NISAN - the National Institute for Stroke and Applied Neurosciences

Permanent link for this collection

https://hdl.handle.net/10292/10244

Institute Director: Professor Valery Feigin

Deputy Director: Associate Professor Alice Theadom

The National Institute for Stroke and Applied Neurosciences (NISAN) conducts epidemiological studies and clinical trials to improve health and outcomes in people with major neurological disorders. Current research programmes focus on:

Stroke
Traumatic brain injury
Neuromuscular disorders

Research with this aim is unique in New Zealand and NISAN is a hub for information sharing and developing a cohesive network between existing research and clinical groups with interests in:

Neuroepidemiology
Public health
Neurorehabilitation
Neuropsychology
Biostatistics

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Now showing 1 - 14 of 14

Assessing the Individual Risk of Stroke in Caregivers of Patients with Stroke
(Georg Thieme Verlag KG, 2024-03-11) Marquez-Romero, Juan Manuel; Romo-Martínez, Jessica; Hernández-Curiel, Bernardo; Ruiz-Franco, Angélica; Krishnamurthi, Rita; Feigin, Valery
BACKGROUND: Genetic factors influence the risk of developing stroke. Still, it is unclear whether this risk is intrinsically high in certain people or if nongenetic factors explain it entirely. OBJECTIVE: To compare the risk of stroke in kin and nonkin caregivers. METHODS: In a cross-sectional study using the Stroke Riskometer app (AUT Ventures Limited, Auckland, AUK, New Zealand), we determined the 5- and 10-year stroke risk (SR) among caregivers of stroke inpatients. The degree of kinship was rated with a score ranging from 0 to 50 points. RESULTS: We studied 278 caregivers (69.4% of them female) with a mean age of 47.5 ± 14.2 years. Kin caregivers represented 70.1% of the sample, and 49.6% of them were offspring. The median SR at 5 years was of 2.1 (range: 0.35-17.3) versus 1.73 (range: 0.04-29.9), and of 4.0 (range: 0.45-38.6) versus 2.94 (range: 0.05-59.35) at 10 years for the nonkin and kin caregivers respectively. In linear logistic regression controlled for the age of the caregivers, adding the kinship score did not increase the overall variability of the model for the risk at 5 years (R2 = 0.271; p = 0.858) nor the risk at 10 years (R2 = 0.376; p = 0.78). CONCLUSION: Caregivers of stroke patients carry a high SR regardless of their degree of kinship.
Association of Early Blood-Based Biomarkers and Six-Month Functional Outcomes in Conventional Severity Categories of Traumatic Brain Injury: Capturing the Continuous Spectrum of Injury
(Elsevier BV, 2024) Wilson, L; Newcombe, VFJ; Whitehouse, DP; Mondello, S; Maas, AIR; Menon, DK; Ackerlund, C; Amrein, K; Andelic, N; Andreassen, L; Anke, A; Antoni, A; Audibert, G; Azouvi, P; Azzolini, ML; Bartels, R; Barzó, P; Beauvais, R; Beer, R; Bellander, BM; Belli, A; Benali, H; Berardino, M; Beretta, L; Blaabjerg, M; Bragge, P; Brazinova, A; Brinck, V; Brooker, J; Brorsson, C; Buki, A; Bullinger, M; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, MR; Cameron, P; Lozano, GC; Carbonara, M; Castaño-León, AM; Cavallo, S; Chevallard, G; Chieregato, A; Citerio, G; Clusmann, H; Coburn, MS; Coles, J; Cooper, JD; Correia, M; Čović, A; Curry, N; Czeiter, E; Czosnyka, M; Dahyot-Fizelier, C; Dark, P; Dawes, H; De Keyser, V; Degos, V; Della Corte, F; Boogert, HD; Depreitere, B; Đilvesi, Đ; Dixit, A; Donoghue, E; Dreier, J; Dulière, GL; Ercole, A; Esser, P; Ezer, E; Fabricius, M; Feigin, VL; Foks, K; Frisvold, S; Furmanov, A; Gagliardo, P; Galanaud, D; Gantner, D; Gao, G; George, P; Ghuysen, A; Giga, L; Glocker, B; Golubović, J; Gomez, PA; Gratz, J; Gravesteijn, B; Grossi, F; Gruen, RL; Gupta, D; Haagsma, JA; Haitsma, I; Helbok, R; Helseth, E; Horton, L; Huijben, J; Hutchinson, PJ; Jacobs, B; Jankowski, S; Jarrett, M; Jiang, JY
Background: Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods: Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings: Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation: Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity. Funding: European Union 7th Framework program (EC grant 602150), Hannelore Kohl Stiftung, One Mind, Integra LifeSciences, Neuro-Trauma Sciences, NIHR Rosetrees Trust.
