ-2 ≥2 or PHQ-9 ≥8.

PSCI was defined as a score of 22 or less on the Montreal Cognitive Assessment (MoCA).

A cross-sectional comparison between those with PSCI and PSD and those with PSCI only was performed.

Results

In a sample of 59 PSCI patients, 31 (52.5%) had concurrent PSD. PSCI comorbid with PSD was associated with greater functional disability, small vessel strokes and strokes in basal ganglia/thalamus, whereas in contrast, PSCI alone was associated with large vessel strokes, cardioembolic strokes and strokes in non-strategic locations. Profile on the MoCA showed that language impairments were more frequent than impairments in orientation in PSCI comorbid with PSD. The reverse was seen in PSCI alone.

Conclusions

Strokes involving basal ganglia/thalamus are implicated in multiple poststroke neuropsychiatric phenomena eg, PSD, PSCI and aphasia, implying that such patients are more complex and require more focused interventions.

Background and Aims

In clinical practice, sleep-wake disturbance after stroke is a challenge. Few studies have examined the association between sleep after stroke and outcomes such as mood and cognition.

We aim to examine the mood and cognitive correlates of poor sleep after stroke from hospital setting to post-discharge.

Methods

Data was extracted from a database containing real-world clinical data of hospitalised stroke patients who were screened for depression (PSD), poor sleep and cognitive impairment and followed-up after discharge.

Poor sleep was defined as scoring > 5 on the Pittsburgh Sleep Quality Index (PSQI). PSD was identified using the Hospital Anxiety and Depression Scale (HADS) and 9-item Patient Health Questionnaire (PHQ-9) and defined as HADS-A ≥7 or HADS-D ≥7 or HADS-T ≥10 or PHQ-9 ≥8. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA).

Cross-sectional and correlation analyses were done.

Results

60% of 192 hospitalised stroke patients reported poor sleep, while 30.2% screened positive for PSD. Follow-up of 55 patients at <12 months after stroke, 40% reported poor sleep while 16.6% screened positive for PSD.

PSQI scores had a weak positive correlation with mood scores for hospitalised stroke patients, and a strong positive correlation at follow-up.

No correlation between PSQI score and MoCA score were found in both cross-sections.

Conclusions

There is a dynamic relationship between poor sleep and PSD. The lack of relationship between poor sleep and cognitive function is either due to MoCA being an insensitive tool or a longer duration of sleep disturbance is required to have a demonstrable impact on cognitive function.

Background and Aims

Post-stroke depression (PSD) is the most frequent and burdensome neuropsychiatric post-stroke complication. It is associated to higher mortality, poorer recovery, more pronounced cognitive deficits, and lower quality of life.

The objective of our study is to determine the prevalence of PSD and to examine predictors of its occurrence.

Methods

We conducted a retrospective study including patients followed for stroke. Those who have a history of psychiatric disorders or disability before stroke were excluded. Severity of vascular event was evaluated according to the National Institute of Health Stroke Score (NIHSS). Depression was evaluated according to Hamilton depression rating scale (HAMD-21). A score ≥10 testifies presence of depression. Association is significant if p ≤ 0,05 .

Results

We included 23 patients. Median age was 61 years old. Sex ratio was 1.09. Middle HAMD-21 score was 14.83. Depression was found in 78.3%. Five patients had familial medical history of depression. We found a significant association between NIHSS, persistence of disability after stroke and PSD (p= 0.05, p=0.034). We didn’t found any association between depression and clinical features, vascular territory or lesions of predominant hemisphere.

Conclusions

Depression is common after stroke. Its physiopathology is complex and poorly understood. Recognizing risk factors for PSD helps guide closer monitoring of depressive symptoms by clinicians and may lead to more intensive preventive interventions. We found that the key risk factors for PSD appear to be the severity of stroke and persistence of disability. Evidence regarding to the effect of lateralization of stroke on rates of PSD remains inconsistent.

Background and Aims

Background and aims: To observe the effect of post stroke depression on functional outcomes during inpatient rehabilitation

Methods

Method:

Design: Prospective observational study

Setting: Neurological Rehabilitation unit in a tertiary care university hospital

Study Period: October 2019 to April 2020

Participants: Patients with first ever stroke, male and female with age ≥18 yrs and duration less than 1 year

Assessment and outcomes: All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression sub-scale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS) and Modified Rankin Scale (MRS).

