Learning with music can change brain structure

Learning with music can change brain structure

Using musical cues to learn a physical task significantly develops an important part of the brain, according to a new study.

People who practiced a basic movement task to music showed increased structural connectivity between the regions of the brain that process sound and control movement.

The findings focus on white matter pathways — the wiring that enables brain cells to communicate with each other. (more…)

Stroke – Equal Access to Evidence Based High Quality Prevention, Management and Rehabilitation

Stroke – Equal Access to Evidence Based High Quality Prevention, Management and Rehabilitation

The Experts Statement Document
Tallinn, Estonia, July, 6 2017

Inequalities in stroke risk and stroke provision across Europe should be of great concern to European policy makers, especially considering the predicted increase in the number of people having a stroke in the future. Stroke is a leading cause of disability and mortality among adults.

Stroke is the second most common cause of death and the third most common cause of loss of disability-adjusted life years (DALYs) worldwide. Two types of stroke can be distinguished: 80% ischaemic, most often caused by an occlusion of a cerebral artery. The remaining 20% are haemorrhagic, most often caused by a rupture of an artery. Every year, 1,3 million Europeans have a first stroke. 20 – 35% of these patients succumb within the first month, and around one third remain dependent on the help of others. Even in patients who survive a stroke with minor disabilities, quality of life is often substantially and irreversibly impaired.

stroke equal access

From left to the right: Üllar Kaljumäe, Chief Medical Officer of Estonia; Jelena Misita, SAFE; Prof. Janika Kõrv, University of Tartu, Estonia; Prof. Kaste Markku, University of Helsinki, Finland; Prof. Toomas Asser, University of Tartu, Estonia; Vinciane Quoidbach, EBC

Across Europe, stroke accounts over 1 million deaths each year. Most of these victims are elderly patients. However, death rates vary substantially between countries and are more than three times higher in central and eastern Europe than in northern, southern and western Europe.10 Although early stroke mortality rates have decreased over the past two decades, the burden of stroke in terms of the absolute number of people affected, related deaths and DALYs lost are increasing, with most of the burden in low-income and middle-income European countries. The quality of stroke care varies widely throughout the EU, mirroring death rates ranging from approximately 6% to nearly 20%. Other disparities include gender imbalances and the number of hospital discharges and lengths of stay for patients treated for CVD. Across Europe, it has been estimated that only 30% of patients are treated in a Stroke Unit, which means that 70% of patients with acute stroke are withheld care that is of proven benefit.
There is a need to reduce the burden of stroke throughout the EU through better evidenced based prevention and care.

In 2006, co-sponsored by the WHO Regional Office for Europe, the second Helsingborg Declaration set new targets for stroke management and care: “continuum of care from organized stroke units in the acute phase to appropriate rehabilitation and secondary prevention measures.” The specific goals for 2015 had been that: > 85% of patients should survive the first month after stroke, that 70% of survivors should be independent at 3 months and that all patients with acute stroke, potentially eligible for acute, specific treatment, should be transferred to hospitals with adequate capacity and expertise to administer treatments defined as a Stroke Unit or Stroke dedicated areas. A 3rd European Action plan is currently drafted to verify the achievement of these goals and set goals for 2030.

Effective stroke care planning and adequate resource allocation across Europe are crucial to address primary and secondary prevention and timely intervention as well as equal access and quality of care for all patients. Indeed, care for stroke patients begins before a stroke has happened with the identification of people at risk of stroke, modification of lifestyle patterns, and treatment of vascular risk factors in the primary care setting. Stroke care strategies should then focus on optimal treatment of acute stroke in an acute stroke unit and on avoiding further vascular events, delivered through a comprehensive stroke service quality standards. Every step of the patient care pathway from symptom onset to the start of treatment within the hospital should be optimized in order to save time and to offer all medical opportunities including thrombolysis and thrombectomy for improved survival rates, reduced complications and disability. During and after the acute phase, targeted rehabilitation is needed for better recovery and quality of life.

Our aim is to prevent stroke from happening in the first place and improve the quality of life of the stroke patients and their carers. To achieve these goals, every national stakeholder when assessing, planning and implementing their national stroke strategy should consider the following recommendations:

Primary and secondary stroke prevention is crucial and should be available to all of the people at risk.

