Publications by authors named "Mayowa Owolabi"

157 Publications

Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans.

Stroke 2021 Sep 30:STROKEAHA120032072. Epub 2021 Sep 30.

Federal Medical Centre Umuahia, , Nigeria (K.U., I.I.C., U.O., O.O., K.A.O.).

Background And Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans.

Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI.

Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (<0.0001).

Conclusions: Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.
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http://dx.doi.org/10.1161/STROKEAHA.120.032072DOI Listing
September 2021

Dementia in Africa: Current evidence, knowledge gaps, and future directions.

Alzheimers Dement 2021 Sep 27. Epub 2021 Sep 27.

Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria.

In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
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http://dx.doi.org/10.1002/alz.12432DOI Listing
September 2021

Stroke in Africa: profile, progress, prospects and priorities.

Nat Rev Neurol 2021 Oct 15;17(10):634-656. Epub 2021 Sep 15.

Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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http://dx.doi.org/10.1038/s41582-021-00542-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441961PMC
October 2021

Quality of stroke guidelines in low- and middle-income countries: a systematic review.

Bull World Health Organ 2021 Sep 29;99(9):640-652E. Epub 2021 Jun 29.

Department of Medicine, University College Hospital, Ibadan, Nigeria.

Objective: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries.

Methods: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences.

Findings: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations.

Conclusion: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.
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http://dx.doi.org/10.2471/BLT.21.285845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8381090PMC
September 2021

Prestroke cognitive decline in africans: Prevalence, predictors and association with poststroke dementia.

J Neurol Sci 2021 Oct 19;429:117619. Epub 2021 Aug 19.

Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.

Objectives: Pre-existing cognitive decline is a risk factor for stroke onset and poststroke dementia. There is a knowledge gap on prestroke cognitive decline in indigenous Africans. We estimated prevalence and predictors of prestroke cognitive decline, as well as its association with poststroke dementia at one year in Nigerian survivors of a first ever stroke.

Methods: Prospective observational study. Prestroke cognitive decline was ascertained using an average score > 3.31 on the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQ-CODE). Poststroke dementia was ascertained according to the 'National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria'. Associations were investigated using multivariate logistic regression models and presented as odds ratios (O.R) within 95% confidence intervals (C.I).

Results: Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I = 11.5%-23.6%). In analyses adjusting for the effect of age, education and stroke severity, prestroke cognitive decline was associated with diabetes mellitus (O.R = 3.0, 95% C.I = 1.2-7.6). Ten (62.5%) survivors in the prestroke cognitive decline sub-sample developed dementia at one-year poststroke. In analyses adjusting for the effects of age, education, stroke severity and comorbid diabetes mellitus, survivors with prestroke cognitive decline had six times the odds of dementia at one year poststroke (O.R = 6.2, 95% C.I = 1.3-30.4).

Conclusion: Prestroke cognitive decline is common, assessment is feasible and identifying pre-stroke problems has prognostic implications.
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http://dx.doi.org/10.1016/j.jns.2021.117619DOI Listing
October 2021

New Onset Poststroke Dementia at one Year in Africans.

J Geriatr Psychiatry Neurol 2021 Aug 2:8919887211036190. Epub 2021 Aug 2.

Department of Psychiatry, College of Medicine University of Ibadan, Ibadan, Nigeria.

Background: There is limited information on new onset poststroke dementia (NPSD) in sub-Saharan Africa (SSA). We estimated incidence, cumulative incidence, risk factors and outcome of NPSD at 1 year in Nigerian survivors of a first-ever stroke.

Methods: Hospital-based prospective observational study. Assessments for global cognition, learning, memory, executive and activities of daily life (ADL) functioning were conducted at 3 poststroke timepoints (Baseline, 3- and 12 months). NPSD was ascertained according to the "National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria." Outcomes were assessed using the modified Rankin Scale (mRS), center for epidemiologic studies depression scale (CES-D 10), health related quality of life in stroke patients (HRQOLISP-26) and caregivers strain index (CSI).

