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"Cerebrovascular disease Psychological aspects."
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Psychological management of stroke
Psychological Management of Stroke presents a review and synthesis of the current theory and data relating to the assessment, treatment, and psychological aspects of stroke.
* Provides comprehensive reviews of evidence based practice relating to stroke
* Written by clinical psychologists working in stroke services
* Covers a broad range of psychological aspects, including fitness to drive, decision making, prevention of stroke, and involvement of carers and families
* Reviews and synthesizes new data across a wide range of areas relevant to stroke and the assessment, treatment, and care of stroke survivors and their families
* Represents a novel approach to the application of psychological theory and principles in the stroke field
eBook
The vascular depression hypothesis: mechanisms linking vascular disease with depression
The ‘Vascular Depression’ hypothesis posits that cerebrovascular disease may predispose, precipitate or perpetuate some geriatric depressive syndromes. This hypothesis stimulated much research that has improved our understanding of the complex relationships between late-life depression (LLD), vascular risk factors, and cognition. Succinctly, there are well-established relationships between LLD, vascular risk factors and cerebral hyperintensities, the radiological hallmark of vascular depression. Cognitive dysfunction is common in LLD, particularly executive dysfunction, a finding predictive of poor antidepressant response. Over time, progression of hyperintensities and cognitive deficits predicts a poor course of depression and may reflect underlying worsening of vascular disease. This work laid the foundation for examining the mechanisms by which vascular disease influences brain circuits and influences the development and course of depression. We review data testing the vascular depression hypothesis with a focus on identifying potential underlying vascular mechanisms. We propose a disconnection hypothesis, wherein focal vascular damage and white matter lesion location is a crucial factor, influencing neural connectivity that contributes to clinical symptomatology. We also propose inflammatory and hypoperfusion hypotheses, concepts that link underlying vascular processes with adverse effects on brain function that influence the development of depression. Testing such hypotheses will not only inform the relationship between vascular disease and depression, but also provide guidance on the potential repurposing of pharmacological agents that may improve LLD outcomes.
Journal Article
Cognitive function in patients with stable coronary heart disease: Related cerebrovascular and cardiovascular responses
Chronic exercise has been shown to prevent or slow age-related decline in cognitive functions in otherwise healthy, asymptomatic individuals. We sought to assess cognitive function in a stable coronary heart disease (CHD) sample and its relationship to cerebral oxygenation-perfusion, cardiac hemodynamic responses, and [Formula: see text] peak compared to age-matched and young healthy control subjects. Twenty-two young healthy controls (YHC), 20 age-matched old healthy controls (OHC) and 25 patients with stable CHD were recruited. Cognitive function assessment included short term-working memory, perceptual abilities, processing speed, cognitive inhibition and flexibility and long-term verbal memory. Maximal cardiopulmonary function (gas exchange analysis), cardiac hemodynamic (impedance cardiography) and left frontal cerebral oxygenation-perfusion (near-infra red spectroscopy) were measured during and after a maximal incremental ergocycle test. Compared to OHC and CHD, YHC had higher [Formula: see text] peak, maximal cardiac index (CI max), cerebral oxygenation-perfusion (ΔO2 Hb, ΔtHb: exercise and recovery) and cognitive function (for all items) (P<0.05). Compared to OHC, CHD patients had lower [Formula: see text] peak, CI max, cerebral oxygenation-perfusion (during recovery) and short term-working memory, processing speed, cognitive inhibition and flexibility and long-term verbal memory (P<0.05). [Formula: see text] peak and CI max were related to exercise cerebral oxygenation-perfusion and cognitive function (P<0.005). Cerebral oxygenation-perfusion (exercise) was related to cognitive function (P<0.005). Stable CHD patients have a worse cognitive function, a similar cerebral oxygenation/perfusion during exercise but reduced one during recovery vs. their aged-matched healthy counterparts. In the all sample, cognitive functions correlated with [Formula: see text] peak, CI max and cerebral oxygenation-perfusion.
Journal Article
Changes in measures of cognitive function in patients with end-stage kidney disease on dialysis and the effect of dialysis vintage: A longitudinal cohort study
Prevalence of cognitive impairment increases with worsening severity of chronic kidney disease (CKD) and majority of end-stage kidney disease (ESKD) patients on dialysis have cognitive impairment. Trends of cognitive function (CF) in this population are less well known with published studies reporting conflicting results. We assessed CF in a cohort of non-dialysis CKD and ESKD patients undergoing dialysis using modified mini-mental state examination (3MS), trail-making test (TMT-A & B) scores and Stroop task, and evaluated demographics, comorbidities and depression using Beck depression inventory at baseline. We repeated tests of CF and depression [greater than or equal to] 1-year after baseline in both groups and compared change scores in CF and depression between ESKD/ CKD sub-groups. Among ESKD patients we compared change scores between patients with dialysis vintage of 1-year. Analysis of covariance was used to adjust for the effect of age on these change scores. At baseline (N = 211), compared to CKD (N = 108), ESKD (N = 103) patients had significantly worse CF based on 3MS and TMT-A & B scores, and depression scores. On follow-up (N = 160) 3MS scores, especially the memory subscale significantly improved in ESKD, but worsened in CKD, with no significant changes in TMT A /TMT-B, or depression scores after adjusting for age. Among ESKD patients, 3MS, especially memory subscale improved in patients with dialysis vintage 1-year. The 51 patients who discontinued after baseline assessment had worse baseline CF scores suggesting differential attrition. Though baseline cognitive scores were worse in ESKD patients on dialysis, compared to CKD, their 3MS, especially memory subscale improved on follow-up. Among ESKD patients, the improvement was significant only in patients who have been on dialysis for less than one-year which may indicate a beneficial effect of clearance of uraemic toxins. Differential attrition of study subjects may have impacted the observed results.
