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Background: Spatial navigation, the ability to determine and maintain a route from one place to another, is needed for independence in everyday life. Knowledge about impairments in spatial navigation in people with mild stroke is scarce. Objectives: To explore impairments in spatial navigation in patients ≤70 years after first-ever mild ischemic stroke (NIHSS≤3) and to explore which variables are associated with these impairments 12 months later. Methods: Patients were examined in the acute phase, and after 3 and 12 months. To assess impairments in spatial navigation, we used the Floor Maze Test (FMT), with time and FMT-errors as outcomes. Patients' perceived navigational skills were collected using self-report. Logistic regression was used to explore which variables (sociodemographic data, stroke characteristics, cognition, and mobility) were associated with impaired navigation ability. Results: Ninety-seven patients (20 females) were included. The mean (SD) age was 55.5 (11.4) years. Timed FMT improved significantly from the acute phase to 12 months (p = <.001). At 12 months, 24 (24.7%) of the participants walked through the maze with errors, and 22 (22.7%) reported spatial navigational problems. The Trail Making Test (TMT)-B was the only variable from the acute phase associated with FMT-errors at 12 months, and being female was the only variable associated with self-reported navigational problems at 12 months. Conclusion: Nearly one in four patients experienced spatial navigation problems 12 months after a mild stroke. Executive function (TMT-B), measured in the acute phase, was associated with navigational impairments (FMT-errors) at 12 months, and being female was associated with self-reported navigational problems. [ABSTRACT FROM AUTHOR]

Background Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. Objective The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score ≤3). This study also explored factors predicting impaired balance after 12 months. Design This study was designed as an explorative longitudinal cohort study. Methods Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. Results This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85–0.95) was the only predictor of balance impairments (Mini-BESTest score ≤22) at 12 months poststroke. Limitations Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. Conclusion This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months. [ABSTRACT FROM AUTHOR]

Background Persistent physical activity is important to maintain motor function across all stages after stroke. Objective The objective of this study was to investigate adherence to an 18-month physical activity and exercise program. Design The design was a prospective, longitudinal study including participants who had had a stroke randomly allocated to the intervention arm of a randomized controlled trial. Methods The intervention consisted of individualized monthly coaching by a physical therapist who motivated participants to adhere to 30 minutes of daily physical activity and 45 minutes of weekly exercise over an 18-month period. The primary outcome was the combination of participants' self-reported training diaries and adherence, as reported by the physical therapists. Mixed-effect models were used to analyze change in adherence over time. Intensity levels, measured by the Borg scale, were a secondary outcome. Results In total, 186 informed, consenting participants who had had mild-to-moderate stroke were included 3 months after stroke onset. Mean age was 71.7 years (SD = 11.9). Thirty-four (18.3%) participants withdrew and 9 (4.8%) died during follow-up. Adherence to physical activity and exercise each month ranged from 51.2% to 73.1%, and from 63.5% to 79.7%, respectively. Adherence to physical activity increased by 2.6% per month (odds ratio = 1.026, 95% CI = 1.014–1.037). Most of the exercise was performed at moderate-to-high intensity levels, ranging from scores of 12 to 16 on the Borg scale, with an increase of 0.018 points each month (95% CI = 0.011–0.024). Limitations Limitations included missing information about adherence for participants with missing data and reasons for dropout. Conclusions Participants with mild and moderate impairments after stroke who received individualized regular coaching established and maintained moderate-to-good adherence to daily physical activity and weekly exercise over time. [ABSTRACT FROM AUTHOR]

Aims. The main purpose was to investigate balance and mobility in the acute phase post-stroke regarding the Oxfordshire Community Stroke Project (OCSP) classification, as well as to determine the relationship between balance, mobility and socio-demographic characteristics in patients with first-ever stroke or transient ischaemic attack. Methods. A cross-sectional study of 183 participants. The Berg Balance Scale (BBS), Figure-of-Eight test (Fig8), Maximal Walking Speed (MWS) and Timed Up and Go (TUG) were assessed. The OCSP subgroups were total anterior circulation syndromes (TACS); partial anterior circulation syndromes (PACS); posterior circulation syndromes (POCS) or lacunar syndromes (LACS). Major findings. Mean age was 72 years and 48.6% were women. Male, cohabitant and younger participants scored significantly better on the BBS compared with females, those living alone and older participants. Despite impaired balance and mobility usually following strokes in the brain stem and cerebellum, the POCS group scored on the same level as LACS and PACS groups regarding balance and mobility. Only the TACS group had significantly lower BBS, TUG and MWS scores than the other participants. Conclusions. The results show that being younger, male and a cohabitant were significantly associated with better balance in the acute phase post-stroke. The TACS group differed significantly from the other OCSP groups, performing worse regarding balance and mobility. [ABSTRACT FROM AUTHOR]

