Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors.

OBJECTIVE: To evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: All patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985-1993, 1994-2002, and 2003-2011). Multivariable ordinal and logistic regression models were applied. RESULTS: Five hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87-3.23, p = 0.124 for 1994-2002; and OR 1.97, 95% CI, 1.08-3.60, p = 0.027 for 2003-2011 vs 1985-1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16-3.82, p = 0.014 for 1994-2002; and OR 2.73; 95% CI 1.54-4.84, p = 0.001 for 2003-2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24-0.99, p = 0.048 for 1994-2002; and OR 0.32, 95% CI 0.16-0.64, p = 0.001 for 2003-2011). CONCLUSION: The decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.

French validation of the Stroke Specific Quality of Life Scale (SS-QoL).

OBJECTIVE: To adapt the SS-QoL into French and test its psychometric properties. METHODS: Seventy-seven patients from a population-based registry were enrolled 3 months after their stroke. SS-QoL, NIHSS score, Barthel index, HAD, FSS, SF-36 scales, and MMSE were administered at enrolment. SS-QoL was re-administered at 15 days and 2 months. Internal consistency was assessed by Cronbach's α coefficients, factorial validity by an exploratory factor analysis and external validity by Mann-Whitney test and Spearman's correlations (ρ), comparing SS-QoL scores with those obtained from established scales. Reliability was assessed by intra-class correlation coefficients (ICC) and responsiveness by standardized effect sizes (ES). RESULTS: Test-retest and inter-observer reliabilities were excellent (ICC> 0.88). Internal consistency was acceptable (α= 0.65-0.91), except for the Personality domain (α= 0.58). Factor analysis individualized eight homogenous axes. SS-QoL scores were different between groups opposed by their modified Rankin score at enrolment or their overall quality of life compared with pre-stroke status (p < 0.001). Ten of the twelve domains correlated moderately (ρ> 0.35) to strongly (ρ> 0.5) with established measures. Nine domains were mildly to moderately responsive to change (ES> 0.3). CONCLUSION: The French version of the SS-QoL is a valid, reliable and moderately responsive instrument.

Associations between Thyroid Stimulating Hormone Levels and Both Severity and Early Outcome of Patients with Ischemic Stroke.

We aimed to investigate associations between serum thyroid stimulating hormone (TSH) levels and both severity and outcome after ischemic stroke (IS). A total of 731 patients consecutive IS patients were enrolled (mean age 69.4 ± 15.4, 61.6% men), and serum TSH levels were measured at admission and analyzed according to the tertiles of their distribution (<0.822 vs. 0.822-1.6 vs. >1.6 mUI/l). Associations between TSH and both severity at admission (National Institutes of Health Stroke Scale (NIHSS) scores <5 vs. ≥5) and functional outcome at discharge assessed by the modified Rankin Scale were analyzed using logistic regression and ordinal logistic regression models, respectively. High TSH levels were independently associated with both a decreased risk of NIHSS score ≥5 at admission (prevalence proportion ratio = 0.62; 95% CI 0.41-0.94, p = 0.024 for tertile 3 vs. tertile 1). In addition, patients with high TSH levels had a better functional outcome at discharge (OR 0.43; 95% CI 0.30-0.60, p < 0.001 for tertile 2 vs. tertile 1; OR 0.39; 95% CI 0.27-0.56, p < 0.001 for tertile 3 vs. tertile 1). The mechanisms underlying these associations and their potential exploitation in terms of therapeutic strategies need to be explored.

Association between Admission Serum 25-Hydroxyvitamin D Levels and Functional Outcome of Thrombolyzed Stroke Patients.

