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PLoS Medicine Mar 2023Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Depression is the most frequent psychiatric condition after stroke and is associated with negative health outcomes. We aim to undertake a systematic review and meta-analysis of the prevalence and natural history of depression after stroke.
METHODS AND FINDINGS
Studies published up to 4 November 2022 on Medline, Embase, PsycINFO, and Web of Science Core Collection were searched. We included studies of adults with stroke, where depression was assessed at a prespecified time point. Studies excluding people with aphasia and history of depression are excluded. Critical Appraisal Skills Programme(CASP) cohort study tool was used to assess risk of bias. A total of 77 studies were included in the pooled estimates of the prevalence of poststroke depression (PSD). The overall prevalence of depression was 27% (95% CI 25 to 30). Prevalence of depression was 24% (95% CI 21 to 28) by clinical interview and 29% (95% CI 25 to 32) by rating scales. Twenty-four studies with more than one assessment time point reported the natural history of PSD. Among people who were depressed within 3 months of stroke, 53% (95% CI 47 to 59) experienced persistent depression, while 44% (95% CI 38 to 50) recovered. The incidence of later depression (3 to 12 months after stroke) was 9% (95% CI 7 to 12). The cumulative incidence during 1 year after stroke was 38% (95% CI 33 to 43), and the majority (71% (95% CI 65 to 76)) of depression had onset within 3 months after stroke. The main limitation of the present study is that excluding people in source studies with severe impairments may produce imprecise estimates of the prevalence of PSD.
CONCLUSIONS
In this study, we observed that stroke survivors with early-onset depression (within 3 months after stroke) are at high risks for remaining depressed and make up two-thirds of the incident cases during 1 year after stroke. This highlights the need for ongoing clinical monitoring of patients depressed shortly after stroke.
TRIAL REGISTRATION
PROSPERO CRD42022314146.
Topics: Adult; Humans; Cohort Studies; Depression; Prevalence; Stroke; Longitudinal Studies
PubMed: 36976794
DOI: 10.1371/journal.pmed.1004200 -
Surgical Neurology International 2023Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote... (Review)
Review
BACKGROUND
Propeller-related injuries from motorboats are a major cause of injury in recreational water activities including severe and multiple lacerations that can promote scarring, blood loss, traumatic, or surgical amputations. The real incidence of these accidents is still unclear. The authors here present a systematic review of the literature, focusing on head injury, and related recommendations for its evaluation and management, also reporting a case of a female patient injured by a motorboat propeller.
METHODS
A systematic literature review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of publication date. The following Mesh and free text terms were identified: "motorboat and propeller and injuries" (107 results).
RESULTS
A total of 12 papers were included in this systematic review. Only few case reports describing traumatic brain injury (TBI) have been documented. Out of a total of 90 cases analyzed, only five cases with TBI were reported. The authors also reported a case of a 12-year-old female, that during a boat trip, reported a severe polytrauma with concussive head trauma from a penetrating left fronto-temporo-parietal lesion, left mammary gland trauma and fracture of the left hand from falling into the water and impact with a motorboat propeller. She underwent an urgent left fronto-temporo-parietal decompressive craniectomy and then surgery with a multidisciplinary team. At the end of the surgical procedure, the patient was transferred to the pediatric intensive care unit. She was discharged on postoperative day 15. The patient was able to walk without assistance, with mild right hemiparesis and persistence of aphasia nominum.
CONCLUSION
Motorboat propeller injuries can result in extensive damage to soft tissue and bones with severe functional disability, amputations, and high mortality. There are still no recommendations and protocols for the management of motorboat propeller related injuries. Although there are several potential solutions that aim to prevent or ease motorboat-propeller injuries, there are still lack of consistent regulations.
PubMed: 37292416
DOI: 10.25259/SNI_219_2023 -
Brain and Language Nov 2023Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results.... (Meta-Analysis)
Meta-Analysis Review
Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results. We conducted a systematic review and a meta-analysis to examine within- and cross-language treatment effects and the variables that affect them. We searched PubMed, PsycINFO, CINAHL, and Google Scholar (February 2020; January 2023), identifying 40 studies reporting on 1573 effect sizes from 85 individuals. We synthesized effect sizes for treatment outcomes using a multi-level model to correct for multiple observations from the same individuals. The results showed significant treatment effects, with robust within-language treatment effects and weaker cross-language treatment effects. Age of language acquisition of the treatment language predicted within-language and cross-language effects. Our results suggest that treating multilingual people with aphasia in one language may generalize to their other languages, especially following treatment in an early-acquired language and a later-learned language that became the language of immersion.
