Post-stroke cognitive impairment (PSCI) is a common complication in stroke survivors,significantly reducing their quality of life and impairing long-term prognosis.Disability and mortality rates associated with PSCI increase with age.In clinical practice, conditions such as post-stroke delirium and transient cognitive impairment may resolve early, whereas PSCI diagnosis typically requires cognitive assessment conducted 3-6 months after stroke.Delaying intervention until a definitive PSCI diagnosis is confirmed may result in missing the optimal treatment window.Therefore, thorough understanding of PSCI risk factors, early screening of acute stroke patients, development of prediction models, and early identification of high-risk individuals for specialized management can improve outcomes for PSCI patients.This review summarizes recent progress on PSCI risk factors across three domains: neuropsychological assessment scales, neuroimaging techniques (magnetic resonance imaging, ultrasound, brain networks),and blood biomarkers.Additionally, it evaluates the advantages and limitations of clinical prediction models constructed using key, easily accessible risk factors, aiming to provide insights for early identification and management of high-risk PSCI populations.
To investigate the effects of cognitive-motor dual-task training (DTT)on multidimensional cognitive function and activities of daily living (ADL) in patients with post-stroke cognitive impairment (PSCI).
Methods
A total of 28 eligible patients with PSCI admitted to the Department of Rehabilitation Medicine at Beijing Tiantan Hospital, Capital Medical University, from August 2023 to September 2024 were enrolled and randomly assigned to a control group (n=14) and an intervention group (n=14).The control group received cognitive training alone (5 sessions/week, 30 minutes/session, for 2 weeks),while the intervention group underwent cognitive-motor DTT with identical training frequency and duration.Pre- and post-training scores on the Stroop color-word test (SCWT), Rey-Osterrieth complex figure test (ROCF),digit symbol substitution test (DSST), and Alzheimer's disease assessment scale-cognitive subscale (ADAS-Cog)were compared between groups.Additionally, differences in Montreal cognitive assessment (MoCA),modified Barthel index (MBI), and functional independence measure (FIM) scores at 1-month follow-up were analyzed relative to baseline.
Results
Compared with the control group, the intervention group showed significantly higher scores in DSST (P＜0.05), MBI (P＜0.05), and FIM (P＜0.05), and lower ADAS-Cog scores (P＜0.05) at 1-month follow-up.Both groups exhibited improved ROCF and MoCA scores after training, without statistical significance.SCWT completion time decreased post-training, without statistical significance (P＞0.05).
Conclusion
Cognitive-motor DTT may cognitive functions related to attention and memory, as well as improve ADL capabilities in PSCI patients.Further research is needed to validate its long-term efficacy.
To explore the characteristics of global cognitive function and domain-specific cognitive test performance in patients with asymptomatic posterior cerebral artery atherosclerotic stenosis (aPCAS).
Methods
A total of 19 patients diagnosed with aPCAS (stenosis ＞50%) at the Neurology Department of Peking Union Medical College Hospital between February 2021 and July 2024 were enrolled, along with 53 age-, sex-, and education-matched control subjects.Linear regression models were used to compare Z-scores across cognitive domains (including memory, attention, executive function, visuospatial ability, language, and calculation) and cognitive test results [including the mini-mental state examination (MMSE), Montreal cognitive assessment(MoCA), and domain-specific subtests] between the two groups, with demographic variables statistically adjusted.P-values were corrected using the Bonferroni method.
Results
Compared to the control group, the aPCAS group exhibited significantly lower MoCA scores [(23.11±4.25) vs(26.47±3.03), β=-3.46, 95% CI: -4.88 to -2.03, P＜0.001], as well as reduced Z-scores in the memory[(-0.94±0.73) vs (-0.27±0.73), β=-0.67, 95% CI:-1.07 to -0.28, P=0.001], language [(-0.09±0.88) vs(0.83±0.85), β=-0.91, 95% CI: -1.37 to -0.46, P＜0.001], and calculation [(-0.82±0.91) vs (0.02±0.92),β=-0.84, 95% CI: -1.34 to -0.33, P=0.001].
Conclusion
Despite the absence of stroke episodes,aPCAS patients demonstrate cognitive impairment even with mild cortical atrophy and low white matter hyperintensity burden, indicating that they should be considered a high-risk population for dementia.
To analyze the current research landscape and evolving trends in rehabilitation care for post-stroke dysphagia through bibliometric methods, aiming to elucidate research progress and future directions in this field.
