Cognitive impairment before and after intracerebral haemorrhage: a systematic review

Introduction: There is increasing interest in understanding cognitive dysfunction before and after Intracerebral haemorrhage (ICH), given the higher prevalence of dementia reported (ranging from 5 to 44%) for this stroke type. Much of the evidence to date examining cognitive impairment associated with cerebrovascular disease has tended to focus more on ischaemic stroke. The aim of this review was to identify and quantify studies that focused on cognitive dysfunction pre and post ICH. / Methods: We conducted a systematic search using databases PubMed, Science Direct, Scopus and PsycINFO to identify studies that exclusively assessed cognitive function pre and post ICH. Studies were included in the review if used a measure of global cognition and/or a neuropsychological battery to assess cognitive function. Nineteen studies were deemed relevant for inclusion, where n = 8 studies examined cognitive impairment pre ICH and n = 11 post ICH. / Results: Prevalence of cognitive impairment ranged between 9–29% for pre ICH and 14–88% for post ICH. Predictive factors identified for pre and post ICH were previous stroke, ICH volume and location and markers of cerebral amyloid angiopathy (CAA). Most common cognitive domains affected post ICH were information processing speed, executive function, memory, language and visuo-spatial abilities. Most common cognitive assessments tools were the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) for pre-existing cognitive impairment and the Mini-Mental State Examination for global cognition post ICH and the Trail Making Test where neuropsychological tests were used. / Conclusion: Cognitive impairment and dementia affected almost one-third of patients, whether assessed pre or post ICH

Stroke: causes and clinical features

Stroke is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury (infarction, haemorrhage) of the central nervous system. Stroke is the second leading cause of death and disability worldwide. Stroke is not a single disease but can be caused by a wide range of risk factors, disease processes and mechanisms. Hypertension is the most important modifiable risk factor for stroke, although its contribution differs for different subtypes. Most (85%) strokes are ischaemic, predominantly caused by small vessel arteriolosclerosis, cardioembolism and large artery athero-thromboembolism. Ischaemic strokes in younger patients can result from a different spectrum of causes such as extracranial dissection. Approximately 15% of strokes worldwide are the result of intracerebral haemorrhage, which can be deep (basal ganglia, brainstem), cerebellar or lobar. Deep haemorrhages usually result from deep perforator (hypertensive) arteriopathy (arteriolosclerosis), while lobar haemorrhages are mainly caused by cerebral amyloid angiopathy or arteriolosclerosis. A minority (about 20%) of intracerebral haemorrhages are caused by macrovascular lesions (vascular malformations, aneurysms, cavernomas), venous sinus thrombosis or rarer causes; these are particularly important in young patients (<50 years). Knowledge of vascular and cerebral anatomy is important in localizing strokes and understanding their mechanisms. This guides rational acute management, investigation, and secondary prevention

Layer-by-layer assembly of nanoclays for improved barrier properties of biobased polymers

Today, 26 % of the total plastic volume in the world is used for packaging, and over 90 % of this plastic is fossil-based (MacArthur et al., 2016). A growing consumer awareness has led to a demand for alternatives to fossil-based plastic. Polymers made of biobased resources, called biobased polymers, are therefore of interest. Biopolymers are a promising replacement to fossil-based packaging. The industrial application of biopolymers for packaging has been limited because most biopolymers have poor mechanical- and barrier properties compared to fossil-based plastic. To improve these properties nanoclay can be used. The purpose of this thesis was to find the best combination of liquids and substrates which was able to create an even coating and improve the barrier properties of the substrates. The study was performed step by step, and only one nanoclay-suspension was combined with PEI at the time. Changes and adjustments of the experimental design were done to improve the method. The biobased polymers PLA and three carton qualities were used as substrates. The substrates were coated with a polyethyleneimine (PEI)-solution and three different nanoclays by using the layer-by-layer (LBL) method through dip-coating. The three nanoclays were montmorillonite K10, halloysite and hydrophilic bentonite. Dip-coating includes using liquids to coat a solid substrate by immersing it and then withdraw and dry it. After drying the substrate were immersed in liquid again. The dip-cycle was repeated for as many times as necessary based on the experimental design.Norwegian LevyM-MA

Feasibility of clinical trial recruitment for cerebral amyloid angiopathy: A specialist single centre experience

INTRODUCTION Cerebral amyloid angiopathy (CAA) is a small vessel disease characterised by vascular amyloid-beta deposition and recurrent intracerebral haemorrhage, for which there are limited data on the practicalities of clinical trial recruitment. METHODS We describe our single centre recruitment experience for a small biomarker pilot study, which aimed to recruit 10 patients with CAA. RESULTS The BOCAA (Biomarkers and Outcomes in Cerebral Amyloid Angiopathy) study recruited 10 CAA patients over 18 months. All patients were recruited from a prospective CAA database (n = 186); the majority of patients (n = 146, 78.5%) were ineligible for the BOCAA study. The most common reasons for exclusion were co-existent cognitive impairment or dementia (n = 42), failure to meet the imaging (modified Boston) criteria (n = 41), and anticoagulant or dual antiplatelet use (n = 18). CONCLUSIONS Recruitment of CAA patients to a small pilot study is feasible from a single specialist centre; however, centralised multicentre research databases will allow for more effective and co-ordinated recruitment to larger studies. Any future trial will need to consider how best to define mild disease, factors that influence group heterogeneity, and the impact of comorbidities that could limit participation in multimodal testing - but be mindful that more stringent entry criteria will limit recruitment capabilities