Results: Among 144 stroke survivors who were free of dementia at baseline, we found a 1-year cumulative incidence of 4.52% (95% C.I = 3.20, 6.39). In multivariate Cox regression analyses, diabetes was associated with NPSD (Hazard Ratio = 2.10, 95% CI = 1.02, 4.35). NPSD at 3 months was independently associated with motor decline [Mean difference (MD) in mRS = 1.6, 95% C.I = 0.9, 2.3)], depression (MD in CES-D = 2.9, 95% C.I = 0.3, 5.4), caregivers burden (MD in CSI = 1.2, 95% C.I = 0.5, 1.8), and poor quality of life (MD in HRQOLISP-26 = -11.2, 95% C.I = -15.7, -6.8) at 1 year.

Conclusion: Approximately 4.5% of stroke survivors in Nigeria had NPSD at 1 year. Diabetes, which can be prevented, represent a primary prevention target for NPSD and its consequences in SSA.
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http://dx.doi.org/10.1177/08919887211036190DOI Listing
August 2021

A Novel Afrocentric Stroke Risk Assessment Score: Models from the Siren Study.

J Stroke Cerebrovasc Dis 2021 Oct 28;30(10):106003. Epub 2021 Jul 28.

Medical University of South Carolina, SC, USA.

Background: Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African.

Objectives: To develop Afrocentric risk-scoring models for stroke occurrence.

Materials And Methods: We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off.

Results: For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%).

Conclusions: The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.106003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511059PMC
October 2021

Influence of age on links between major modifiable risk factors and stroke occurrence in West Africa.

J Neurol Sci 2021 09 9;428:117573. Epub 2021 Jul 9.

College of Medicine, University of Ibadan, Nigeria. Electronic address:

Background The burden of stroke in Africa is high. Understanding how age associates with major modifiable stroke risk factors could inform tailored demographic stroke prevention strategies. Purpose To quantify the magnitude and direction of the effect sizes of key modifiable stroke risk factors according to three age groups: <50 years (young), 50-65 years (middle age) and > 65 years (elderly) in West Africa. Methods This was a case-control study involving 15 sites in Ghana and Nigeria. Cases included adults aged ≥18 years with CT/MRI scan-typed stroke. Controls were age-and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. We estimated adjusted odds ratios (aOR) using conditional logistic regression and population attributable risk (PAR) with 95% Confidence Interval of vascular risk factors by age groups. Results Among 3553 stroke cases, 813 (22.9%) were young, 1441 (40.6%) were middle-aged and 1299 (36.6%) were elderly. Among the 5 co-shared risk factors, dyslipidemia with PAR and aOR (95%CI) of 62.20% (52.82-71.58) and 4.13 (2.64-6.46) was highest among the young age group; hypertension with PAR of 94.31% (91.82-96.80) and aOR of 28.93 (15.10-55.44) was highest among the middle-age group. Diabetes with PAR of 32.29%(27.52-37.05) and aOR of 3.49 (2.56-4.75); meat consumption with PAR of 42.34%(32.33-52.35) and aOR of 2.40 (1.76, 3.26); and non-consumption of green vegetables, PAR of 16.81%(12.02-21.60) and aOR of 2.23 (1.60-3.12) were highest among the elderly age group. However confidence intervals of risk estimates overlapped across age groups. Additionally, among the young age group cigarette smoking, psychosocial stress and cardiac disease were independently associated with stroke. Furthermore, education, stress, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusion There is a differential influence of age on the associations of major risk factors with stroke in this West African cohort. Targeting modifiable factors predominant within an age group may be more effective as a stroke prevention strategy.
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http://dx.doi.org/10.1016/j.jns.2021.117573DOI Listing
September 2021

Strategies for Reducing Non-Communicable Diseases in Africa.

Pharmacol Res 2021 08 17;170:105736. Epub 2021 Jun 17.

Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, University College Hospital, Ibadan, Nigeria. Electronic address:

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http://dx.doi.org/10.1016/j.phrs.2021.105736DOI Listing
August 2021

Frequency and factors associated with post-stroke seizures in a large multicenter study in West Africa.

J Neurol Sci 2021 Aug 9;427:117535. Epub 2021 Jun 9.

Federal Medical Centre, Abeokuta, Nigeria; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria.

Background: Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa.

Purpose: To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana.

Methods: We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.