Ethnic Differences in Stroke Outcomes in Aotearoa New Zealand: A National Linkage Study
(SAGE Publications, 2023-03-05) Denison, Hayley; Corbin, Marine; Douwes, Jeroen; Thompson, Stephanie; Harwood, Matire; Davis, Alan; Fink, John N; Barber, P Alan; Gommans, John; Cadilhac, Dominique; Levack, William; McNaughton, Harry; Kim, Joosup; Feigin, VL; Abernethy, Virginia; Girvan, Jackie; Wilson, Andrew; Ranta, Annemarei
BACKGROUND: Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke sub-types, but evidence is mixed. AIMS: This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. METHODS: This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017-October 2018 were included (N=6,879). Post-stroke unfavourable outcome was defined as being dead, change in residence, or unemployed if working pre-stroke. RESULTS: In total, 5,394 NZ Europeans, 762 Māori, 369 Pacific Peoples and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavourable outcome at all three time-points (OR=1.6 (95%CI=1.3-1.9); 1.4 (1.2-1.7); 1.4 (1.2-1.7), respectively). Māori also had increased odds of death at all time-points (1.7 (1.3-2.1); 1.5 (1.2-1.9); 1.7 (1.3-2.1)) and unemployment at twelve months (2.5 (1.2-5.2). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. CONCLUSIONS: We found ethnic disparities in care and outcomes following stroke, independent of traditional risk factors raising concern for potential unconscious bias and institutional racism in stroke services.
Frequency and Predictors of Headache in the First 12 Months After Traumatic Brain Injury: Results from CENTER-TBI
(BMC, 2024-03-25) Howe, Emilie Isager; Andelic, Nada; Brunborg, Cathrine; Zeldovich, Marina; Helseth, Eirik; Skandsen, Toril; Olsen, Alexander; Fure, Silje CR; Theadom, Alice; Rauen, Katrin; Madsen, Benedikte Å; Jacobs, Bram; van der Naalt, Joukje; Tartaglia, Maria Carmela; Einarsen, Cathrine Elisabeth; Storvig, Gøril; Tronvik, Erling; Tverdal, Cathrine; von Steinbüchel, Nicole; Røe, Cecilie; Hellstrøm, Torgeir; CENTER-TBI Participants and Investigators
BACKGROUND: Headache is a prevalent and debilitating symptom following traumatic brain injury (TBI). Large-scale, prospective cohort studies are needed to establish long-term headache prevalence and associated factors after TBI. This study aimed to assess the frequency and severity of headache after TBI and determine whether sociodemographic factors, injury severity characteristics, and pre- and post-injury comorbidities predicted changes in headache frequency and severity during the first 12 months after injury. METHODS: A large patient sample from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study was used. Patients were stratified based on their clinical care pathway: admitted to an emergency room (ER), a ward (ADM) or an intensive care unit (ICU) in the acute phase. Headache was assessed using a single item from the Rivermead Post-Concussion Symptoms Questionnaire measured at baseline, 3, 6 and 12 months after injury. Mixed-effect logistic regression analyses were applied to investigate changes in headache frequency and associated predictors. RESULTS: A total of 2,291 patients responded to the headache item at baseline. At study enrolment, 59.3% of patients reported acute headache, with similar frequencies across all strata. Female patients and those aged up to 40 years reported a higher frequency of headache at baseline compared to males and older adults. The frequency of severe headache was highest in patients admitted to the ICU. The frequency of headache in the ER stratum decreased substantially from baseline to 3 months and remained from 3 to 6 months. Similar trajectory trends were observed in the ICU and ADM strata across 12 months. Younger age, more severe TBI, fatigue, neck pain and vision problems were among the predictors of more severe headache over time. More than 25% of patients experienced headache at 12 months after injury. CONCLUSIONS: Headache is a common symptom after TBI, especially in female and younger patients. It typically decreases in the first 3 months before stabilising. However, more than a quarter of patients still experienced headache at 12 months after injury. Translational research is needed to advance the clinical decision-making process and improve targeted medical treatment for headache. TRIAL REGISTRATION: ClinicalTrials.gov NCT02210221.
Global Stroke Statistics 2023: Availability of Reperfusion Services Around the World
(SAGE Publications, 2023-10-18) Kim, Joosup; Olaiya, Muideen T; De Silva, Deidre Anne; Norrving, Bo; Bosch, Jackie; Aguiar de Sousa, Diana; Christensen, Hanne; Ranta, Anna; Donnan, Geoffrey; Feigin, Valery L; Martins, Sheila; Schwamm, Lee; Werring, David; Howard, George; Owolabi, Mayowa; Pandian, Jeyaraj Durai; Mikulik, Robert; Thayabaranathan, Tharshanah; Cadilhac, Dominique
BACKGROUND: Disparities in the availability of reperfusion services for acute ischaemic stroke are considerable globally, and require urgent attention. Contemporary data on the availability of reperfusion services in different countries provide the necessary evidence to prioritise where access to acute stroke treatment is needed. AIMS: To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services. Methods: We searched PubMed to identify original papers, published up to January 2023, with the most recent, representative and relevant data for each country. Keywords included thrombolysis and telemedicine. We also screened reference lists of review papers, citation history of papers, and the grey literature. The information is provided as a narrative summary. RESULTS: Of 11,222 potentially eligible papers retrieved, 148 were included for review following de-duplications and full text review. Data were also obtained from national stroke clinical registry reports, Registry of Stroke Care Quality (RES-Q) and Pre-hospital Stroke Treatment Organization (PRESTO) repositories, and other national sources. Overall, we found evidence of the provision of intravenous thrombolysis services in 70 countries (6463% high-income countries (HICs)) and endovascular thrombectomy services in 33 countries (68% HICs), corresponding to far less than half of the countries in the world. Recent data (from 2019 or later) were lacking for 35 of 67 countries with known year of data (52%). We found published data on 74 different stroke telemedicine programs (93% in HICs) and 14 active mobile stroke unit pre-hospital ambulances services (80% in HICs) around the world. CONCLUSION: Despite remarkable advancements in reperfusion therapies for stroke, it is evident from available data that their availability remains unevenly distributed globally. Contemporary published data on availability of reperfusion services remain scarce, even in HICs, thereby making it difficult to reliably ascertain current gaps in the provision of this vital acute stroke treatment around the world.
