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Objectives: We aimed to assess longitudinal changes in MRI measures of brain atrophy and white matter lesions in stroke and transient ischemic attack (TIA) survivors, and explore whether carotid stenosis predicts progression of these changes, assessed by visual rating scales., Materials and Methods: All patients with a first-ever stroke or TIA admitted to Bærum Hospital, Norway, in 2007/2008, were invited in the acute phase and followed for seven years. Carotid ultrasound was performed during the hospital stay. Carotid stenosis was defined as ≥50% narrowing of lumen. MRI was performed one and seven years after the index event and analyzed according to the visual rating scales Fazekas scale (0-3), Medial Temporal Lobe Atrophy (MTLA) (0-4) score, and Global Cortical Atrophy (GCA) scale (0-3). Patients with MRI scans at both time points were included in this sub-study., Results: Of 227 patients recruited, 76 had both MRI examinations. Mean age 73.9±10.6, 41% women, and 9% had ≥50% carotid stenosis. Mean Fazekas scale was 1.7±0.9 and 1.8±1.0, mean MTLA score 1.0 ±1.0 and 1.7±1.0, and mean GCA scale score 1.4±0.7 and 1.4±0.6 after one and seven years, respectively. 71% retained the same Fazekas scale score, while 21% showed progression. Deterioration in GCA scale was seen in 20% and increasing MTLA score in 57%. Carotid stenosis was not associated with progression on Fazekas score, MTLA score or GCA scale., Conclusions: Three out of five showed progression on the MTLA score. Carotid stenosis was not associated with longitudinal change of visual rating scales., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Stroke and coronary heart disease share the same risk factors, and a multifactorial intervention after stroke may potentially result in the same reduction in cardiovascular mortality as seen after coronary events. We aimed to evaluate the effect on survival 7 years after a 1-year multifactorial risk factor intervention, and identify clinical predictors for long-term survival in a hospital-based cohort of patients with first-ever stroke or transient ischemic attack (TIA)., Materials and Methods: We performed a secondary analysis of a randomized controlled trial including patients between February 2007 and July 2008 comparing an intensive risk factor intervention vs usual care the first year poststroke to prevent cognitive impairment. From February 2014 to July 2016, all patients were invited to a follow-up. For patients dying throughout the follow-up period, date of death was obtained from the medical record. Examination at baseline and 1-year follow-up included extensive assessment of vascular risk factors and cognitive assessments., Results: A total of 195 patients were randomized. Mean (SD) age was 71.6 (12.5) years, 53.3% were male, mean (SD) body mass index (BMI) was 25.6 (4.1) kg/m 2 . During follow-up, 35 patients in the intervention group and 41 in the control group died. Kaplan-Meier survival estimates show no significant difference in intention-to-treat (ITT) population or complete case (CC) population (log-rank P =0.29 vs log-rank P =0.07). In multivariable Cox proportional hazards regression analyses, lower age and higher BMI was independently associated with long-term survival, adjusted HR (95% CI) 1.08 (1.05-1.11) per year and 0.91 (0.85-0.97) per kg/m 2 ., Conclusion: In this post hoc analysis, we found no significant effect on survival after 7 years of a multifactorial risk factor program given during the first year after first-ever stroke or TIA. Higher BMI was an independent predictor for long-term survival in this cohort., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background and Purpose: An increasing proportion of patients presenting with suspected stroke prove to have other conditions, often referred to as stroke mimics. The aim of this study was to present a projection of the number of hospitalized strokes, transient ischemic attacks (TIAs), and stroke mimics in Norway up to the year 2050 based on expected demographic changes, to estimate the burden of stroke mimics in the coming decades., Materials and Methods: This prospective study included all admissions to the stroke unit of Akershus University Hospital from March 1, 2012, to February 28, 2013. Relevant resource use was recorded. Based on the age- and sex-specific absolute incidences for the study period, the expected numbers of strokes, TIAs, and stroke mimics in the entire Norwegian population were computed for every fifth year for the period 2020-2050., Results: We included 1881 admissions, of which 38.2% were stroke mimics. With constant age- and sex-dependent incidence rates, we estimated that the number of strokes and stroke mimics will respectively increase by 121.3% and 88.7% (men) and 97.6% and 71.7% (women). For hospital admission levels to stay constant at the 2013 level, an annual reduction of 2.1% and 1.7% (men) and 1.8% and 1.5% (women) must take place for strokes and mimics, respectively., Conclusions: A significant proportion of stroke unit admissions prove to have other conditions than stroke. With constant age- and sex-dependent incidence rates, the number of stroke mimics admissions will increase substantially over the next decades., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients., Methods: This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway. Patients with previous cerebrovascular disease, patients receiving thrombolytic treatment and patients who were not able to answer the questions in the questionnaire were excluded. Patients were asked two closed-ended questions: "Do you believe that stroke is a serious disorder?" and "Do you believe that time is of importance for stroke treatment?". In addition, patients were asked three open-ended questions where they were asked to list as many stroke risk factors, stroke symptoms and stroke treatment options as they could., Results: A total of 173 patients were included, of whom 158 (91.3%) confirmed that they regarded stroke as a serious disorder and 148 patients (85.5%) considered time being of importance. In all, 102 patients (59.0%) could not name any treatment option. Forty-one patients (23.7%) named one or more adequate treatment options, and they were younger ( p <0.001) and had higher educational level ( p <0.001), but had a nonsignificant shorter prehospital delay time ( p =0.292)., Conclusion: The level of stroke treatment knowledge in stroke patients seems to be poor. Public campaigns should probably also focus on information on treatment options, which may contribute to reduce prehospital delay and