Methods
Using "stroke," "dysphagia," and "nursing" as search terms, literature was retrieved from the Web of Science database.VOSviewer and CiteSpace software were utilized for keyword co-occurrence analysis, co-citation analysis, and visualization to identify research hotspots and frontiers.
Results
A total of 316 relevant articles were included, authored by 1458 researchers from 664 institutions across 44 countries, published in 156 journals, and citing 8471 references from 3021 unique journals.The top three countries in terms of publication output were the United States, China, and Australia.Keyword co-occurrence and burst detection analyses revealed research hotspots, including swallowing function assessment, nursing interventions, nutritional support, aspiration prevention, quality of life, and rehabilitation.Co-citation analysis underscored the critical role of formal dysphagia screening in reducing pneumonia risk and indicated that this field remains in a developmental stage, necessitating further research to optimize nursing strategies.
Conclusion
Rehabilitation nursing for post-stroke dysphagia is an active research domain, with current focus on dysphagia screening and aspiration prevention.Future studies should prioritize developing personalized care protocols, advancing technology-assisted swallowing function assessments, and optimizing interdisciplinary collaborative models to drive progress in this field.
To investigate the correlation between retinal thickness and cognitive impairment in patients with cerebral small vessel disease (CSVD).
Methods
A total of 161 CSVD patients treated at the Department of Neurology, Huashan Hospital Affiliated to Fudan University from September 2022 to May 2024 were enrolled.Based on the Montreal cognitive assessment (MoCA) scores, patients were divided into a non-cognitive impairment group (29 cases) and a cognitive impairment group (132 cases).Optical coherence tomography (OCT) was used to measure retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness in the optic disc and macular regions.Retinal parameters were compared between the two groups, followed by univariate and multivariate logistic regression analyses.Spearman correlation analysis was used to explore the associations between independent influencing factors and MoCA scores.
Results
The temporal RNFL thickness of the optic disc in the cognitive impairment group [75.0 (68.0,81.5) µm] was significantly thinner than that in the non-cognitive impairment group [86.0 (72.5, 92.0) µm],with a statistically significant difference (Z=2.602, P=0.009).Logistic regression analysis revealed that thicker temporal RNFL of the optic disc was an independent protective factor against cognitive impairment in CSVD patients (OR=0.96, 95% CI: 0.92-0.99, P=0.032).Temporal RNFL thickness was positively correlated with MoCA scores (r=0.235, P=0.006).
Conclusion
Thicker temporal RNFL of the optic disc is an independent protective factor against cognitive impairment in CSVD patients.
To investigate the impact of perioperative stroke on clinical outcomes and identify associated factors.
Methods
Clinical data of perioperative stroke patients admitted to Beijing Friendship Hospital, Capital Medical University, from January 1, 2018 to January 1, 2022 were analyzed.Perioperative stroke was defined as hemorrhagic or ischemic stroke events occurring during surgery or within 30 day postoperatively in hospitalized patients.The primary endpoint was 90-day all-cause mortality after perioperative stroke.Intergroup differences in variables were compared using Pearson Chi-Square test or Mann-Whitney U test.Variables with P ≤0.10 in univariate analysis were included in logistic regression to identify influencing factors for the primary endpoint.
Results
A total of 186 eligible perioperative stroke patients were included, accounting for 3.35% (186/5,547) of all surgical inpatients during the study period,with 32 patients (17.2%) dying within 90 days of perioperative stroke.The cohort included 74 females (39.8%),with median age of 69 (63, 77) years, median National Institutes of Health stroke scale (NIHSS) score of 5 (2, 11), median hospitalization duration of 18 (11, 28) days, and 16 cases (8.6%) of medical disputes.Logistic regression revealed NIHSS score (OR=1.246; 95%CI: 1.146-1.354; P＜0.001), age (OR=1.053;95%CI: 1.002-1.106; P=0.040), heart failure (OR=5.484; 95%CI: 1.714-17.549; P=0.004) and international normalized ratio (INR) ≥1.2 (OR=5.226; 95%CI: 1.694-16.120; P=0.004) were independent risk factors for 90-day mortality.
Conclusion
Stroke severity, cardiac function, and coagulation status are crucial factors influencing 90-day mortality risk in perioperative stroke patients, warranting focused clinical management.
To investigate the clinical efficacy of 3D printing-assisted neuroendoscopic surgery in treating supratentorial hypertensive intracerebral hemorrhage (HICH) with intraventricular extension.