Objectives: Depression and anxiety related to stroke are caused by vascular lesions and psychological reactions. Treatment of vascular and modifiable behavioral risk factors reduces the risk of stroke and may also reduce the risk of emotional changes after stroke. We aimed to investigate whether a multifactorial risk factor intervention program in patients with first-ever stroke or transient ischemic attack (TIA) can influence post-stroke anxiety and depressive symptoms in patients one year post-stroke. Method: The study population consisted of first-ever stroke and TIA patients allocated in a randomized, evaluator-blinded, controlled trial to care as usual or a structured and multidisciplinary follow-up including intensive treatment of vascular risk. The primary endpoint (cognition) has previously been reported. The secondary endpoint, reported here, was changes in the Hospital Anxiety and Depression Scale (HADS) from baseline to 12-month follow-up. Results: One hundred and ninety-five patients were randomized. The estimated difference between treatment groups, in changes in HADS, from baseline to 12 months was −1.32 (95% confidence interval: −2.61, −0.04; P = 0.044) in favor of the intervention group. One year post-stroke, 4/85 (4.7%) patients in the intervention group and 12/89 (13.5%) in the control group suffered from depression (P = 0.045), while 7/85 (8.2%) patients in the intervention group and 13/89 (14.6%) patients in the control group suffered from anxiety (P = 0.19). Conclusion: A structured, multidisciplinary, multifactorial risk factor program including vascular risk factor management may be associated with reduced HADS scores and a lower prevalence of depressive symptoms one year after stroke. [ABSTRACT FROM AUTHOR]

Aims: Clinical guidelines recommend stroke patients are routinely screened for cognitive impairment. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was evaluated for screening for post-stroke cognitive impairment. Methods: The RBANS and a neuropsychological test battery were administered to 60 participants recruited from acute stroke wards. Results: Using a cut-off of <70 points, the RBANS Total Index demonstrated 50% sensitivity and 100% specificity for detecting any cognitive impairment. ROC curve analysis identified an optimum total index cut-off score of <84 points (sensitivity 84%; specificity 90%). The RBANS Indices did not have acceptable sensitivity and specificity using a cut-off of <70 points. ROC curve analysis identified higher optimum cut-offs (sensitivity 79-89%; specificity 48-96%). Conclusion: The RBANS was an acceptable measure for detecting post-stroke cognitive impairment but does not include assessment of executive ability. [ABSTRACT FROM AUTHOR]

Background: Post-stroke dementia is defined as any dementia occurring after stroke, and includes vascular, degenerative and mixed dementia. The aim of this study was to assess the incidence of dementia and mild cognitive impairment (MCI) one year after stroke in a population free from pre-stroke cognitive decline, and to investigate the different aetiological subtypes of post-stroke dementia and MCI, using a novel method of subclassification in order to separate vascular causes of MCI or dementia from a neurodegenerative disease. Methods: All patients with a first-ever stroke and TIA admitted to the stroke unit of Asker and Bærum Hospital were invited. After 12 months, dementia and MCI were diagnosed. Sub-classification was made using MRI findings, the results of biomarkers in cerebrospinal fluid and the patients' clinical cognitive profile. Results: 36 (19.6%) patients developed dementia during the first year after stroke and 69 (37.5%) developed MCI. Fourteen (13.3%) were diagnosed as suffering from degenerative cognitive disease, 34 (32.4%) from vascular cognitive disease, and 57 (54.3%) from mixed disease. Conclusion: Fifty-seven percent suffered from cognitive impairment one year after stroke and only one third from isolated vascular cognitive disease. Post-stroke cognitive impairment is complex with a high coexistence of vascular and degenerative changes. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]