Results

Results: Thirty participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (n=17) had symptoms of depression (HADS-D>7). Participants in both groups (with and without depression) showed improvement in all the functional outcomes measures (BI, SSS, MRS) at the time of discharge as compare to admission scores. The changes in the outcomes measures were statistically significant within groups (p< 0.05) but not significant between the groups (p>0.05).

Conclusions

Conclusion: The post stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.

Background and Aims

Stroke is a very common condition and a public health problem. The occurrence of depression after a stroke can complicate its management. Aim of the study:To investigate the prevalence of depression in an Algerian stroke population, as well as the modalities of its management

Methods

In this study, 30 patients with a stroke, in whom we administered a specific depression score (PHQ-9) and assessed its impact on their disability and quality of life. Correlation tests between the severity of the PHQ-9 score and the degree of disability as well as the age and sex of the patients were also performed.

Results

21 patients (70%) had a significant PHQ-9 score with mainly mild to moderate depression. A negative correlation between the severity of the score and the age of the patients was observed, whereas no correlation with the severity of the disability score was found. The main objective of our work was to evaluate the frequency of depression in a hospital series, its average time of occurrence after stroke, but also to assess the response of the patients to the different treatments as well as to the psychological care proposed.

Conclusions

Our study found a high frequency of post-stroke depression. It could compromise functional recovery because it is a source of demotivation for patients. It should be systematically sought in all stroke patients, particularly in the early phase.

Background and Aims

Dysphagia is a common and serious complication of stroke and is associated with increased mortality from aspiration, pneumonia, and malnutrition. We aimed to identify the long-term changes in dysphagia and determine the factors associated with exacerbation of dysphagia after stroke.

Methods

This is an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation(KOSCO). Out of 7,858 patients who agreed with participation, 4,735 patients were enrolled for analysis. We demonstrated dysphagia recovery pattern for total, ischemic, and hemorrhagic stroke separately, using the American Speech-Language-Hearing Association National Outcomes Measurement System(ASHA-NOMS) scale. Patients were additionally classified into 2groups according to the changes in ASHA-NOMS between 24 to 36 months; stable group or exacerbation group.

Results

ASHA-NOMS showed the greatest improvement from the 7th day of onset to the time of discharge, and gradually increased until 24months to achieve plateau, and then showed a tendency to decrease slightly until 36months. Among patients with ischemic stroke, 3,354(79.2%) were classified as stable group, while 983(20.8%) were belonged to the exacerbation group. Among patients with hemorrhagic stroke, 889(90.4%) were classified as stable group, while 94(9.6%) were belonged to the exacerbation group. Additionally, the prediction model for the exacerbation of dysphagia identified sex, age, ASHA-NOMS level and mRS at 3month, K-FAST at 7th day, EQ5D at transfer, rehabilitation as independent indicators at ischemic stroke.

Conclusions

This study showed the long-term changes and the factors associated with exacerbation of dysphagia after stroke in Korea. These results provide useful information for preventing a decrease in swallowing function and proper swallowing treatment in stroke patients.

Background and Aims

Infection is a common complication in the acute phase after stroke and an added cause of morbimortality in these patients. Hence, identifying patients at risk of infection following stroke-induced immunosuppression is of paramount importance in the task of improving outcomes. Neutrophil extracellular traps (NETs) are large structures released by neutrophils that aid in host defence against pathogens. However, NETs may play a role in infection following stroke.

Methods

317 patients were recruited who met the following criteria: adults suffering ischemic stroke over 18 years-old; previously independent (modified Rankin Score < 2); admitted within 9 hours of symptom-onset / wake-up stroke. Blood samples were obtained upon admission and in the following 12-24 hours. Plasma from admission was used to perform four different ELISA assays to quantify for NETs markers.

Results

20.5% of patients suffered at least one infection during their inpatient hospital stay. In patients with post-stroke infection, a significantly higher proportion (72.31%) were female. Infected patients had higher admission plasma levels of NET marker neutrophil-specific elastase. A multivariate model consisting of admission NIHSS, gender (female) and neutrophil elastase predicts 79% of infection cases in our population.

Conclusions

We anticipate our research to be a starting point for the identification of patients at risk of infections through elastase levels upon admission, to prompt early interventions and improve patient care.

Background and Aims

Complex regional pain syndrome (CRPS) is a clinical syndrome with disabling pain which severely affects post-stroke recovery if left untreated. Incidence of CRPS in post-stroke patients has been reported as high as 50%.