Methods
A retrospective analysis was performed on 50 patients with supratentorial HICH and intraventricular hemorrhage admitted to the Department of Neurosurgery, Suzhou Municipal Hospital from October 2020 to April 2023.Patients were divided into a control group [(25 cases, treated with traditional microscopic surgery + external ventricular drainage (EVD)] and an observation group(25 cases, treated with 3D printing-assisted neuroendoscopic surgery + EVD).Demographic and clinical parameters were compared between groups, including age, sex, hematoma volume, Glasgow coma scale(GCS) score, preoperative muscle strength of the affected limb, operative time, bone window area, EVD duration, hospitalization duration, hematoma clearance rates (intraparenchymal and intraventricular),rebleeding episodes, intracranial/pulmonary infection cases, modified Rankin scale (mRS) scores at 3-month follow-up, and postoperative muscle strength at 3 months in patients with preoperative mild/moderate compression of the posterior limb of the internal capsule.
Results
No significant differences were observed between groups in age, sex, hematoma volume, GCS score, or preoperative muscle strength (P＞0.05).The observation group showed significantly shorter operative time, smaller bone window area, shorter EVD duration, and reduced hospitalization time compared to the control group(P＜0.05).While intraparenchymal hematoma clearance rates were comparable (P＞0.05), the observation group achieved significantly higher intraventricular hematoma clearance rates (P＜0.05).Rates of rebleeding,intracranial infection, and pulmonary infection were lower in the observation group, though without statistical significance (P＞0.05).No intergroup significant difference was found in 3-month mRS scores (P＞0.05); however, patients with preoperative mild/moderate posterior limb compression in the observation group exhibited significantly improved postoperative muscle strength at 3 months (P＜0.05).
Conclusion
3D printing-assisted neuroendoscopic minimally invasive surgery effectively clears both intraparenchymal and intraventricular hematomas, offering advantages of minimal trauma, shorter operative time, and reduced hospitalization.It represents a promising therapeutic modality for hypertensive intracerebral hemorrhage.
To explore the application value of CT cerebral perfusion imaging in assessing disease severity and guiding surgical planning for patients with large-area cerebral infarction.
Methods
A retrospective analysis was conducted on 126 patients with large-area cerebral infarction admitted to Xingtai Central Hospital from September 2021 to September 2023.All patients underwent CT cerebral perfusion imaging, and disease severity was evaluated using the National Institutes of Health stroke scale(NIHSS).Based on NIHSS scores, patients were categorized into mild (NIHSS score ≤ 4, 0 cases), moderate(NIHSS 5-20, 92 cases), and severe (NIHSS＞20, 34 cases) groups.CT perfusion imaging was analyzed for detecting infarct location and size, comparing cerebral perfusion parameters across different brain regions,assessing correlations between perfusion parameters and disease severity, and informing surgical decision-making.
Results
Among 126 patients, infarct locations included the basal ganglia (34.13%, 43 cases), frontal lobe(29.37%, 37 cases), temporal lobe (25.40%, 32 cases), occipital lobe (17.46%, 22 cases), and parietal lobe(4.76%, 6 cases).Infarct volumes were categorized as 10-15 cm3 (42.06%, 53 cases), ＞15-25 cm3 (37.30%,47 cases), and ＞25 cm3 (20.64%, 26 cases).Compared to healthy contralateral regions, both the infarct core and ischemic penumbra showed significantly lower cerebral blood flow (CBF) and cerebral blood volume(CBV), and higher time-to-peak (Tmax) and mean transit time (MTT) (all P＜0.05).The severe group exhibited lower CBF and CBV and higher Tmax and MTT in the infarct core than the moderate group (P＜0.05).Spearman correlation analysis revealed negative associations between CBF/CBV and disease severity(r=-0.419, P＜0.05; r=-0.522, P＜0.05) and positive association between Tmax/MTT and disease severity(r=0.356, P＜0.05; r=0.617, P＜0.05).Logistic regression identified CBF, CBV, Tmax, MTT, and infarct volume as independent predictors of disease severity (P＜0.05).Receiver operating characteristic curves demonstrated areas under the curve of 0.820 (CBF), 0.755 (CBV), 0.766 (Tmax), 0.842 (MTT), and 0.610(infarct volume) for severity assessment.All patients received medical treatment, with 94 undergoing arterial thrombolysis and 32 decompressive craniectomy.Postoperative survival was 94.44% (119/126), with 7 deaths and residual neurological sequelae in some survivors.