Global, Regional, and National Burden of Disorders Affecting the Nervous System, 1990–2021: A Systematic Analysis for the Global Burden of Disease Study 2021
(Elsevier BV, 2024) Steinmetz, Jaimie D; Seeher, Katrin Maria; Schiess, Nicoline; Nichols, Emma; Cao, Bochen; Servili, Chiara; Cavallera, Vanessa; Cousin, Ewerton; Hagins, Hailey; Moberg, Madeline E; Mehlman, Max L; Abate, Yohannes Habtegiorgis; Abbas, Jaffar; Abbasi, Madineh Akram; Abbasian, Mohammadreza; Abbastabar, Hedayat; Abdelmasseh, Michael; Abdollahi, Mohammad; Abdollahi, Mozhan; Abdollahifar, Mohammad-Amin; Abd-Rabu, Rami; Abdulah, Deldar Morad; Abdullahi, Auwal; Abedi, Aidin; Abedi, Vida; Abeldaño Zuñiga, Roberto Ariel; Abidi, Hassan; Abiodun, Olumide; Aboagye, Richard Gyan; Abolhassani, Hassan; Aboyans, Victor; Abrha, Woldu Aberhe; Abualhasan, Ahmed; Abu-Gharbieh, Eman; Aburuz, Salahdein; Adamu, Lawan Hassan; Addo, Isaac Yeboah; Adebayo, Oladimeji M; Adekanmbi, Victor; Adekiya, Tayo Alex; Adikusuma, Wirawan; Adnani, Qorinah Estiningtyas Sakilah; Adra, Saryia; Afework, Tsion; Afolabi, Aanuoluwapo Adeyimika; Afraz, Ali; Afzal, Saira; Aghamiri, Shahin; Agodi, Antonella; Agyemang-Duah, Williams; Ahinkorah, Bright Opoku; Ahmad, Aqeel; Ahmad, Danish; Ahmad, Sajjad; Ahmadzade, Amir Mahmoud; Ahmed, Ali; Ahmed, Ayman; Ahmed, Haroon; Ahmed, Jivan Qasim; Ahmed, Luai A; Ahmed, Muktar Beshir; Ahmed, Syed Anees; Ajami, Marjan; Aji, Budi; Ajumobi, Olufemi; Akade, Seyed Esma'il; Akbari, Morteza; Akbarialiabad, Hossein; Akhlaghi, Shiva; Akinosoglou, Karolina; Akinyemi, Rufus Olusola; Akonde, Maxwell; Al Hasan, Syed Mahfuz; Alahdab, Fares; AL-Ahdal, Tareq Mohammed Ali; Al-amer, Rasmieh Mustafa; Albashtawy, Mohammed; AlBataineh, Mohammad T; Aldawsari, Khalifah A; Alemi, Hediyeh; Alemi, Sharifullah; Algammal, Abdelazeem M; Al-Gheethi, Adel Ali Saeed; Alhalaiqa, Fadwa Alhalaiqa Naji; Alhassan, Robert Kaba; Ali, Abid; Ali, Endale Alemayehu; Ali, Liaqat; Ali, Mohammed Usman; Ali, Musa Mohammed; Ali, Rafat; Ali, Shahid; Ali, Syed Shujait Shujait; Ali, Zahid; Alif, Sheikh Mohammad; Alimohamadi, Yousef; Aliyi, Ahmednur Adem; Aljofan, Mohamad; Aljunid, Syed Mohamed; Alladi, Suvarna; Almazan, Joseph Uy; Almustanyir, Sami; Al-Omari, Basem; Alqahtani, Jaber S; Alqasmi, Ibrahim; Alqutaibi, Ahmed Yaseen; Al-Shahi Salman, Rustam; Altaany, Zaid; Al-Tawfiq, Jaffar A; Altirkawi, Khalid A; Alvis-Guzman, Nelson; Al-Worafi, Yaser Mohammed; Aly, Hany; Aly, Safwat; Alzoubi, Karem H; Amani, Reza; Amindarolzarbi, Alireza; Amiri, Sohrab; Amirzade-Iranaq, Mohammad Hosein; Amu, Hubert; Amugsi, Dickson A; Amusa, Ganiyu Adeniyi; Amzat, Jimoh; Ancuceanu, Robert; Anderlini, Deanna; Anderson, David B; Andrei, Catalina Liliana; Androudi, Sofia; Angappan, Dhanalakshmi; Angesom, Teklit W; Anil, Abhishek; Ansari-Moghaddam, Alireza; Anwer, Razique; Arafat, Mosab; Aravkin, Aleksandr Y; Areda, Demelash; Ariffin, Hany; Arifin, Hidayat; Arkew, Mesay; Ärnlöv, Johan; Arooj, Mahwish; Artamonov, Anton A; Artanti, Kurnia Dwi; Aruleba, Raphael Taiwo; Asadi-Pooya, Ali A; Asena, Tilahun Ferede; Asghari-Jafarabadi, Mohammad; Ashraf, Muhammad; Ashraf, Tahira; Atalell, Kendalem Asmare; Athari, Seyyed Shamsadin; Atinafu, Bantalem Tilaye Tilaye; Atorkey, Prince; Atout, Maha Moh'd Wahbi; Atreya, Alok; Aujayeb, Avinash; Avan, Abolfazl; Ayala Quintanilla, Beatriz Paulina; Ayatollahi, Haleh; Ayinde, Olatunde O; Ayyoubzadeh, Seyed Mohammad; Azadnajafabad, Sina; Azizi, Zahra; Azizian, Khalil; Azzam, Ahmed Y; Babaei, Mahsa; Badar, Muhammad; Badiye, Ashish