Journal Article
Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise
Physical and cognitive exercise may prevent or delay dementia in later life but the neural mechanisms underlying these therapeutic benefits are largely unknown. We examined structural and functional magnetic resonance imaging (MRI) brain changes after 6 months of progressive resistance training (PRT), computerized cognitive training (CCT) or combined intervention. A total of 100 older individuals (68 females, average age=70.1, s.d.±6.7, 55–87 years) with dementia prodrome mild cognitive impairment were recruited in the SMART (Study of Mental Activity and Resistance Training) Trial. Participants were randomly assigned into four intervention groups: PRT+CCT, PRT+SHAM CCT, CCT+SHAM PRT and double SHAM. Multimodal MRI was conducted at baseline and at 6 months of follow-up (immediately after training) to measure structural and spontaneous functional changes in the brain, with a focus on the hippocampus and posterior cingulate regions. Participants’ cognitive changes were also assessed before and after training. We found that PRT but not CCT significantly improved global cognition (F(90)=4.1,
P<
0.05) as well as expanded gray matter in the posterior cingulate (
P
corrected
<0.05), and these changes were related to each other (
r
=0.25,
P
=0.03). PRT also reversed progression of white matter hyperintensities, a biomarker of cerebrovascular disease, in several brain areas. In contrast, CCT but not PRT attenuated decline in overall memory performance (F(90)=5.7,
P<
0.02), mediated by enhanced functional connectivity between the hippocampus and superior frontal cortex. Our findings indicate that physical and cognitive training depend on discrete neuronal mechanisms for their therapeutic efficacy, information that may help develop targeted lifestyle-based preventative strategies.
Journal Article
The effect of flavanol-rich cocoa on cerebral perfusion in healthy older adults during conscious resting state: a placebo controlled, crossover, acute trial
Rationale
There has recently been increasing interest in the potential of flavanols, plant-derived compounds found in foods such as fruit and vegetables, to ameliorate age-related cognitive decline. Research suggests that cocoa flavanols improve memory and learning, possibly as a result of their anti-inflammatory and neuroprotective effects. These effects may be mediated by increased cerebral blood flow (CBF), thus, stimulating neuronal function.
Objectives
The present study employed arterial spin labelling functional magnetic resonance imaging to explore the effect of a single acute dose of cocoa flavanols on regional CBF.
Methods
CBF was measured pre- and post-consumption of low (23 mg) or high (494 mg) 330 ml equicaloric flavanol drinks matched for caffeine, theobromine, taste and appearance according to a randomized counterbalanced crossover double-blind design in eight males and ten females, aged 50–65 years. Changes in perfusion from pre- to post-consumption were calculated as a function of each drink.
Results
Significant increases in regional perfusion across the brain were observed following consumption of the high flavanol drink relative to the low flavanol drink, particularly in the anterior cingulate cortex and the central opercular cortex of the parietal lobe.
Conclusions
Consumption of cocoa flavanol improves regional cerebral perfusion in older adults. This provides evidence for a possible acute mechanism by which cocoa flavanols are associated with benefits for cognitive performance.
Journal Article
Cerebrovascular and amyloid pathology in predementia stages: the relationship with neurodegeneration and cognitive decline
Background
Cerebrovascular disease (CVD) and amyloid-β (Aβ) often coexist, but their influence on neurodegeneration and cognition in predementia stages remains unclear. We investigated the association between CVD and Aβ on neurodegenerative markers and cognition in patients without dementia.
Methods
We included 271 memory clinic patients with subjective or objective cognitive deficits but without dementia from the BioBank Alzheimer Center Limburg cohort (
n
= 99) and the LeARN (
n
= 50) and DESCRIPA (
n
= 122) multicenter studies. CSF Aβ
1–42
and white matter hyperintensities (WMH) on magnetic resonance imaging (MRI) scans were used as measures of Aβ and CVD, respectively. Individuals were classified into four groups based on the presence (+) or absence (−) of Aβ and WMH. We investigated differences in phosphorylated tau, total tau (t-tau), and medial temporal lobe atrophy (MTA) between groups using general linear models. We examined cognitive decline and progression to dementia using linear mixed models and Cox proportional hazards models. All analyses were adjusted for study and demographics.
