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Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis

BACKGROUND AND PURPOSE: The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. METHODS: This...

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Autores principales: Teuschl, Y., Ihle‐Hansen, H., Matz, K., Dachenhausen, A., Ratajczak, P., Tuomilehto, J., Ursin, M. H., Hagberg, G., Thommessen, B., Øksengård, A. R., Brainin, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099341/
https://www.ncbi.nlm.nih.gov/pubmed/29782693
http://dx.doi.org/10.1111/ene.13684
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author Teuschl, Y.
Ihle‐Hansen, H.
Matz, K.
Dachenhausen, A.
Ratajczak, P.
Tuomilehto, J.
Ursin, M. H.
Hagberg, G.
Thommessen, B.
Øksengård, A. R.
Brainin, M.
author_facet Teuschl, Y.
Ihle‐Hansen, H.
Matz, K.
Dachenhausen, A.
Ratajczak, P.
Tuomilehto, J.
Ursin, M. H.
Hagberg, G.
Thommessen, B.
Øksengård, A. R.
Brainin, M.
author_sort Teuschl, Y.
collection PubMed
description BACKGROUND AND PURPOSE: The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. METHODS: This pooled patient‐level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)‐A, TMT‐B and 10‐words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention‐to‐treat (ITT) principle using different imputation approaches and one was based on complete cases. RESULTS: Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT‐A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. CONCLUSION: We found indications that multidomain interventions compared with standard care can improve the scores in TMT‐A at 1 year after stroke but not those for TMT‐B or the 10‐words test. These results have to be interpreted with caution due to the small number of patients.
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spelling pubmed-60993412018-08-23 Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis Teuschl, Y. Ihle‐Hansen, H. Matz, K. Dachenhausen, A. Ratajczak, P. Tuomilehto, J. Ursin, M. H. Hagberg, G. Thommessen, B. Øksengård, A. R. Brainin, M. Eur J Neurol Original Articles BACKGROUND AND PURPOSE: The aim of this pooled patient‐level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post‐stroke care for the prevention of cognitive decline after stroke. METHODS: This pooled patient‐level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)‐A, TMT‐B and 10‐words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention‐to‐treat (ITT) principle using different imputation approaches and one was based on complete cases. RESULTS: Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT‐A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. CONCLUSION: We found indications that multidomain interventions compared with standard care can improve the scores in TMT‐A at 1 year after stroke but not those for TMT‐B or the 10‐words test. These results have to be interpreted with caution due to the small number of patients. John Wiley and Sons Inc. 2018-06-22 2018-09 /pmc/articles/PMC6099341/ /pubmed/29782693 http://dx.doi.org/10.1111/ene.13684 Text en © 2018 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Teuschl, Y.
Ihle‐Hansen, H.
Matz, K.
Dachenhausen, A.
Ratajczak, P.
Tuomilehto, J.
Ursin, M. H.
Hagberg, G.
Thommessen, B.
Øksengård, A. R.
Brainin, M.
Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title_full Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title_fullStr Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title_full_unstemmed Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title_short Multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
title_sort multidomain intervention for the prevention of cognitive decline after stroke – a pooled patient‐level data analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6099341/
https://www.ncbi.nlm.nih.gov/pubmed/29782693
http://dx.doi.org/10.1111/ene.13684
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