D; Baghdadi, Soroush; Bagherieh, Sara; Bai, Ruhai; Baig, Atif Amin; Balakrishnan, Senthilkumar; Balalla, Shivanthi; Baltatu, Ovidiu Constantin; Banach, Maciej; Bandyopadhyay, Soham; Banerjee, Indrajit; Baran, Mehmet Firat; Barboza, Miguel A; Barchitta, Martina; Bardhan, Mainak; Barker-Collo, Suzanne Lyn; Bärnighausen, Till Winfried; Barrow, Amadou; Bashash, Davood; Bashiri, Hamideh; Bashiru, Hameed Akande; Basiru, Afisu; Basso, João Diogo; Basu, Sanjay; Batiha, Abdul-Monim Mohammad; Batra, Kavita; Baune, Bernhard T; Bedi, Neeraj; Begde, Ahmet; Begum, Tahmina; Behnam, Babak; Behnoush, Amir Hossein; Beiranvand, Maryam; Béjot, Yannick; Bekele, Alehegn; Belete, Melaku Ashagrie; Belgaumi, Uzma Iqbal; Bemanalizadeh, Maryam; Bender, Rose G; Benfor, Bright; Bennett, Derrick A; Bensenor, Isabela M; Berice, Betyna; Bettencourt, Paulo JG; Beyene, Kebede A; Bhadra, Abhishek; Bhagat, Devidas S; Bhangdia, Kayleigh; Bhardwaj, Nikha; Bhardwaj, Pankaj; Bhargava, Ashish; Bhaskar, Sonu; Bhat, Ajay Nagesh; Bhat, Vivek; Bhatti, Gurjit Kaur; Bhatti, Jasvinder Singh; Bhatti, Rajbir; Bijani, Ali; Bikbov, Boris; Bilalaga, Mariah Malak; Biswas, Atanu; Bitaraf, Saeid; Bitra, Veera R; Bjørge, Tone; Bodolica, Virginia; Bodunrin, Aadam Olalekan; Boloor, Archith; Braithwaite, Dejana; Brayne, Carol; Brenner, Hermann; Briko, Andrey; Bringas Vega, Maria L; Brown, Julie; Budke, Christine M; Buonsenso, Danilo; Burkart, Katrin; Burns, Richard A; Bustanji, Yasser; Butt, Muhammad Hammad; Butt, Nadeem Shafique; Butt, Zahid A; Cabral, Lucas Scotta; Caetano dos Santos, Florentino Luciano; Calina, Daniela; Campos-Nonato, Ismael R; Cao, Chao; Carabin, Hélène; Cárdenas, Rosario; Carreras, Giulia; Carvalho, Andre F; Castañeda-Orjuela, Carlos A; Casulli, Adriano; Catalá-López, Ferrán; Catapano, Alberico L; Caye, Arthur; Cegolon, Luca; Cenderadewi, Muthia; Cerin, Ester; Chacón-Uscamaita, Pamela R Uscamaita; Chan, Jeffrey Shi Kai; Chanie, Gashaw Sisay; Charan, Jaykaran; Chattu, Vijay Kumar; Chekol Abebe, Endeshaw; Chen, Hui; Chen, Jianqi; Chi, Gerald; Chichagi, Fatemeh; Chidambaram, Saravana Babu; Chimoriya, Ritesh; Ching, Patrick R; Chitheer, Abdulaal; Chong, Yuen Yu; Chopra, Hitesh; Choudhari, Sonali Gajanan; Chowdhury, Enayet Karim; Chowdhury, Rajiv; Christensen, Hanne; Chu, Dinh-Toi; Chukwu, Isaac Sunday; Chung, Eric; Coberly, Kaleb; Columbus, Alyssa; Comachio, Josielli; Conde, Joao; Cortesi, Paolo Angelo; Costa, Vera Marisa; Couto, Rosa AS; Criqui, Michael H; Cruz-Martins, Natália; Dabbagh Ohadi, Mohammad Amin; Dadana, Sriharsha; Dadras, Omid; Dai, Xiaochen; Dai, Zhaoli; D'Amico, Emanuele; Danawi, Hadi A; Dandona, Lalit; Dandona, Rakhi; Darwish, Amira Hamed; Das, Saswati; Das, Subasish; Dascalu, Ana Maria; Dash, Nihar Ranjan; Dashti, Mohsen; De la Hoz, Fernando Pio; de la Torre-Luque, Alejandro; De Leo, Diego; Dean, Frances E; Dehghan, Amin; Dehghan, Azizallah; Dejene, Hiwot; Demant, Daniel; Demetriades, Andreas K; Demissie, Solomon; Deng, Xinlei; Desai, Hardik Dineshbhai; Devanbu, Vinoth Gnana Chellaiyan; Dhama, Kuldeep; Dharmaratne, Samath Dhamminda; Dhimal, Meghnath; Dias da Silva, Diana; Diaz, Daniel; Dibas, Mahmoud; Ding, Delaney D; Dinu, Monica; Dirac, M Ashworth; Diress, Mengistie; Do, Thanh Chi; Do, Thao Huynh Phuong; Doan, Khanh Duy Khanh; Dodangeh, Milad; Doheim, Mohamed Fahmy; Dokova, Klara Georgieva; Dongarwar, Deepa; Dsouza, Haneil Larson; Dube, John; Duraisamy, Senbagam; Durojaiye, Oyewole Christopher; Dutta, Sulagna; Dziedzic, Arkadiusz Marian; Edinur, Hisham