Topics: Humans; Language; Aphasia; Multilingualism; Language Development; Treatment Outcome
PubMed: 37994828
DOI: 10.1016/j.bandl.2023.105326 -
Journal of Alzheimer's Disease : JAD 2023Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding which fluency task is more affected while developing AD. Most studies focus on SF assessment, given its connection with the temporoparietal amnesic system. PF is less reported, it is related to working memory, which is also impaired in probable and diagnosed AD. Differentiating between performance on these tasks might be informative in early AD diagnosis, providing an accurate linguistic profile.
OBJECTIVE
Compare SF and PF performance in healthy volunteers, volunteers with probable AD, and patients with AD diagnosis, considering the heterogeneity of age, gender, and educational level variables.
METHODS
A total of 8 studies were included for meta-analysis, reaching a sample size of 1,270 individuals (568 patients diagnosed with AD, 340 with probable AD diagnosis, and 362 healthy volunteers).
RESULTS
The three groups consistently performed better on SF than PF. When progressing to a diagnosis of AD, we observed a significant difference in SF and PF performance across our 3 groups of interest (p = 0.04). The age variable explained a proportion of this difference in task performance across the groups, and as age increases, both tasks equally worsen.
CONCLUSION
The performance of SF and PF might play a differential role in early AD diagnosis. These tasks rely on partially different neural bases of language processing. They are thus worth exploring independently in diagnosing normal aging and its transition to pathological stages, including probable and diagnosed AD.
Topics: Humans; Semantics; Alzheimer Disease; Verbal Behavior; Neuropsychological Tests; Linguistics
PubMed: 37482994
DOI: 10.3233/JAD-221272 -
Journal of Communication Disorders 2023Prosody serves central functions in language processing including linguistic functions (linguistic prosody), like structuring the speech signal. Impairments in... (Review)
Review
A systematic review on production and comprehension of linguistic prosody in people with acquired language and communication disorders resulting from unilateral brain lesions.
BACKGROUND
Prosody serves central functions in language processing including linguistic functions (linguistic prosody), like structuring the speech signal. Impairments in production and comprehension of linguistic prosody have been described for persons with unilateral right (RHDP) or left hemisphere damage (LHDP). However, reported results differ with respect to the characteristics and severities of these impairments AIMS: We conducted a systematic literature review focusing on production and comprehension of linguistic prosody at the prosody-syntax interface (i.e., phrase or sentence level) in LHDP and RHDP.
METHODS & PROCEDURES
In a systematic literature search we included: (i) empirical studies with (ii) adult RHDP and/or LHDP (iii) investigating production and/or comprehension of linguistic prosody at the (iv) phrase or sentence level (v) reporting quantitative data on prosodic measures. We excluded overview papers; studies involving participants with dysarthria, apraxia of speech, foreign accent syndrome, psychiatric diseases, and/or neurodegenerative diseases; studies focusing primarily on emotional prosody; and on lexical stress / word level; studies of which no full text was available and/or that were published in a language other than English. We searched the databases BIOSIS, MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Cochrane Library, PSYNDEX, PsycINFO and speechBITE, last searched on January 13 2022.We found 2,631 studies without duplicates. We identified 43 studies which were included into our systematic review. For data extraction and synthesis of results, we grouped studies by (i) modality (production vs. comprehension), (ii) function (syntactic structure vs. information structure), and (iii) by experiment task. For production studies, outcome measures were defined as the productive use of the different prosodic cues (lengthening, pause, f0, amplitude). For comprehension studies, performance measures (accuracy and reaction times) were defined as outcome measures. In accordance with the PRISMA 2020 statement (Page et al., 2021), we conducted a quality check to assess study risk of bias. Our review was pre-registered with PROSPERO (CRD42019120308).