Results: Among 3344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7-16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p = 0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p = 0.01. The factors associated with PSS occurrence were age < 50 years, aOR of 1.59 (1.08-2.33), National Institute of Health Stroke Score (NIHSS), 1.29 (1.16-1.42) for each 5 units rise and white cell count 1.07 (1.01-1.13) for each 10^3 mm rise. Factors associated with PSS in ischemic were NIHSS score, aOR of 1.17 (1.04-1.31) and infarct volume of 10-30 cm aOR of 2.17(1.37-3.45). Among ICH, associated factors were alcohol use 5.91 (2.11-16.55) and lobar bleeds 2.22 (1.03-4.82).

Conclusion: The burden of PSS among this sample of west Africans is substantial and may contribute to poor outcomes of stroke in this region. Further longitudinal studies are required to understand the impact on morbidity and mortality arising from PSS in Africa.
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http://dx.doi.org/10.1016/j.jns.2021.117535DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325635PMC
August 2021

Dietary intakes of green leafy vegetables and incidence of cardiovascular diseases.

Cardiovasc J Afr 2021 Jul-Aug 23;32(4):215-223. Epub 2021 Jun 10.

Department of Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria; Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan; University College Hospital; Blossom Specialist Medical Centre, Ibadan, Nigeria. Email:

Aim: Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. This study sought to determine the specific effect of GLV intake on the incidence of CVD.

Methods: Previously published cohort studies on GLV intake and incidence of CVD were retrieved through a systematic search of Google Scholar, EMBASE, MEDLINE, HINARI and Cochrane Library. A methodological evaluation of studies was carried out using the network of Ottawa scale, and a fixed-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI). Heterogeneity was determined using the I statistic. Sensitivity analysis was done using the leave-one-study-out technique. All statistical analysis was carried out at < 0.05 using RevMan 5.4.

Results: The pooled RR (95% CI) of incident CVD events from 17 studies was 0.93 (0.92-0.95). Specifically, GLV intake was inversely related with incident cerebral infarction (RR: 0.92; 95% CI: 0.88-0.96), heart disease (RR: 0.93; 95% CI: 0.87-0.99) and other CVD events (RR: 0.95; 95% CI: 0.93-0.98).

Conclusions: GLV intake was associated with a lower incidence of CVD, and may be a promising primary-prevention strategy against CVD events. The findings are especially important in LMICs where the burden of CVD remains high.
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http://dx.doi.org/10.5830/CVJA-2021-017DOI Listing
June 2021

The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys.

Int J Stroke 2021 May 27:17474930211019568. Epub 2021 May 27.

National Institute for Stroke and Applied Neurosciences (NISAN), School of Clinical Sciences, Auckland University of Technology, New Zealand.

Background: Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization- Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries.

Methods: Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019.

Results: Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ∼ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol.

Conclusions: There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.
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http://dx.doi.org/10.1177/17474930211019568DOI Listing
May 2021

Cognitive decline before and after a first-ever stroke in Africans.

Acta Neurol Scand 2021 Sep 29;144(3):266-274. Epub 2021 Apr 29.

Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Objectives: There is a knowledge gap on the impact of pre-existing cognitive decline on poststroke decline in indigenous Africans. We describe the trajectories of domain-specific cognitive and activities of daily life (ADL) functioning across the first year of stroke in Nigerians with pre-existing cognitive decline.

Materials And Methods: Prospective observational study. Prestroke cognitive decline was ascertained retrospectively using the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Assessments for global cognition, learning, memory, executive and ADL functioning were conducted at 3 time points using the Mini-Mental state examination (MMSE), 10-words list learning and delayed recall test (10 WDRT), Animal naming test and Barthel index, respectively.

Results: Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I = 11.5%-23.6%). In linear regression analyses adjusting for the effect of age, education, stroke severity and comorbid diabetes mellitus, prestroke cognitive decline predicted poor memory scores at one year [Adjusted standardized mean difference (SMD) = -0.6, 95% C.I = -1.1, -0.1, p = 0.016)]. The association of prestroke cognitive decline with poststroke poor memory was substantially mediated by age (SMD = -0.9, 95% C.I = -1.4, -0.4, p < 0.001).