Results
MTA and t-tau were elevated in the Aβ − WMH+, Aβ + WMH−, and Aβ + WMH+ groups. MTA was most severe in the Aβ + WMH+ group compared with the groups with a single pathology. Both WMH and Aβ were associated with cognitive decline, but having both pathologies simultaneously was not associated with faster decline.
Conclusions
In the present study, we found an additive association of Aβ and CVD pathology with baseline MTA but not with cognitive decline. Because our findings may have implications for diagnosis and prognosis of memory clinic patients and for future scientific research, they should be validated in a larger sample with longer follow-up.
Journal Article
Psychological stress among hypertensive male patients in Jordan: prevalence and associated factors
Background
Hypertension is a global, modifiable risk factor for cardiovascular and cerebrovascular disorders, imposing a significant burden due to its high mortality and morbidity rates. This study aimed to assess the prevalence and severity of psychological stress among hypertensive patients in Jordan and identify the factors associated with psychological stress.
Methods
This descriptive, cross-sectional study was conducted on hypertensive patients at three community healthcare clinics in Jordan from May to July 2024. A sample of 276 hypertensive male patients was randomly selected, representing 85% of the total patients in the selected clinics. Patients were selected via systematic random sampling. A self-administered questionnaire on psychological stress using the Depression, Anxiety, and Stress Scale (DASS-42) was employed. The data were collected through Google Forms and analyzed using SPSS statistical software (version 27).
Results
A total of 276 hypertensive males participated in the study, and the mean score of psychological stress was 16.02(± 7.59). The prevalence of psychological stress was 55.1%, with 60 (39.5%) experiencing mild stress and 57 (37.5%) experiencing moderate stress. Chronic diseases and inadequate exercise were significantly associated with psychological stress (
p
-values: 0.003 and < 0.001, respectively). Participants reporting stressful work were more than four times more likely to experience psychological stress than those who did not report work-related stress (OR = 4.06; 95% CI: 2.00–8.25;
p
< 0.001). A stressful home environment and insufficient sleep were also significantly associated with psychological stress (
p
= 0.026 and
p
< 0.001, respectively).
Conclusions
The results highlight a strong association between psychological stress and hypertension. Factors such as chronic diseases, insufficient exercise, occupational stress, a stressful home environment, and inadequate sleep contribute to psychological stress among hypertensive patients. These findings provide valuable insights for healthcare providers in developing tailored interventions to alleviate stress while managing hypertension.
Journal Article
A retrospective and comprehensive analysis of excess life-years lost, mortality risk, and cause of death among severe mental illness in China
Background
Individuals with severe mental illness (SMI) experience higher mortality rates than the general population. We conducted a comprehensive, population-based study to quantify the excess life-years lost (LYLs), mortality risks, and cause of death among SMIs.
Methods
Using data from the Jiangsu Province Management Information System for Patients with SMI, we identified 321,436 SMI patients in Jiangsu, China, between January 2014 and December 2022; 33,947 of them died during follow-up. We calculated the excess LYLs for each type of SMI and estimated the standardized mortality ratios (SMRs) for all-cause and specific-cause mortality among individuals with four types of SMIs.
Results
The excess LYLs in four types of SMIs were as follows: for schizophrenia, 12.87 years in males and 11.92 years in females; for bipolar disorder, 8.43 years in males and 5.54 years in females; for paranoid disorder, 13.90 years in males and 14.03 years in females; and for schizoaffective disorder, 16.69 years in males and 15.82 years in females, when compared to the general population. Individuals with SMI had nearly twice the all-cause mortality of the general population (adjusted SMR 1.96, 95% CI 1.94–1.98). Elevated mortality rates were observed across all types of SMIs, with SMRs varying from 1.23 to 2.96. The SMRs for specific causes showed distinct patterns, with infectious diseases ranging from 1.60 to 3.08, neoplasms from 0.73 to 1.15, diabetes from 1.82 to 3.89, nervous system diseases from 1.44 to 3.15, cardiovascular diseases from 1.05 to 2.35, cerebrovascular diseases from 1.26 to 2.18, respiratory diseases from 0.86 to 1.69, digestive diseases from 1.25 to 2.66, accidents from 2.15 to 4.01, suicide from 6.16 to 14.81, and all other causes from 2.06 to 4.33 across four types of SMIs; alcohol misuse was elevated only in schizophrenia (SMR 6.57), with < 10 events in the other disorders.
Conclusions
Individuals with SMI in China experienced marked loss of life expectancy and faced nearly double the mortality, with cause-specific patterns varying by diagnosis. Our findings provide insights into the need for our government to continually enhance physical and mental health policies to prevent and decrease premature mortality in individuals with SMI.
Journal Article