OUTCOMES & RESULTS
Of the 43 studies reviewed, 30 studies involved RHDP (n = 309), assessing production in 15 studies and focusing on comprehension of prosody in 16 studies (one study investigated production and comprehension). LHDP (n = 438) were included in 35 studies of which 15 studied production and 21 evaluated comprehension of prosody (one study investigated production and comprehension). Despite the heterogeneity of results in the studies reviewed, our synthesis of results suggests that both LHDP and RHDP show limitations, but no complete impairment, in their production and/or comprehension of linguistic prosody. Prosodic limitations are evident in different areas of processing linguistic prosody, like syntactic disambiguation or the distinction between sentence types. There is a tendency towards more severe limitations in LHDP as compared to RHDP.
CONCLUSIONS
We only included published studies into our review and did not perform an assessment of risk of reporting bias as well as systematic certainty assessments of the outcomes. Despite these limitations, we conclude that both groups show deficits in production and comprehension of linguistic prosody, but neither LHDP nor RHDP are completely impaired in their prosodic processing. This suggests that prosody is a relevant communicative resource for LHDP and RHDP worth being addressed in speech-language-therapy.
Topics: Adult; Humans; Comprehension; Language; Linguistics; Communication Disorders; Brain; Speech Perception
PubMed: 36623377
DOI: 10.1016/j.jcomdis.2022.106298 -
International Journal of Stroke :... Oct 2023Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote... (Review)
Review
BACKGROUND
Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management.
AIMS
To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management.
SUMMARY OF REVIEW
We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored > 66.7% on Domain 3: "Rigor of Development"), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based.
CONCLUSION
More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related; aphasia-specific recommendation gaps were identified in three clinical practice areas: "accessing community supports," "return to work, leisure, driving," and "interprofessional practice."
Topics: Humans; Stroke; Aphasia; Databases, Factual; PubMed; Consensus
PubMed: 36803248
DOI: 10.1177/17474930231161454 -
Cureus Jul 2021Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery... (Review)
Review
Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery occlusion, can often lead to LIS. LIS has three subtypes: classical, partial, and total. There is loss of motion in the four extremities in classical LIS, loss of horizontal gaze, and aphasia. In partial LIS, the patient still has some motor function. Complete LIS has the worst outcome because patients cannot blink or have vertical gaze, thus rendering them incapable of communicating. Most cases of LIS occur due to ischemic infarcts. These patients require a great deal of physical rehabilitation to regain partial motor ability and a means to communicate. While the clinical features and pathophysiology are known, the prognosis and long-term treatment remain unknown. We conducted a systematic review using the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) protocol. We use an advanced PubMed strategy using the inclusion criteria of observational studies or clinical trials conducted in the last 20 years, written in English, and conducted on humans. We excluded systematic reviews, literature reviews, metanalysis, and studies that did not meet the outcomes of our objectives. The prognosis of LIS is not good, and most patients remain locked in, with poor quality of life, especially motor functions. Respiratory failure and depression are big comorbidities. In the acute setting, patients benefit from rapid intervention. The subacute treatment needs to manage aggressively to improve functional scores best. The long-term treatment focus is on the quality of life and managing comorbidities.
PubMed: 34471579
DOI: 10.7759/cureus.16727 -
Annals of Palliative Medicine May 2021It was to examine the influence of preoperative doctor-patient communication (D-PC) on surgery, and to improve the postoperative recovery effect of patients via... (Meta-Analysis)
Meta-Analysis
BACKGROUND
It was to examine the influence of preoperative doctor-patient communication (D-PC) on surgery, and to improve the postoperative recovery effect of patients via meta-analysis.
METHODS
Meta-analysis was performed to study the influence of preoperative D-PC on surgery and improve the postoperative recovery effect of patients. Boolean logic search method was adopted, and "Preoperative communication", "psychological counseling", "Surgical effect", and "D-PC" were set as search terms. Literature retrieval of PubMed, Medline, and CNKI from the establishment to the present was conducted. Literatures that performed comparative studies and set group without preoperative communication between doctors and patients as a control were screened. Review Manager (RevMan) was adopted to carry out meta-analysis.