The aims of the case series are: (1) highlight the clinical features of CRPS (2) review association of CRPS with right hemisphere strokes.

Methods

Case series

Results

Case one was a 75-year-old female who presented with left-sided upper and lower limb pain, four months after diagnosis of right hemispheric infarcts. Her clinical findings included oedema, weakness, and allodynia of the left-sided limbs.

Case two was an 82-year-old male who presented with left-sided upper limb pain, after a two-month history of right basal ganglia haemorrhagic stroke. His clinical features included swelling, weakness, and warmth of the left hand, as well as hyperalgesia in the affected shoulder, and hand.

Triphasic bone scans of both cases confirmed diagnoses of CRPS of left upper and left lower limbs.

With institution of appropriate rehabilitation and treatment, both cases demonstrated improvements in pain control, participation, and function.

Conclusions

Paresis of left limbs has been reported to be associated with post-stroke CRPS which could relate to right hemispheric lesions having a higher risk for trauma of the contralateral shoulder due to neglect syndromes. Right hemispheric strokes have also been reported to be more commonly associated with pain as the right hemisphere is more adept at pain processing. Prompt recognition of CRPS especially in those with right hemisphere lesions is important as appropriate treatment improves functional outcomes.

Background and Aims

Acute headache is the most frequent manifestation (90%) in patients with cerebral venous thrombosis (CVT) and the unique manifestation in 15%, but there is limited information related to long persistence headache in CVT. The aim of this study is to stablish the persistent headache frequency, its burden in patients and its relationship with other previously known severity variables in CVT.

Methods

We evaluated the cohort-study of patients with CVT at the Instituto Nacional de Neurologia y Neurocirugia in Mexico city between 2015 and 2021, in patients with at least 6 months of follow-up. The frequency of persistent headache defined as headache that persists beyond 3 months after CVT and its association with risk features of CVT (presence of hematoma, compromised venous sinuses, onset), clinical data (acute headache,altered consciousness,weakness) and comorbidities (pregnancy,infection,thrombophilia) were determinated through chi square-test, considering significant values p <0.05.

Results

86 patients were included, the mean age was 40 years +/- 14, 26 (30.2%) were male. In 54(62.8%) persistant headache was identified, all patients used painkillers. In the bivariate analysis, no association was identified with the characteristics of thrombosis, clinical or demographic data (p>0.05).

Conclusions

In our study persistent headache in patients with CVT was a very frequent residual condition with an extensive painkiller use. These results should be interpreted with caution due to the small sample of patients included.

Background and Aims

Background

In the acute stage of a stroke, sleep disruptions are common. However, there is limited literature on the changes in sleep architecture in chronic stage of these patients.

Aim

To evaluate the sleep parameters in patients with acute stage of stroke and follow-up.

Methods

In this study, ischemic stroke patients were prospectively recruited to evaluate changes in sleep architecture. Patients underwent overnight polysomnography twice- initially within 2 weeks of stroke onset and later after 3 months. Sleep was scored according to AASM criteria.

Results

The records of 56 patients who had a follow-up PSG were analyzed in the study. 23 patients had AHI < 5 (41%), 15 patients had AHI between 5-14 (26.7%), 11 patients had AHI between 15-30 (19.6%) and 7 patients had AHI >30 (12.5%). There is no significant difference between the AHI of the initial and follow-up study. The number of long duration of obstructive apnea (15%), central apnea(11%), and hypopnea (23%) reduced during follow-up. There was a significant difference between total sleep time [304.7±105.4 vs 350.6±81] and REM periods [44.3 (24,62.5) vs 63 (96.3, 34)] between the studies. The sleep efficiency [64.7±22.1 vs 74.7±15.8] tends to improve in the follow-up study. There is no significant difference between the other sleep parameters of the first and follow-up study.

Conclusions

This study shows no significant difference in the AHI on first and follow-up polysomnography. However, there was a reduction in long-duration apnea and hypopnea as well as a trend of improvement in sleep efficiency during the chronic stage of stroke.

Background and Aims

To describe the frequency and associated factors of depression and anxiety in aphasic stroke patients, and its association with aphasia recovery.

Methods

We performed a retrospective chart review of 95 consecutive aphasic stroke patients who were screened for depression and anxiety between January 2020 and August 2021. Patients who had pre-stroke dementia and substance abuse were excluded.