Conclusion: Pre-existing cognitive decline in this sample was associated with an age-mediated poor memory function at one-year poststroke. Early institution of targeted cognitive rehabilitation in stroke survivors with pre-existing cognitive decline may reduce the neurocognitive burden of stroke in Black Africans.
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http://dx.doi.org/10.1111/ane.13442DOI Listing
September 2021

The copy number variation and stroke (CaNVAS) risk and outcome study.

PLoS One 2021 19;16(4):e0248791. Epub 2021 Apr 19.

University of Maryland School of Medicine, Baltimore, MD, United States of America.

Background And Purpose: The role of copy number variation (CNV) variation in stroke susceptibility and outcome has yet to be explored. The Copy Number Variation and Stroke (CaNVAS) Risk and Outcome study addresses this knowledge gap.

Methods: Over 24,500 well-phenotyped IS cases, including IS subtypes, and over 43,500 controls have been identified, all with readily available genotyping on GWAS and exome arrays, with case measures of stroke outcome. To evaluate CNV-associated stroke risk and stroke outcome it is planned to: 1) perform Risk Discovery using several analytic approaches to identify CNVs that are associated with the risk of IS and its subtypes, across the age-, sex- and ethnicity-spectrums; 2) perform Risk Replication and Extension to determine whether the identified stroke-associated CNVs replicate in other ethnically diverse datasets and use biomarker data (e.g. methylation, proteomic, RNA, miRNA, etc.) to evaluate how the identified CNVs exert their effects on stroke risk, and lastly; 3) perform outcome-based Replication and Extension analyses of recent findings demonstrating an inverse relationship between CNV burden and stroke outcome at 3 months (mRS), and then determine the key CNV drivers responsible for these associations using existing biomarker data.

Results: The results of an initial CNV evaluation of 50 samples from each participating dataset are presented demonstrating that the existing GWAS and exome chip data are excellent for the planned CNV analyses. Further, some samples will require additional considerations for analysis, however such samples can readily be identified, as demonstrated by a sample demonstrating clonal mosaicism.

Conclusion: The CaNVAS study will cost-effectively leverage the numerous advantages of using existing case-control data sets, exploring the relationships between CNV and IS and its subtypes, and outcome at 3 months, in both men and women, in those of African and European-Caucasian descent, this, across the entire adult-age spectrum.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248791PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055008PMC
September 2021

[São Paulo call to action for the prevention and control of high blood pressure: 2020Chamado à ação de São Paulo para prevenção e controle da hipertensão arterial: 2020].

Rev Panam Salud Publica 2021 26;45:e26. Epub 2021 Feb 26.

División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston Carolina del Sur Estados Unidos División de Neurociencias Aplicadas y Estudios de Población, Universidad Médica de Carolina del Sur, Charleston, Carolina del Sur, Estados Unidos.

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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http://dx.doi.org/10.26633/RPSP.2021.26DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905751PMC
February 2021

[São Paulo call to action for the prevention and control of high blood pressure: 2020Llamado a la acción de San Pablo para la prevención y el control de la hipertensión arterial, 2020].

Rev Panam Salud Publica 2021 26;44:e27. Epub 2021 Feb 26.

Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul Charleston Estados Unidos Divisão de Neurociências Translacionais e Estudos Populacionais, Universidade de Medicina da Carolina do Sul, Charleston, Estados Unidos.

About 1/4th of adults have high blood pressure which is the single most important risk for death (including heart disease and stroke).There are effective policies that could facilitate people making healthy choices to prevent raised blood pressure, and if fully implemented, could largely prevent hypertension from occurring.Hypertension is easy to screen and treat for BUT only about 50% of adults with hypertension are aware of their condition and only about 1 in 7 is adequately treated.Preventing and controlling high blood pressure is the major mechanism for NCD prevention and control and a model for other NCD risks.Effective lifestyle and drug treatments could prevent and control hypertension in most individuals if systematically applied to the population, simple interventions are feasible in all settings, and can be used to enhance primary care.Urgent sustained action is needed is needed for effective public policies and health system changes to prevent and control hypertension.
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http://dx.doi.org/10.26633/RPSP.2021.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905737PMC
February 2021

Green leafy vegetable intakes are inversely related to the incidence of stroke.