Atan; Eissazade, Negin; Ekholuenetale, Michael; Ekundayo, Temitope Cyrus; El Nahas, Nevine; El Sayed, Iman; Elahi Najafi, Mohammad Amin; Elbarazi, Iffat; Elemam, Noha Mousaad; Elgar, Frank J; Elgendy, Islam Y; Elhabashy, Hala Rashad; Elhadi, Muhammed; Elilo, Legesse Tesfaye; Ellenbogen, Richard G; Elmeligy, Omar Abdelsadek Abdou; Elmonem, Mohamed A; Elshaer, Mohammed; Elsohaby, Ibrahim; Emamverdi, Mehdi; Emeto, Theophilus I; Endres, Matthias; Esezobor, Christopher Imokhuede; Eskandarieh, Sharareh; Fadaei, Abdolmajid; Fagbamigbe, Adeniyi Francis; Fahim, Ayesha; Faramarzi, Ali; Fares, Jawad; Farjoud Kouhanjani, Mohsen; Faro, Andre; Farzadfar, Farshad; Fatehizadeh, Ali; Fathi, Mobina; Fathi, Saeid; Fatima, Syeda Anum Fatima; Feizkhah, Alireza; Fereshtehnejad, Seyed-Mohammad; Ferrari, Alize J; Ferreira, Nuno; Fetensa, Getahun; Firouraghi, Neda; Fischer, Florian; Fonseca, Ana Catarina; Force, Lisa M; Fornari, Arianna; Foroutan, Behzad; Fukumoto, Takeshi; Gadanya, Muktar A; Gaidhane, Abhay Motiramji; Galali, Yaseen; Galehdar, Nasrin; Gan, Quan; Gandhi, Aravind P; Ganesan, Balasankar; Gardner, William M; Garg, Naval; Gau, Shuo-Yan; Gautam, Rupesh K; Gebre, Teshome; Gebrehiwot, Mesfin; Gebremeskel, Gebreamlak Gebremedhn; Gebreslassie, Haftay Gebremedhin; Getacher, Lemma; Ghaderi Yazdi, Bardiya; Ghadirian, Fataneh; Ghaffarpasand, Fariborz; Ghanbari, Reza; Ghasemi, MohammadReza; Ghazy, Ramy Mohamed; Ghimire, Sailaja; Gholami, Ali; Gholamrezanezhad, Ali; Ghotbi, Elena; Ghozy, Sherief; Gialluisi, Alessandro; Gill, Paramjit Singh; Glasstetter, Logan M; Gnedovskaya, Elena V; Golchin, Ali; Golechha, Mahaveer; Goleij, Pouya; Golinelli, Davide; Gomes-Neto, Mansueto; Goulart, Alessandra C; Goyal, Anmol; Gray, Richard J; Grivna, Michal; Guadie, Habtamu Alganeh; Guan, Bin; Guarducci, Giovanni; Guicciardi, Stefano; Gunawardane, Damitha Asanga; Guo, Hanbing; Gupta, Bhawna; Gupta, Rajeev; Gupta, Sapna; Gupta, Veer Bala; Gupta, Vivek Kumar; Gutiérrez, Reyna Alma; Habibzadeh, Farrokh; Hachinski, Vladimir; Haddadi, Rasool; Hadei, Mostafa; Hadi, Najah R; Haep, Nils; Haile, Teklehaimanot Gereziher; Haj-Mirzaian, Arvin; Hall, Brian J; Halwani, Rabih; Hameed, Sajid; Hamiduzzaman, Mohammad; Hammoud, Ahmad; Han, Hannah; Hanifi, Nasrin; Hankey, Graeme J; Hannan, Md Abdul; Hao, Junwei; Harapan, Harapan; Hareru, Habtamu Endashaw; Hargono, Arief; Harlianto, Netanja I; Haro, Josep Maria; Hartman, Nicholas Nathaniel; Hasaballah, Ahmed I; Hasan, Faizul; Hasani, Hamidreza; Hasanian, Mohammad; Hassan, Amr; Hassan, Shoaib; Hassanipour, Soheil; Hassankhani, Hadi; Hassen, Mohammed Bheser; Haubold, Johannes; Hay, Simon I; Hayat, Khezar; Hegazy, Mohamed I; Heidari, Golnaz; Heidari, Mohammad; Heidari-Soureshjani, Reza; Hesami, Hamed; Hezam, Kamal; Hiraike, Yuta; Hoffman, Howard J; Holla, Ramesh; Hopf, Kathleen Pillsbury; Horita, Nobuyuki; Hossain, Md Mahbub; Hossain, Md Belal; Hossain, Sahadat; Hosseinzadeh, Hassan; Hosseinzadeh, Mehdi; Hostiuc, Sorin; Hu, Chengxi; Huang, Junjie; Huda, Md Nazmul; Hussain, Javid; Hussein, Nawfal R; Huynh, Hong-Han; Hwang, Bing-Fang; Ibitoye, Segun Emmanuel; Ilaghi, Mehran; Ilesanmi, Olayinka Stephen; Ilic, Irena M; Ilic, Milena D; Immurana, Mustapha; Iravanpour, Farideh; Islam, Sheikh Mohammed Shariful; Ismail, Faisal; Iso, Hiroyasu; Isola, Gaetano; Iwagami, Masao; Iwu, Chidozie CD; Iyer, Mahalaxmi; Jaan, Ali; Jacob, Louis; Jadidi-Niaragh, Farhad; Jafari, Mahboobeh; Jafarinia, Morteza; Jafarzadeh, Abdollah; Jahankhani, Kasra; Jahanmehr, Nader; Jahrami, Haitham; Jaiswal, Abhishek; Jakovljevic, Mihajlo; Jamora, Roland