Post stroke depression was defined as a score of more than 8/32 on the Aphasic Depression Rating Scale (ADRS), and 13/30 on the Stroke Aphasic Depression Questionnaire Hospital Version (SADQ-H 10). Post stroke anxiety was defined as having a score of 16/30 or more on the Behavioural Outcomes of Anxiety scale (BOA).

The presence of speech improvement (yes/no) was extracted from follow-up notes.

Results

Out of 95 patients, 8 (8.42%) screened positive for depression/anxiety, with 6 (6.32%) screening positive while inpatient and 2 (2.11%) screening positive post-discharge. Screen-positive patients were not different in characteristics from the screen-negative patients. Significant improvement was shown in the patients’ motor and cognitive Functional Independence Measure (FIM) scores (p<0.001); 14 patients (31.11%) also had speech improvement. Younger aphasic patients were possibly more likely to have post-stroke neuropsychiatric disturbance, with the odds ratio approaching statistical significance (OR 0.80, 95% CI 0.64 to 1.00, p=0.055).

Conclusions

Local prevalence for post-stroke depression and anxiety in aphasic patients appear lower than published rates, likely due to the screening tools used. Late-onset depression or anxiety was not associated with non-improvement of aphasia. Aphasic patients who were younger might be more likely to have post-stroke neuropsychiatric disturbance.

Background and Aims

Post-stroke pain is a common complication that is often overlooked. It leads to depression, impaired quality of life and increased economic burden. In this study, we aimed to determine the prevalence and risk factors of post-stroke pain in a Malaysian stroke centre.

Methods

This is a single-centered, cross-sectional study of 175 post-stroke patients attending the neurology clinic. Their demographic data and clinical variables were collected. They were interviewed using the Brief Pain Inventory (BPI), Geriatric Depression Scale (GDS), Barthel Score (BI) and EuroQol-5D (EQ-5D) questionnaires.

Results

The prevalence of post-stroke pain was 26.3%, with most of them aged 51-70 years (52.2%). The types of pain included headache (30.4%), pain secondary to spasticity (32.6%), central post-stroke pain (26.1%) and shoulder joint pain (19.6%), in which they first experienced the pain between a week to three months post-index stroke. Our study showed that a high NIHSS, prolonged hospital stay for index stroke, poor modified Rankin Scale (mRS) and no post-discharge rehabilitation increased the probability of developing post-stroke pain. This resulted in depression, regression of functional status and poor quality of life. There was no correlation between older age, gender, ethnicity, and pre-existing medical conditions with the development of post-stroke pain.

Conclusions

Post-stroke pain should be diligently screened and treated in every stroke survivor to improve quality of life.

Background and Aims

Obstructive sleep apnea (OSA) links with ischemic strokes(IS) and TIA but it remains underdiagnosed due to the cost of polysomnography in the developing countries.The previous researches showed that early treatment with CPAP in moderate to severe OSA patient improved NIHSS and lowered stroke recurrent. STOP-BANG questionnaire (SBQ) is a good screening tool but may need some adjustments for Asian population. STOP-BANG stands for: Snoring, Tired, Observed stop breathing while sleep, High BP, BMI ≥ 35 kg/m2, Age ≥ 50 years, Neck circumference (NC) ≥ 40 cm and male. The objective of this study is to investigate the best cut off points of NC and BMI of Asian stroke patients.

Methods

This cross sectional study was conducted during April to November 2021 in the Stroke Unit, King Chulalongkorn Memorial Hospital, Thailand. We consecutively recruited stroke patients aged > 18 years with the diagnosis of IS/TIA. All patients were assessed by the continuous overnight pulse oximetry for diagnosing OSA and SBQ for evaluating OSA risk.

Results

We compared between 29 moderate to severe OSA and 54 non to mild OSA stroke patients.
The best cutoff points for the BMI and the NC were 23 kg/m2 and 36.5 cm, sensitivity 75.9% and 69% while the previous cutoff points for the BMI and the NC at 35 kg/m2 and 40 cm show very low sensitivity 7% and 24%

Conclusions

The appropriate cutoff points of BMI and NC for SBQ to predict moderate to severe OSA for Asian IS/TIA patients should be 23 kg/m² and 36.5 cm.

Background and Aims

Post-stroke anxiety affects 20 to 35% patients. Fluoxetine may reduce post‐stroke anxiety as well as overall disability by direct effects on the brain. This study was undertaken to study the efficacy of Fluoxetine in post-stroke anxiety.