Conclusion
CT cerebral perfusion effectively identifies infarct location and vomule, evaluates disease severity, and provides critical insights for surgical planning in patients with large-area cerebral infarction.
To investigate the impact of total cerebral small vessel disease (CSVD)burden on infarction growth rate (IGR) and clinical outcomes in patients with acute anterior circulation large vessel occlusion undergoing endovascular therapy (EVT).
Methods
This retrospective study included 198 patients with acute anterior circulation large vessel occlusion who underwent EVT with successful recanalization at Suqian First People’s Hospital between January 2021 and December 2023.Based on modified Rankin scale (mRS) scores at 90 days, patients were divided into a favorable outcome group (mRS: 0-2,n=104) and a poor outcome group (mRS: 3-6, n=94).Clinical data, including age, baseline National Institutes of Health stroke scale (NIHSS) score, and IGR calculated from pre-operative CT perfusion imaging, were collected.Total CSVD burden was graded using brain MRI (0-1: mild; 2: moderate; 3-4: severe).Collateral circulation was assessed using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grading scale on digital subtraction angiography(DSA).Multivariate logistic regression was performed to identify risk factors for poor outcomes.Receiver operating characteristic (ROC) curves evaluated the predictive value of IGR for poor outcomes.Patients were further stratified into fast-IGR (≥9.78 mL/h) and slow-IGR groups based on the optimal IGR cutoff.
Results
Compared to the favorable outcome group, the poor outcome group exhibited significantly higher age, baseline NIHSS score, IGR, and CSVD burden, and lower ASITN/SIR scores (all P＜0.001).Multivariate analysis identified age, baseline NIHSS score, ASITN/SIR score, IGR, and moderate-to-severe CSVD as independent risk factors for 90-day poor outcomes.ROC analysis showed an area under the curve (AUC)of 0.813 (95% CI: 0.738-0.905, P＜0.001) for IGR in predicting poor outcomes, with an optimal cutoff of 9.78 mL/h.Fast-IGR patients had higher baseline NIHSS scores and CSVD burden, and lower ASITN/SIR scores(all P＜0.001).Multivariate logistic regression identified NIHSS score, ASITN/SIR score, and moderate-tosevere CSVD were independent risk factors for fast IGR (P＜0.05).
Conclusion
Increased CSVD burden is associated with impaired collateral circulation, accelerated IGR, and worse clinical outcomes.Total CSVD burden may serve as a biomarker for predicting tissue injury progression and clinical prognosis after EVT in acute anterior circulation large vessel occlusion.
Ischemic stroke is a major global health challenge with profound impacts on human well-being.Reperfusion therapy represents the most effective intervention, yet successful blood flow restoration often triggers cerebral ischemia-reperfusion injury (CIRI), a complex pathological cascade that exacerbates structural damage and functional deficits.Real-time monitoring, early warning, and timely intervention are prerequisites for mitigating CIRI.Consequently, the development of highly sensitive and specific probes and technologies for CIRI detection has emerged as a research priority.This review systematically summarizes advances in molecular probes and analytical platforms targeting CIRI-related reactive species, mitochondrial dysfunction, and biothiol homeostasis.These innovations not only provide diagnostic and therapeutic insights for CIRI but also serve as critical tools for advancing neuroprotective strategies.
In recent years, the rapid advancement of neuroimaging techniques and the continuous discovery, validation and exploration of novel biomarkers have significantly increased the detection rate of cerebral small vessel disease (CSVD).Cognitive impairment caused by CSVD is highly prevalent and exerts a substantial negative impact on the quality of life among the Chinese population.Consequently, CSVD and its associated cognitive impairment have emerged as both a major focus and a substantial challenge in scientific research.Current evidence strongly supports that inflammatory mechanisms, particularly vascular inflammatory responses mediated by lipoprotein-associated phospholipase A2 (LP-PLA2), play a critical role in the pathogenesis and progression of CSVD and its cognitive sequelae.For instance, LP-PLA2-driven pathways may contribute to blood-brain barrier disruption, structural and functional damage to vascular endothelium, acceleration of atherosclerosis, and sustained chronic inflammatory states, all of which collectively influence the initiation and progression of CSVD-related cognitive impairment.This review aims to synthesize recent advances in understanding cognitive impairment in CSVD and to elucidate the biological role of LPPLA2 as a representative mediator of specific vascular inflammatory responses in its pathological cascade.