BACKGROUND: 25-Hydroxyvitamin D (25(OH)D) deficiency is a frequent condition in patients who suffer a stroke, and several studies suggested that it may be associated with a poorer prognosis. The aim of this study was to investigate specifically the association between 25(OH)D levels and functional outcome at 3 months in ischemic stroke patients treated with intravenous thrombolysis. METHODS: Consecutive ischemic stroke patients who received intravenous thrombolysis were enrolled between 2010 and 2013. Baseline characteristics were collected, and serum concentrations of 25(OH)D were measured within the first 24 hours after admission and were analyzed according to the quartiles of their distribution (<25 nmol/L versus ≥ 25 nmol/L). Multivariable ordinal logistic regression was used to evaluate the association between 25(OH)D and 3-month functional outcome assessed by the modified Rankin score. RESULTS: Three hundred fifty-two patients were included (mean age 68.6 ± 15.8, 50.7% women, mean 25(OH)D level 45 ± 25 nmol/L). The characteristics of the patients only differed with regard to higher premorbid functional impairment in patients with low 25(OH)D. In univariate analysis, the risk of functional impairment in patients with low 25(OH)D levels was greater than that in patients with higher 25(OH)D levels (odds ratio [OR] 2.10, 95% confidence interval [CI]: 1.35-3.27, P = .001). This association was still observed after adjustment for confounding variables (OR 1.70, 95% CI: 1.06-2.71, P = .027). CONCLUSION: A low serum 25(OH)D level is associated with worse functional outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. Further investigations are required to understand the underlying mechanisms of this association.

The Clock'N Test as a Possible Measure of Emotions: Normative Data Collected on a Non-clinical Population.

OBJECTIVE: At present emotional experience and implicit emotion regulation (IER) abilities are mainly assessed though self-reports, which are subjected to several biases. The aim of the present studies was to validate the Clock'N test, a recently developed time estimation task employing emotional priming to assess implicitly emotional reactivity and IER. METHODS: In Study 1, the Clock'N test was administered to 150 healthy participants with different age, laterality and gender, in order to ascertain whether these factors affected the test results. In phase 1 participant were asked to judge the duration of seven sounds. In phase 2, before judging the duration of the same sounds, participants were presented with short arousing video-clip used as emotional priming stimuli. Time warp was calculated as the difference in time estimation between phase 2 and phase 1, and used to assess how emotions affected subjective time estimations. In study 2, a representative sample was selected to provide normative scores to be employed to assess emotional reactivity (Score 1) and IER (Score 2), and to calculate statistical cutoffs, based on the 10th and 90th score distribution percentiles. RESULTS: Converging with previous findings, the results of study 1 suggested that the Clock'N test can be employed to assess both emotional reactivity, as indexed by an initial time underestimation, and IER, as indexed by a progressive shift to time overestimation. No effects of gender, age and laterality were found. CONCLUSIONS: These results suggest that the Clock'N test is adapted to assess emotional reactivity and IER. After collection of data on the test discriminant and convergent validity, this test may be employed to assess deficits in these abilities in different clinical populations.

A time estimation task as a possible measure of emotions: difference depending on the nature of the stimulus used.

OBJECTIVE: Time perception is fundamental for human experience. A topic which has attracted the attention of researchers for long time is how the stimulus sensory modality (e.g., images vs. sounds) affects time judgments. However, so far, no study has directly compared the effect of two sensory modalities using emotional stimuli on time judgments. METHODS: In the present two studies, healthy participants were asked to estimate the duration of a pure sound preceded by the presentation of odors vs. emotional videos as priming stimuli (implicit emotion-eliciting task). During the task, skin conductance (SC) was measured as an index of arousal. RESULTS: Olfactory stimuli resulted in an increase in SC and in a constant time overestimation. Video stimuli resulted in an increase in SC (emotional arousal), which decreased linearly overtime. Critically, video stimuli resulted in an initial time underestimation, which shifted progressively towards a time overestimation. These results suggest that video stimuli recruited both arousal-related and attention-related mechanisms, and that the role played by these mechanisms changed overtime. CONCLUSIONS: These pilot studies highlight the importance of comparing the effect of different kinds on temporal estimation tasks, and suggests that odors are well suited to investigate arousal-related temporal distortions, while videos are ideal to investigate both arousal-related and attention-related mechanisms.