Eur J Prev Cardiol 2020 Oct 23. Epub 2020 Oct 23.

Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan 200284 Ibadan, Nigeria.

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http://dx.doi.org/10.1093/eurjpc/zwaa040DOI Listing
October 2020

The Independent Association of Prestroke Psychiatric Symptoms and Acute Phase Delirium with Poststroke Mortality at One Year in Nigeria.

J Stroke Cerebrovasc Dis 2021 Apr 23;30(4):105622. Epub 2021 Jan 23.

Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.

Background: Undetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria.

Methods: A prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I).

Results: Forty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively.

Conclusion: This study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2021.105622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263700PMC
April 2021

Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study.

J Clin Hypertens (Greenwich) 2021 04 23;23(4):773-784. Epub 2021 Jan 23.

Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community-dwelling stroke-free population in Ghana and Nigeria. Data for 4267 community-dwelling stroke-free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti-hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p < .05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p < .0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p < .0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p < .0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p < .0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community-dwelling stroke-free controls in west Africa. Community-oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.
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http://dx.doi.org/10.1111/jch.14183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263562PMC
April 2021

Editorial: Translating Innovations in Stroke Rehabilitation to Improve Recovery and Quality of Life Across the Globe.

Front Neurol 2020 14;11:630830. Epub 2020 Dec 14.

Division of Rehabilitation, Department of Medicine of Tung Wah Hospital Hong Kong, Hong Kong, Hong Kong.

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http://dx.doi.org/10.3389/fneur.2020.630830DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767826PMC
December 2020

Prevalence, predictors, and prognoses of prestroke neuropsychiatric symptoms at 3 months poststroke.

Int Psychogeriatr 2021 08 30;33(8):827-834. Epub 2020 Dec 30.

Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Objectives: Prior neuropsychiatric disturbances are risk factors for stroke. There is a knowledge gap on the predictors of prestroke psychopathology, as well as their association with stroke outcomes in survivors living in low- and middle-income countries (LMICs). We estimated prevalence, predictors, and association of prestroke neuropsychiatric symptoms with poststroke depression (PSD), disability, and mortality.

Design: Prospective observation.

Setting: Nigeria.

Participants: Adult ischemic and hemorrhagic stroke survivors.

Measurements: Prestroke psychopathology were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Outcomes were assessed using validated tools, including the Centre for Epidemiologic Studies - Depression Scale (CES-D 10) and modified Rankin scale (mRS). Independent associations were investigated using regression models with Bonferroni corrections, and presented as standardized mean differences (SMD) and odds ratios (OR) within 95% confidence intervals (CI).

Results: Among 150 participants, prestroke neuropsychiatric symptoms were found in 78 (52%). In multivariate logistic regression analyses, prestroke sleep disturbance was associated with systemic hypertension (OR = 5.39, 95% CI = 1.70-17.08). Prestroke neuropsychiatric symptoms independently predicted worse motor disability scores (SMD = 0.92, 95% CI = 0.21-1.62) and greater odds of poststroke mortality (OR = 2.7, 95% CI = 1.1-7.0) at 3 months. However, prestroke depression was not significantly associated with PSD.

Conclusion: Prestroke sleep disturbances was associated with systemic hypertension, a key index of high cardiovascular risk profile and stroke. The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with sleep symptoms who have multiple, additional, risks of stroke.
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http://dx.doi.org/10.1017/S1041610220003816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285572PMC
August 2021

Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study.

J Am Coll Cardiol 2020 12;76(25):2982-3021

University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.
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http://dx.doi.org/10.1016/j.jacc.2020.11.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755038PMC
December 2020

Development and implementation of guidelines for the management of depression: a systematic review.

Bull World Health Organ 2020 Oct 27;98(10):683-697H. Epub 2020 Aug 27.

School of Clinical Medicine, The University of Queensland, Brisbane, Australia.

Objective: To evaluate the development and implementation of clinical practice guidelines for the management of depression globally.

Methods: We conducted a systematic review of existing guidelines for the management of depression in adults with major depressive or bipolar disorder. For each identified guideline, we assessed compliance with measures of guideline development quality (such as transparency in guideline development processes and funding, multidisciplinary author group composition, systematic review of comparative efficacy research) and implementation (such as quality indicators). We compared guidelines from low- and middle-income countries with those from high-income countries.