Dominic G; Jana, Somnath; Javadi, Nilofer; Javed, Saad; Javeed, Saad; Jayapal, Sathish Kumar; Jayaram, Shubha; Jiang, Heng; Johnson, Catherine Owens; Johnson, Walter D; Jokar, Mohammad; Jonas, Jost B; Joseph, Abel; Joseph, Nitin; Joshua, Charity Ehimwenma; Jürisson, Mikk; Kabir, Ali; Kabir, Zubair; Kabito, Gebisa Guyasa; Kadashetti, Vidya; Kafi, Fatemeh; Kalani, Rizwan; Kalantar, Farnaz; Kaliyadan, Feroze; Kamath, Ashwin; Kamath, Sagarika; Kanchan, Tanuj; Kandel, Amit; Kandel, Himal; Kanmodi, Kehinde Kazeem; Karajizadeh, Mehrdad; Karami, Jafar; Karanth, Shama D; Karaye, Ibraheem M; Karch, André; Karimi, Aliasghar; Karimi, Hanie; Karimi Behnagh, Arman; Kasraei, Hengameh; Kassebaum, Nicholas J; Kauppila, Joonas H; 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Global, Regional, and National Burden of Stroke and Its Risk Factors 1990-2021: A Systematic Analysis for the Global Burden of Disease Study 2021
(Elsevier, 2024) Feigin, Valery; Nair, B; Rautalin, I; Bhatia, A; GBD 2021 Stroke Risk Factor Collaborators
Background Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden.
Living with Dementia in Aotearoa (LiDiA): A feasibility study for a dementia prevalence study in Māori and non-Māori Living in New Zealand
(SAGE Publications, 2023) Martinez-Ruiz, Adrian; Yates, Susan; Cheung, Gary; Cullum, Sarah; Dudley, Makarena; Krishnamurthi, Rita; Fa'alau, Fuafiva; Kerse, Ngaire; Roberts, Mary; Taufa, Seini; Rivera Rodriguez, Claudia
INTRODUCTION: Recent estimations have projected a threefold increase in dementia prevalence in Aotearoa New Zealand (NZ) by 2050, particularly in Maori and Pacific peoples. However, to date, there are no national data on dementia prevalence, and overseas data are used to estimate the NZ dementia statistics. The aim of this feasibility study was to prepare the groundwork for the first full-scale NZ dementia prevalence study that is representative of Māori, European, Pacific and Asian peoples living in NZ. METHODS: The main feasibility issues were: (i) Sampling to ensure adequate community representation from the included ethnic groups, (ii) Preparing a workforce to conduct the fieldwork and developing quality control, (iii) Raising awareness of the study in the communities (iv) Maximizing recruitment by door-knocking, (v) Retaining those we have recruited to the study and (vi) Acceptability of study recruitment and assessment using adapted versions of the 10/66 dementia protocol in different ethnic groups living in South Auckland. RESULTS: We found that a probability sampling strategy using NZ Census data was reasonably accurate and all ethnic groups were sampled effectively. We demonstrated that we were able to train up a multi-ethnic workforce consisting of lay interviewers who were able to administer the 10/66 dementia protocol in community settings. The response rate (224/297, 75.5%) at the door-knocking stage was good but attrition at subsequent stages was high and only 75/297 (25.2%) received the full interview. CONCLUSIONS: Our study showed that it would be feasible to conduct a population-based dementia prevalence study using the 10/66 dementia protocol in Māori, European and Asian communities living in NZ, utilizing a qualified, skilled research team representative of the families participating in the study. The study has demonstrated that for recruitment and interviewing in Pacific communities a different but culturally appropriate approach is required.