Primary care is increasingly taking on a greater role in both, the assessment and the long-term care of stroke patients – in order to ensure an efficient collaboration between primary care physicians and specialist care, incentives should be created and expertise should be built in order to improve long-term outcome of stroke patients.

The Stroke Units network needs to be established in all European countries to ensure fast admission of all stroke patients. These Stroke Units have to be certified by qualified national authorities either the international professional bodies. A Comprehensive Stroke Centre needs to be established in order to foster access to reperfusion therapies. Furthermore, specific clinical services and targeted training programmes need to be developed.

Access to evidenced-based treatments of acute stroke and prevention strategies need to be guaranteed for all patients.

Effective evidence-based treatments for acute stroke care and for secondary prevention shall be available to all patients.

National evaluations based on audits or quality registries are needed to provide feedback to medical professionals and national decision makers for the implementation of evidence-based medicine in clinical practice.

Access to timely and personalised rehabilitation should be made available to all stroke patients, starting from acute Stroke Units in a continuum of care to rehabilitation service based on patient needs, including early supported discharge, comprehensive inpatient rehabilitation unit and long-term facilities for patients having stroke sequels.
Clinical quality registries are essential to analyze the development of stroke outcome, using the data to provide feedback to healthcare professionals and converge evidence to decision makers.

Stroke research is grossly underfunded. Funding for stroke research needs to be increased proportionally to the burden of disease.

The psychological and emotional impacts of stroke are very often ignored. Therefore, we call on all European countries to consider implementing patient psychological and behavioral support programs after stroke, ensuring a holistic approach to tackling “life after stroke” issues.

Stroke support organisations have important role in helping patients and their caregivers in the life after stroke and should be recognized and supported by medical professionals and governmental bodies in building up their capacity.

Collaboration between health care professional organisations and patient stroke support organisations needs to be recognized by the EU and National Health authorities leading to the equal access to stroke prevention, management, rehabilitation and improved quality of life after stroke.

This document was approved by stroke experts SAFE, ESO and EBC at Joint Meeting the Chief Medical, Chief Dental and Chief Nursing Officers.

EUROPEAN STROKE ORGANISATION

Urs Fischer MD, MSc
Extraordinarius for Acute Neurology and Stroke
Co-Chairman Stroke Center Bern
Co-Director Clinical Trial Unit Bern
University of Bern, Switzerland
Secretary General European Stroke Organisation

Markku Kaste MD, PhD, FESO, FAHA, FANA
Emeritu Professor of Neurology
University of Helsinki, Finland
Past Chairman of the Department of Neurology
Helsinki University Central Hospital, Finland

Janika Kõrv MD, PhD, FESO
Associate Professor,
Department of Neurology and Neurosurgery,
University of Tartu, Estonia

 

STROKE ALLIANCE FOR EUROPE

Jelena Misita, MA, MBA
SAFE Awareness and Advocacy Manager for Europe
London, United Kingdom

 

EUROPEAN BRAIN COUNCIL

Vinciane Quoidbach
Research Project Manager
Public Health and Policy – Value of Treatment
Brussels, Belgium

Please see the signed version of this document here.

Does carrying extra weight offer better survival following a stroke?

Does carrying extra weight offer better survival following a stroke?

Despite the fact that obesity increases both the risk for stroke and death, a new study has found that people who are overweight or even mildly obese survive strokes at a higher rate as compared to those with a normal body weight.

The findings, which appear in the Journal of the American Heart Association, adds to the ‘obesity paradox’ seen in previous studies where increased body weight appears to have a protective effect on certain groups of patients.

A stroke occurs when blood flow to an area of the brain is cut off and brain cells are deprived of oxygen and begin to die. Each year about 185,000 people die from a stroke, the fifth leading cause of death in the U.S. and a leading cause of adult disability. (more…)

Adolescent obesity linked to early mortality from cardiovascular diseases

Adolescent obesity linked to early mortality from cardiovascular diseases

While there is solid evidence that adolescent overweight and obesity are associated with coronary heart disease (CHD) and stroke, less is known about the association between body mass index (BMI) and rarer cardiovascular diseases. A new large-scale, 45-year Israeli study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism found that higher BMI as well as BMI in the accepted normal range in late adolescence may be related to a higher risk of death in mid-adulthood from non-coronary non-stroke cardiovascular diseases such as fatal arrhythmia, hypertensive heart disease, cardiomyopathy, arterial disease, heart failure and pulmonary embolism. (more…)

Higher IQ in childhood is linked to a longer life

Higher IQ in childhood is linked to a longer life

Higher intelligence (IQ) in childhood is associated with a lower lifetime risk of major causes of death, including heart disease, stroke, smoking related cancers, respiratory disease and dementia, finds a study published by The BMJ.