onset-to-treatment-time., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Over the last decades, the approach to patients with transient ischemic attack (TIA) has shifted from treating only patients considered at high risk of recurrent stroke, to referring all patients with TIA to urgent assessment and immediate initiation of preventive treatment. The data on how this change has influenced the stroke rate after TIA are limited. Thus, the primary aim of this study was to identify the incidence of stroke recurrence after TIA. Second, we wanted to evaluate the ABCD2 score as a predictor of recurrent stroke., Methods: Patients discharged with a diagnosis of TIA from the Stroke Unit at Akershus University Hospital between January 1, 2013 and December 31, 2013 were included in the study. Data were obtained from the electronic medical records. Readmission data to capture recurrent strokes were registered until December 31, 2015., Results: In total, 261 patients were included. Mean age was 70.7 years. Stroke incidence at 1 month, 1 year, and the end of follow-up was 1.5% (n = 4), 3.4% (n = 9), and 4.2% (n = 11), respectively. Median time from TIA until recurrent stroke was 90 days. The ability of the ABCD2 score to predict recurrent stroke was low., Conclusions: Urgent admission of patients with TIA is followed by a very low risk of early and late recurrent stroke. The ABCD2 score did not identify patients at high risk of recurrent stroke., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: Vascular risk factor control may not only prevent stroke but also reduce the risk of dementia. We investigated whether a multifactorial intervention program reduces the incidence of cognitive symptoms one-year after stroke and transient ischemic attack in first ever stroke patients without cognitive decline prior to the stroke., Materials and Methods: Patients suffering their first ever stroke were included in this randomized, evaluator-blinded, controlled trial with two parallel groups. Baseline examination included extensive assessment of exposure to vascular risk factors and cognitive assessments regarding memory, attention, and executive function. After discharge, patients were allocated to either intensive vascular risk factor intervention or care as usual. The primary end points were changes in trailmaking test A and 10-word test from baseline to 12 months follow-up., Results: One hundred ninety-five patients were randomized. The difference between groups in trail-making test A, adjusted for baseline measurements, was 3·8 s (95% confidence interval: -4·2 to 11·9; P=0·35) in favor of the intervention group. The difference between groups in the 10-word recall test was 1·1 words (95% confidence interval: -0·5 to 2·7; P=0·17) in favor of the intervention group. We did not observe any differences in the secondary outcomes of incident dementia or mild cognitive impairment., Conclusions: We could not demonstrate cognitive effects of an intensive risk factor intervention at one-year poststroke. Longer follow-up and a more heterogeneous study sample might have lead to larger effects. More effective methods for managing the risk of further cognitive decline after stroke are needed., (© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.)

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.

Background: The time from symptom onset to seeking medical assistance (decision delay) accounts for a proportion of prehospital delay in acute stroke. The aims of this study were to identify factors related to decision delay and calling the emergency medical services (EMS) as the first medical contact., Methods: Data were prospectively collected from 350 patients with acute stroke or transient ischemic attack. Data on decision delay, prehospital delay, types of first medical contact, and previous stroke knowledge were recorded. Multivariable logistic regression analyses were conducted to identify factors related to decision delay of 1 hour or less and calling the EMS as the first medical contact., Results: The median decision delay was 2.0 hours. Decision delay accounted for 62.3% of prehospital delay (median value). Moderate (National Institutes of Health Stroke Scale [NIHSS] score 8-16; odds ratio [OR] 4.16 [95% confidence interval 1.86-9.30]) or severe symptoms (NIHSS score ≥ 17; OR 10.38 [2.70-39.90]) and living together (OR 1.84 [1.02-3.43]) were associated with decision delay of 1 hour or less. Moderate (OR 6.31 [2.79-14.29]) or severe symptoms (OR 8.44 [2.64-26.98]) were associated with calling the EMS as the first medical contact. Previous stroke knowledge did not affect an early decision or EMS use., Conclusions: The decision to seek medical assistance in acute stroke accounts for more than half of the prehospital delay. Severity of symptoms and living together are related to an early decision (≤1 hour). Previous stroke knowledge does not affect decision delay or EMS use., (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Early management improves outcome in acute stroke. This study was designed to assess the prehospital path from symptom onset to arrival in hospital and to identify factors associated with prehospital delay., Methods: A prospective study was conducted including patients with acute ischaemic stroke, intracerebral haemorrhage and transient ischaemic attack admitted to hospital. Time intervals for prehospital delay, background data, severity, type of first medical contact and mode of transport were recorded. Univariate and multivariate analyses were performed to identify factors influencing prehospital delay., Results: A total of 440 patients were included, with a mean age of 71.4±13.0 years (44.3% female subjects), consisting of 65.9% patients with ischaemic stroke, 11.4% with intracerebral haemorrhage and 22.7% with transient ischaemic attack. The median time from symptom onset to admission was 3.0 h (179 min; IQR 77-542). The median decision delay was 1.5 h (92 min, IQR 25-405) and accounted for 55.1% (median value) of the prehospital delay. 310 (70.5%) patients arrived by ambulance. In the multivariate linear regression analysis, high National Institute of Health Stroke Scale score (p<0.001), transport by ambulance (p<0.001) and lower age (p=0.048) were significantly associated with early admission., Conclusions: Severe strokes, use of ambulance and lower age are associated with reduced prehospital delay. The present study shows that more than half of the delay is caused by the hesitation to contact medical services. Public information campaigns should focus on fast symptom recognition and the importance of immediately contacting the Emergency Medical Services upon symptom onset.