Pragmatic Solutions to Reduce the Global Burden of Stroke: A World Stroke Organization-Lancet Neurology Commission
(Elsevier, 2023-10-09) Feigin, Valery L; Owolabi, Mayowa O; World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Group
Prognostic Models for Global Functional Outcome and Post-concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (Center-TBI) Study
(Mary Ann Liebert Inc, 2023-08-16) Mikolić, A; Steyerberg, EW; Polinder, S; Wilson, L; Zeldovich, M; von Steinbueche, N; Newcombe, VFJ; Menon, DK; van der Naalt, J; Lingsma, HF; Maas, AIR; van Klaveren, D; Åkerlund, C; Amrein, K; Andelic, N; Andreassen, L; Anke, A; Antoni, A; Audibert, G; Azouvi, P; Azzolini, ML; Bartels, R; Barzó, P; Beauvais, R; Beer, R; Bellander, BM; Belli, A; Benali, H; Berardino, M; Beretta, L; Blaabjerg, M; Bragge, P; Brazinova, A; Brinck, V; Brooker, J; Brorsson, C; Buki, A; Bullinger, M; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, MR; Cameron, P; Carbayo Lozano, G; Carbonara, M; Cavallo, S; Chevallard, G; Chieregato, A; Citerio, G; Clusmann, H; Coburn, M; Coles, J; Cooper, JD; Correia, M; Čović, A; Curry, N; Czeiter, E; Czosnyka, M; Fizelier, CD; Dark, P; Dawes, H; De Keyser, V; Degos, V; Della Corte, F; den Boogert, H; Depreitere, B; Ðilvesi, Ð; Dixit, A; Donoghue, E; Dreier, J; Dulière, GL; Ercole, A; Esser, P; Ezer, E; Fabricius, M; Feigin, VL; Foks, K; Frisvold, S; Furmanov, A; Gagliardo, P; Galanaud, D; Gantner, D; Gao, G; George, P; Ghuysen, A; Giga, L; Glocker, B; Golubovic, J; Gomez, PA; Gratz, J; Gravesteijn, B; Grossi, F; Gruen, RL; Gupta, D; Haagsma, JA; Haitsma, I; Helbok, R; Helseth, E; Horton, L; Huijben, J
After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3–week post-concussion and mental health symptoms. Predictors were selected based on Akaike’s Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.
Symptoms and Engagement in Anti-social Behaviour 10 Years Following Mild Traumatic Brain Injury Within a Community Civilian Sample: A Prospective Cohort Study with Age-Sex Matched Control Group.
(Elsevier, 2023) Theadom, Alice; Jones, Kelly; Starkey, Nicola; Barker-Collo, Suzanne; Ameratunga, Shanthi; Faulkner, Josh; Ao, Braden Te; Feigin, V
OBJECTIVE: To determine if there are longer-term impacts on symptoms, health status, mood and behaviour 10-years following a mild traumatic brain injury (mTBI). DESIGN: Prospective cohort study SETTING: Community-based, civilian sample PARTICIPANTS: Adults aged ≥16 years at follow up who experienced a mTBI 10-years ago, and an age and sex-matched non-injured control group. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: MTBI cases and controls were asked to complete self-report assessments of functioning (WHODAS 2.0), symptoms (Rivermead Post-Concussion Symptom Questionnaire), health status (100-point scale), alcohol (AUDIT-C) and substance use (ASSIST), and whether they had engaged in any anti-social behaviours over the past 12-months. RESULTS: Data were analysed for 368 participants (184 mTBI cases and 184 age-sex matched controls). Just over a third of mTBI cases (64, 34.8%) reported that they were still affected by their index mTBI 10-years later. After adjusting for education and ethnicity, the mTBI group had statistically higher overall symptom burden (F=22.32, p<0.001, ηp2 =0.07) compared to controls. This difference remained after excluding those who experienced a recurrent TBI. The mTBI group were more than three times as likely to have engaged in anti-social behaviour during the previous 12-months (F=5.89, p=0.02). There were no group differences in health status, functioning, or problematic alcohol or substance use 10-years post-injury. CONCLUSIONS: This study provides evidence of potential longer-term associations between mTBI, post-concussion symptoms and anti-social behaviour which warrants further evaluation. Future research should also examine if longer-term effects may be preventable with access to early rehabilitation post-injury.