It is the largest study to date reporting causes of death in men and women across the life course, and the findings suggest that lifestyle, especially tobacco smoking, is an important component in the effect of intelligence on differences in mortality. (more…)

Giving birth multiple times has impact on stroke recovery, study shows

Giving birth multiple times has impact on stroke recovery, study shows

Stroke is an age-related disease that disproportionately affects women. Although experimental studies have identified several hormonal and genetic factors underlying these differences, little is known about how pregnancy influences risk as this has not been previously studied in the laboratory setting. However, new research published in the Proceedings of the National Academy of Sciences shows that while perimenopausal female mice that gave birth multiple times (multiparous) were at higher risk of stroke, they recovered better than mice that had not ever reproduced. (more…)

New technique makes brain scans better

New technique makes brain scans better

People who suffer a stroke often undergo a brain scan at the hospital, allowing doctors to determine the location and extent of the damage. Researchers who study the effects of strokes would love to be able to analyze these images, but the resolution is often too low for many analyses.

To help scientists take advantage of this untapped wealth of data from hospital scans, a team of MIT researchers, working with doctors at Massachusetts General Hospital and many other institutions, has devised a way to boost the quality of these scans so they can be used for large-scale studies of how strokes affect different people and how they respond to treatment.

“These images are quite unique because they are acquired in routine clinical practice when a patient comes in with a stroke,” says Polina Golland, an MIT professor of electrical engineering and computer science. “You couldn’t stage a study like that.”

Using these scans, researchers could study how genetic factors influence stroke survival or how people respond to different treatments. They could also use this approach to study other disorders such as Alzheimer’s disease.

Golland is the senior author of the paper, which will be presented at the Information Processing in Medical Imaging conference during the week of June 25. The paper’s lead author is Adrian Dalca, a postdoc in MIT’s Computer Science and Artificial Intelligence Laboratory. Other authors are Katie Bouman, an MIT graduate student; William Freeman, the Thomas and Gerd Perkins Professor of Electrical Engineering at MIT; Natalia Rost, director of the acute stroke service at MGH; and Mert Sabuncu, an assistant professor of electrical and computer engineering at Cornell University.

Filling in data

Scanning the brain with magnetic resonance imaging (MRI) produces many 2-D “slices” that can be combined to form a 3-D representation of the brain.

For clinical scans of patients who have had a stroke, images are taken rapidly due to limited scanning time. As a result, the scans are very sparse, meaning that the image slices are taken about 5-7 millimeters apart. (The in-slice resolution is 1 millimeter.)

For scientific studies, researchers usually obtain much higher-resolution images, with slices only 1 millimeter apart, which requires keeping subjects in the scanner for a much longer period of time. Scientists have developed specialized computer algorithms to analyze these images, but these algorithms don’t work well on the much more plentiful but lower-quality patient scans taken in hospitals.

The MIT researchers, along with their collaborators at MGH and other hospitals, were interested in taking advantage of the vast numbers of patient scans, which would allow them to learn much more than can be gleaned from smaller studies that produce higher-quality scans.

“These research studies are very small because you need volunteers, but hospitals have hundreds of thousands of images. Our motivation was to take advantage of this huge set of data,” Dalca says.

The new approach involves essentially filling in the data that is missing from each patient scan. This can be done by taking information from the entire set of scans and using it to recreate anatomical features that are missing from other scans.

“The key idea is to generate an image that is anatomically plausible, and to an algorithm looks like one of those research scans, and is completely consistent with clinical images that were acquired,” Golland says. “Once you have that, you can apply every state-of-the-art algorithm that was developed for the beautiful research images and run the same analysis, and get the results as if these were the research images.”

Once these research-quality images are generated, researchers can then run a set of algorithms designed to help with analyzing anatomical features. These include the alignment of slices and a process called skull-stripping that eliminates everything but the brain from the images.