Findings: We identified 82 national and 13 international clinical practice guidelines from 83 countries in 27 languages. Guideline development processes and funding sources were explicitly specified in a smaller proportion of guidelines from low- and middle-income countries (8/29; 28%) relative to high-income countries (35/58; 60%). Fewer guidelines (2/29; 7%) from low- and middle-income countries, relative to high-income countries (22/58; 38%), were authored by a multidisciplinary development group. A systematic review of comparative effectiveness was conducted in 31% (9/29) of low- and middle-income country guidelines versus 71% (41/58) of high-income country guidelines. Only 10% (3/29) of low- and middle-income country and 19% (11/58) of high-income country guidelines described plans to assess quality indicators or recommendation adherence.

Conclusion: Globally, guideline implementation is inadequately planned, reported and measured. Narrowing disparities in the development and implementation of guidelines in low- and middle-income countries is a priority. Future guidelines should present strategies to implement recommendations and measure feasibility, cost-effectiveness and impact on health outcomes.
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http://dx.doi.org/10.2471/BLT.20.251405DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652558PMC
October 2020

Editorial: The Genetic and Environmental Basis for Diseases in Understudied Populations.

Front Genet 2020 23;11:559956. Epub 2020 Sep 23.

West African Genetic Medicine Center, College of Health Sciences, University of Ghana, Accra, Ghana.

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http://dx.doi.org/10.3389/fgene.2020.559956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538711PMC
September 2020

Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression.

J Geriatr Psychiatry Neurol 2020 Oct 19:891988720968274. Epub 2020 Oct 19.

University of California, San Francisco, CA, USA.

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa.

Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression ("HRQOLISP-E"). Independent associations were investigated using complementary log-log regression and binary logit models.

Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD.

Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.
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http://dx.doi.org/10.1177/0891988720968274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241399PMC
October 2020

Different Cognitive and Functional Outcomes in Attenuated and Full Delirium Syndromes Among Recent Stroke Survivors.

J Stroke Cerebrovasc Dis 2020 Nov 25;29(11):105251. Epub 2020 Aug 25.

Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.

Background: Very little is known about the outcomes of poststroke delirium in relation to its symptom spectrum. We investigated the 3-months cognitive and functional outcomes of attenuated (ADS) and full delirium syndromes in Nigerian survivors of first ever stroke.

Methods: A prospective observational study with repeated assessments conducted in the first week of stroke using the confusion assessment method. Full delirium was diagnosed according to criteria in the fifth edition of the diagnostic and statistical manual of mental disorders (DSM-V). ADS was characterised in survivors who were free of full, but had ≥two core features of, delirium. Baseline and follow-up assessments were conducted using the Mini-Mental state examination (MMSE), 10-words list learning and delayed recall test, Animal naming test and Barthel index.

Results: Among 150 participants, ADS was present in 32 (21.3%), full delirium in 29 (19.3%). In linear regression analyses adjusting for age, economic status and systemic hypertension, ADS [(Mean difference (MD) = -3.8, 95% C.I = -7.0, -0.7)] and full delirium (MD = -5.6, 95% C.I = -9.0, -2.1) independently predicted poorer global cognitive functioning at follow-up. Significant declines in memory (MD = -1.9, 95% C.I = -2.8, 0.9), executive (MD = -2.2, 95% C.I = -4.1, -0.3) and physical functioning (MD = -2.8, 95% C.I = -5.5, -0.2), as well as a 4-fold increase in the independent odds (O.R) for dementia (O.R = 4.1, 95% C.I = 1.0,16.1) were also recorded in full, but not attenuated, delirium.

Conclusion: Attenuated and full delirium are associated with graded risk of poststroke cognitive decline. Reconsideration of poststroke delirium as a spectrum, rather than threshold-based categorical diagnosis will improve detection and prioritization of stroke survivors at increased risk of cognitive decline.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105251DOI Listing
November 2020

Antecedent febrile illness and occurrence of stroke in West Africa: The SIREN study.

J Neurol Sci 2020 Nov 28;418:117158. Epub 2020 Sep 28.