Twenty Years on From the Introduction of the High Risk Strategy for Stroke and Cardiovascular Disease Prevention: A Systematic Scoping Review
(Wiley, 2023) Feigin, Valery; Martins, S; Brainin, M; Norrving, B; Kamenova, S; Giniyat, A; Kondybayeva, A; Aldyngurov, DK; Bapayeva, M; Zhanuzakov, M; Hankey, GJ
Background and purpose Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. Methods In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. Results No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. Conclusions Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
Usability and Feasibility of PreventS-MD Webapp for Stroke Prevention
(SAGE Publications, 2023-07-24) Feigin, VL; Krishnamurthi, Rita; Medvedev, Oleg; Merkin, Alexander; Nair, Bala; Kravchenko, Michael; Jalili Moghaddam, Shabnam; Barker-Collo, Suzanne Lyn; Rathnasabapathy, Yogini; Skinner, Luke; Owolabi, Mayowa; Norrving, Bo; Sachdev, Perminder S; Arroll, Bruce; Brainin, Michael; Thrift, Amanda G; Hankey, Graeme J
Background: Most strokes and cardiovascular diseases (CVDs) are potentially preventable if their risk factors are identified and well controlled. Digital platforms, such as the PreventS-MD webapp (PreventS-MD) may aid health care professionals (HCPs) in assessing and managing risk factors and promoting lifestyle changes for their patients. Methods: This is a mixed methods cross-sectional 2-phase survey using a largely positivist (quantitative and qualitative) framework. During phase 1, a prototype of PreventS-MD was tested internationally by 59 of 69 consenting HCPs of different backgrounds, age, sex, working experience and specialities using hypothetical data. Collected comments/suggestions from the study HCPs in phase 1 were reviewed and implemented. In phase 2, a near-final version of PreventS-MD was developed and tested by 58 of 72 consenting HCPs using both hypothetical and real patient (n=10) data. Qualitative semi-structured interviews with real patients (n=10) were conducted, and 1-month adherence to the preventative recommendations was assessed by self-reporting. The four System Usability Scale (SUS) groups of scores (0-50 unacceptable; 51-68 poor, 68-80.3 good; >80.3 excellent) were used to determine usability of PreventS-MD. Findings: 99 HCPs from 27 countries (45% from low- to middle-income countries) participated in the study, out of whom 10 HCPs were involved in the development of PreventS before the study, and therefore were not involved in the survey. Of the remaining 89 HCPs 69 consented to the first phase of the survey, out of whom 59 completed the first phase of the survey (response rate 86%) and 58 HCPs completed the second phase of the survey (response rate 84%). The SUS scores supported good usability of the prototype (mean score=80.2; 95% CI [77.0-84.0]) and excellent usability of the final version of PreventS-MD (mean score=81.7; 95%CI [79.1-84.3]) in the field. Scores were not affected by the age, sex, working experience or speciality of the HCPs. One month follow-up of the patients confirmed the high level of satisfaction/acceptability of PreventS-MD and (100%) adherence to the recommendations. Interpretation: The PreventS-MD webapp has a high level of usability, feasibility and satisfaction by HCPs and individuals at risk of stroke/CVD. Individuals at risk of stroke/CVD demonstrated a high level of confidence and motivation in following and adhering to preventative recommendations generated by PreventS-MD.
Using Network Analysis To Validate Domains of the Modified Telephone Interview for Cognitive Status
(Wiley, 2023) Cuong, TQ; Cervin, M; Numbers, K; Choo, CC; Bentvelzen, AC; Merkin, AG; Sachdev, PS; Feigin, V; Brodaty, H; Kochan, NA; Medvedev, ON
Background The modified Telephone Interview for Cognitive Status (TICS-M) is a widely used tool for assessing global cognitive functions and screening for cognitive impairments. The tool was conceptualised to capture various cognitive domains, but the validity of such domains has not been investigated against comprehensive neuropsychological assessments tools. Therefore, this study aimed to explore the associations between the TICS-M domains and neuropsychological domains to evaluate the validity of the TICS-M domains using network analysis. Materials and Methods A longitudinal research design was used with a large sample of older adults (aged above 70 years; n = 1037 at the baseline assessment) who completed the TICS-M and comprehensive neuropsychological assessments biennially. We applied network analysis to identify unique links between the TICS-M domains and neuropsychological test scores. Results At baseline, there were weak internal links between the TICS-M domains. The TICS-M memory and language domains were significantly related to their corresponding neuropsychological domains. The TICS-M attention domain had significant associations with executive function and visuospatial abilities. The TICS-M orientation domain was not significantly associated with any of the five neuropsychological domains. Despite an attrition of almost 50% at wave four, weak internal links between the TICS-M domains and most associations between TICS-M and neuropsychological domains that were found initially, remained stable at least over two waves within the 6-year period. Conclusions This study supports the overall structural validity of the TICS-M screener in assessing enduring global cognitive function. However, separate TICS-M cognitive domains should not be considered equivalent to the analogous neuropsychological domains.

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