RESULTS
Fifteen papers were selected in this analysis, most of which were of low-risk bias (medium or high quality). Meta-analysis revealed that there was no statistical heterogeneity in postoperative speech function between control and experimental groups (Chi2 =1.04, I2=0%, P=0.96), and postoperative speech function of experimental group was remarkably better in contrast to control group (Z=4.09, P<0.00001). No statistical heterogeneity was found in the Asiatic aphasia test (AAT) results between two groups (Chi2 =3.77, I2=0%, P=0.44), and there was no considerable difference in AAT test results between groups (Z=1.37, P=0.17). There was statistical heterogeneity in the postoperative quality of life scores between different groups (Chi2 =115.99, I2=97%, P<0.00001), and postoperative quality of life scores of patients in experimental group were greatly superior to the control (Z=1.98, P=0.05). There was statistical heterogeneity in daily communication ability between groups (Chi2 =14.60, I2=73%, P=0.006), and daily communication ability of patients in experimental group was substantially stronger in contrast to the control (Z=7.40, P<0.00001).
DISCUSSION
Through meta-analysis methods, it was found that preoperative D-PC can effectively improve the postoperative speech function and daily communication ability recovery of patients, the postoperative quality of life, and the postoperative recovery of patients.
Topics: Counseling; Humans; Physician-Patient Relations; Quality of Life; Surgical Procedures, Operative
PubMed: 34107721
DOI: 10.21037/apm-21-1058 -
Clinical Microbiology and Infection :... May 2022Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described. (Review)
Review
BACKGROUND
Lyme neuroborreliosis (LNB) presenting with encephalitis is rare and scarcely described.
OBJECTIVES
To describe the available literature on LNB encephalitis and to characterize this patient group through a Scandinavian retrospective cohort study.
DATA SOURCES
Medline, Embase, Scopus, Cochrane library.
STUDY ELIGIBILITY CRITERIA
There was no discrimination on study type, time of publication or language.
PARTICIPANTS
Review: All articles with definite LNB and confirmed/possible encephalitis.
COHORT
LNB cohorts from Denmark, Sweden and Norway 1990-2019 were screened for patients with encephalitis.
METHODS
Review: Adhering to PRISMA guidelines; two authors extracted reviews and assessed quality of studies.
COHORT
Data on demography, symptoms, cerebrospinal fluid findings, differential diagnostic examinations, treatment, residual symptoms, 1-year mortality were registered.
RESULTS
Review: 2330 articles screened on title/abstract, 281 full texts, yielding 42 articles (case reports/series or cohort studies), including 45 patients from 18 countries spanning 35 years. Altered mental status ranged from personality changes and confusion to unconsciousness. Common focal symptoms were hemiparesis, ataxia and dysarthria; seven patients had seizures. Median time from symptom onset to hospital was 2 weeks (IQR 2-90 days). Of 38 patients with available follow-up after median 12 months (IQR 5-13), 32 had fully or partially recovered, two had died.
COHORT
Thirty-five patients (median age 67 years, IQR 48-76) were included. The encephalitis prevalence was 3.3% (95% CI 2.2-4.4%) among 1019 screened LNB patients. Frequent encephalitis symptoms were confusion, personality changes, aphasia, ataxia. EEGs and neuroimaging showed encephalitis in 93.8% and 20.6%, respectively. Median delay from symptom onset to hospital was 14 days (IQR 7-34), with further 7 days (IQR 3-34) delay until targeted therapy. At follow-up (median 298 days post-treatment; IQR 113-389), 65.6% had residual symptoms. None had died.
CONCLUSIONS
This study shows that encephalitis is an uncommon, but likely overlooked clinical manifestation of LNB. As the high frequency of residual symptoms may be related to prolonged treatment delay, prompt LNB testing of patients with encephalitis in Borrelia burgdorferi-endemic areas should be considered.
Topics: Aged; Ataxia; Cohort Studies; Encephalitis; Humans; Lyme Neuroborreliosis; Retrospective Studies
PubMed: 34768019
DOI: 10.1016/j.cmi.2021.11.001 -
Journal of Communication Disorders 2023Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger... (Review)
Review
INTRODUCTION
Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used.
METHODS
We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria.
RESULTS
We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used.
CONCLUSIONS
Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
Topics: Humans; Aphasia; Linguistics; Language Tests; Language Development Disorders
PubMed: 37717472
DOI: 10.1016/j.jcomdis.2023.106368