Throughout this process, the algorithm keeps track of which pixels came from the original scans and which were filled in afterward, so that analyses done later, such as measuring the extent of brain damage, can be performed only on information from the original scans.

“In a sense, this is a scaffold that allows us to bring the image into the collection as if it were a high-resolution image, and then make measurements only on the pixels where we have the information,” Golland says.

Higher quality

Now that the MIT team has developed this technique for enhancing low-quality images, they plan to apply it to a large set of stroke images obtained by the MGH-led consortium, which includes about 4,000 scans from 12 hospitals.

“Understanding spatial patterns of the damage that is done to the white matter promises to help us understand in more detail how the disease interacts with cognitive abilities of the person, with their ability to recover from stroke, and so on,” Golland says.

The researchers also hope to apply this technique to scans of patients with other brain disorders.

“It opens up lots of interesting directions,” Golland says. “Images acquired in routine medical practice can give anatomical insight, because we lift them up to that quality that the algorithms can analyze.”

Find the report online at: https://www.mit.edu/~adalca/files/papers/ipmi2017_patchSynthesis.pdf

Story Source: Massachusetts Institute of Technology. “New technique makes brain scans better: Boosting quality of patient MRIs could enable large-scale studies of stroke outcome.” ScienceDaily. ScienceDaily, 21 June 2017. <www.sciencedaily.com/releases/2017/06/170621125321.htm>.

New technique makes brain scans better

Long-term memories made with meaningful information

When trying to memorize information, it is better to relate it to something meaningful rather than repeat it again and again to make it stick, according to a recent Baycrest Health Sciences study published in NeuroImage.

“When we are learning new information, our brain has two different ways to remember the material for a short period of time, either by mentally rehearsing the sounds of the words or thinking about the meaning of the words,” says Dr. Jed Meltzer, lead author and neurorehabilitation scientist at Baycrest’s Rotman Research Institute. “Both strategies create good short-term memory, but focusing on the meaning is more effective for retaining the information later on. Here’s a case where working harder does not mean better.”

Past studies have looked at repetition to create short-term memories, but these findings suggest that using the word’s meaning will help “transfer” memories from the short-term to the long-term, says Dr. Meltzer. This finding is consistent with the strategies used by the world’s top memory champions, who create stories rich with meaning to remember random information, such as the order of a deck of cards.

Through this work, researchers were able to pinpoint the different parts of the brain involved in creating the two types of short-term memories.

“This finding shows that there are multiple brain mechanisms supporting short-term memory, whether it’s remembering information based on sound or meaning,” says Dr. Meltzer, who is also a psychology professor at the University of Toronto. “When people have brain damage from stroke or dementia, one of the mechanisms may be disrupted. People could learn to compensate for this by relying on an alternate method to form short-term memories.”

For example, people who have trouble remembering things could carry a pad and rehearse the information until they have a chance to write it down, he adds.

The study recorded the brain waves of 25 healthy adults as they listened to sentences and word lists. Participants were asked to hold the information in their short-term memory over several seconds, and then recite it back, while their brain waves were recorded. Participants were then taken to a testing room to see if they could recall the information that had been heard. Through the brain scans, researchers identified brain activity related to memorizing through sound and meaning.

As next steps, Dr. Meltzer will use these findings to explore targeted brain stimulation that could boost the short-term memory of stroke patients. Additional funding would support the exploration of which types of memory are best treated by current drugs or brain stimulation and how these can be improved.

Story Source: Baycrest Centre for Geriatric Care. “Long-term memories made with meaningful information.” ScienceDaily. ScienceDaily, 20 June 2017. <www.sciencedaily.com/releases/2017/06/170620140624.htm>.

Clinical benefit of clot retrieval now proven up to 24 hours after major ischemic stroke

Clinical benefit of clot retrieval now proven up to 24 hours after major ischemic stroke

Results of an international, randomized controlled research study show that mechanical thrombectomy, which is an endovascular treatment to remove a stroke-causing blood clot in the brain, is effective in some patients even when performed within 6 to 24 hours after a stroke.

The findings of the study were presented in late May at the European Stroke Organization Conference 2017 in Prague. Rush University Medical Center is the only Illinois site, one of seven sites in the U.S, and one of only 22 sites in the world to participate in the international study called the DAWN trial where severe stroke patients underwent a thrombectomy after the six hour time window. (more…)