Methods

A prospective randomized open blinded end point (PROBE) study was undertaken between 2019 and 2022. There were 60 patients (30 in intervention (Fluoxetine 20 mg once a day) and 30 in the control arm (best medical care)) who were randomized out of 95 eligible patients. Baseline and follow-up assessment (at 90 ± 7 days) was conducted using Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) for symptoms of anxiety and depression, respectively. Other clinical scores: severity (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), Barthel Index (BI), Short Form-36 (SF-36) was assessed at baseline and follow up.

Results

The mean age of the participants was 52.0 (11.6) years and 75% were males. In the primary outcome, there was no statistically significant benefit in HAM-A scores at follow up between the two treatment arms (Fluoxetine:-6.7(-8.7; -4.8), control:-7.20(-8.98; -5.42);p-value=0.88). The secondary outcomes: mRS(Fluoxetine:1 (1;1),control:1(0; 2);p-value=0.79), BI(Fluoxetine:20.0(19.0;20.0),control:20.0(17.5; 20.0);p-value=0.42), SF-36(Fluoxetine:69.5 (57.1; 83.6),control:80.3(47.8; 89.9);p-value=0.51) were also comparable. This study had about 50.5% of the patients with post-stroke anxiety and 31.6% patients had depression.

Conclusions

In this first randomized trial of Fluoxetine in post stroke patients, we did not see any significant difference in the anxiety scores between intervention and control arm. There were no significant side effects which led to drug withdrawal or non-compliance.

Background and Aims

To investigate the occurrence of sleep disorders in patients with ischemic stroke and the effect of sleep disorders on quality of life.

Methods

A total of 215 patients with ischemic stroke were followed up for 3 months to under the occurrence of sleep disorders after onset. Pittsburgh sleep quality index （PSQI）was used to assess the sleep quality，and the short form-36 health survey questionnaire (SF-36) was used to assess the quality of life.The SF36 scores of were compared,and them with different sleep quality of life of patients was analyzed sleep disorders on the life quality.

Results

The incidence of sleep disorders was 59.5%.The scores of physiological function,role physiology ,role emoficnal ,body pain vitality ,mental health social function and general health of patients with sleep disorders were lower than patients with normal sleep quality (P<0.05).Correlation analys is showed the total score of PSQI was correlated with the scores of VT and MH，SF36 (P<0.01),and the score of subjective sleep quality was correlated with that of Bp VT MH and SF P<0.01).That of sleep and sleep efficiency were correlated with that of VT and P<0.05or 0.01),and that of sleep disorders VT and SF (P<0.01) correlated withRP,RE,BP,VT,MHand SF (P<0.05 or 0.01）while that of sleep latency and daytime function were not correlated with SF36 and each dimension (P<0.05).

Conclusions

The incidence of sleep disorders with ischemic stroke is high. Sleep disorders can reduce their quality of life .Clinical attention should be paid to sleep quality,and targeted measures should be taken to improve sleep quality and life quality.

Background and Aims

To compare the discrimination and calibration of six risk scoring systems in the assessment of patients with stroke-associated pneumonia (SAP) after acute ischemic stroke.

Methods

The validation cohort was derived from the Third China National Stroke Registry . SAP was diagnosed according to the criteria for hospital-acquired pneumonia of the Centers for Disease Control and Prevention. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess discrimination and calibration.

Results

A total of 12071 patients were included in the study and 606 (5.02%) patients were diagnosed with in-hospital SAP after ischemic stroke. The AUROC of the six clinical scores ranged from 0.660 to 0.752. In the pairwise comparison, the AIS-APS score (0.752, 95% CI=0.730-0.773, P<0.001) showed significantly better discrimination than the other risk models, except the PASS score. The AIS-APS score had the largest Cox and Snell R-square for in-hospital SAP after ischemic stroke. In the subgroup analysis, among patients over 61 years of age, all TOAST subtypes except small vessel disease, length of hospital stay longer than 8 days, male and female sex, different groups stratified by admission NIHSS score and time from onset to arrival, the AIS-APS score showed better discrimination than other risk models with regard to SAP after AIS.

Conclusions

Our study compared the discrimination and calibration of the Kwon Pneumonia Score, A2DS2 score, PANTHERIS score, AIS-APS score, ISAN score, and PASS score in SAP identification; of these, the AIS-APS score showed the best performance.