Department of Medicine, University of Ibadan, Nigeria.

Background: Acute infections have been posited as potential precipitants or triggers of the occurrence of stroke among adults with traditional vascular risk factors. We evaluated associations between stroke occurrence and reported febrile illness within 4 weeks (potential antecedent infections) among West Africans.

Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with radiologically confirmed strokes. Controls were stroke-free adults matched with cased by age, gender and ethnicity. Detailed evaluations for vascular, lifestyle and psychosocial factors were performed. Participants were asked for evidence of any febrile illness within the past 4 weeks. We used conditional logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval.

Results: Among 3588 stroke cases recruited in Ghana and Nigeria between August 2014 and July 2018, 363 cases (10.1%) reported having a febrile illness within the 4 weeks prior to stroke occurrence. Having an antecedent infection was associated with stroke occurrence with an unadjusted OR of 1.19 (1.00-1.51) but aOR of 0.83 (0.59-1.17) upon adjusting for traditional vascular risk factors. Stress, aOR of 4.69 (2.59-8.50) and consumption of green vegetables 2.27 (1.35-2.85) were associated with antecedent febrile illness.

Conclusion: 1 in 10 stroke cases reported antecedent history of febrile illness prior to occurrence of stroke but no independent association was observed in this study. Infectious exposures may be important triggers of cardiovascular events requiring further exploratory studies to better understand the role of this emerging risk factor.
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http://dx.doi.org/10.1016/j.jns.2020.117158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006213PMC
November 2020

Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans.

J Stroke Cerebrovasc Dis 2020 Sep 3;29(9):105082. Epub 2020 Jul 3.

University of California San Francisco, United States.

Background: There is relatively limited information on the risk factors and outcome of new onset Poststroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors.

Methods: We analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent (≤ one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26).

Results: Among 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6-39.3). Rates were 36.2% (95% CI =29.6-42.7) for men and 29.2% (95% CI =19.9-38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01-2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= -0.2, 95% C.I= -0.4, -0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2).

Conclusion: One in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673258PMC
September 2020

Letter to the Editor.

J Neurol Sci 2020 11 10;418:117089. Epub 2020 Aug 10.

University of California, San Francisco, USA.

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http://dx.doi.org/10.1016/j.jns.2020.117089DOI Listing
November 2020

Cognitive, Functional, and Mortality Outcomes of Attenuated Delirium Syndrome in Stroke Survivors.

J Geriatr Psychiatry Neurol 2020 Aug 6:891988720944234. Epub 2020 Aug 6.

Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Objectives: There is a knowledge gap on the prognostic significance of subsyndromes of delirium. We describe the association of poststroke attenuated delirium syndrome (ADS) with cognitive, functional, and mortality outcomes at 3 months.

Methods: A longitudinal observational study in which repeated assessments for delirium symptoms were conducted in the first week of stroke using the confusion assessment method. Attenuated delirium syndrome was characterized in survivors who were free of the full delirium syndrome but had ≥2 core features of delirium. Baseline and follow-up assessments were conducted using the Mini-Mental State Examination (MMSE), 10-word list learning and delayed recall test, Animal naming test, and Barthel index.

Results: Among 150 participants recruited consecutively over 2 years, ADS was present in 32 (21.3%). Of 121 who were free of the full delirium syndrome, 21 (17.4%) had died by 3 months. Those who survived were more likely to be receiving treatment for systemic hypertension (88.5%, = .007). In analyses adjusting for the effect of age, economic status, and systemic hypertension, ADS in the first week of stroke predicted cognitive decline at 3 months ([mean difference (MD) in MMSE scores = -3.8, 95% CI = -7.0 to -0.7, = .019]). However, ADS was not associated with greater decline in activities of daily life (MD = -0.4, 95% CI = -2.8 to 2.0) or significant odds ratio (OR) of mortality (OR = 2.3, 95% CI = 0.8-6.3).

Conclusion: Attenuated delirium syndrome may be an important marker of cognitive impairment at 3 months poststroke. Its detection may lead to identification of stroke survivors who are likely to benefit from evidence-based preventive interventions for poststroke cognitive decline.
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August 2020
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