Generic placeholder image

Current Neurovascular Research

Author(s): Ying-Ying Lin, Shi-Jie Guo, Hui Quan, Yan-Xin Zhao* and Dong-Ya Huang*

DOI: 10.2174/1567202617666200413130101

DownloadDownload PDF Flyer Cite As
Donepezil Improves Gait Performance in Patients with an Acute Cerebral Infarction: A Prospective Observational Cohort Study

Page: [304 - 311] Pages: 8

  • * (Excluding Mailing and Handling)

Explore Articles
About Journal
For Authors
For Editors
For Reviewers

Abstract

Background: Hemiplegia is a common symptom after acute cerebral infarction.

Objective: This study aimed to explore the influence factors of gait performance and investigate whether donepezil could improve gait performance in patients with an acute cerebral infarction.

Methods: A total of 107 patients who experienced unilateral paresis after an acute cerebral infarction incident were enrolled in this prospectively observational study. Participants underwent a 3- month assessment. At the study's conclusion, patients were divided into 2 groups-those who received donepezil daily (observation Group) and those who did not (Control Group).

Results: There was a significant difference (t=3.269, P=0.001) of Wisconsin Gait Scale (WGS) score between single site infarction (27.11±6.65) and multiple sites infarction (31.54±6.42). For gender, smoking, drinking, hypertension, hyperlipidemia and diabetes, there was no difference in WGS scores between subgroups (P>0.05), respectively. The patient's admission National Institute of Health Stroke Scale(NIHSS) score had a strongly positive correlation with WGS score (r=0.850, P<0.001). Besides, age (r=0.218, P=0.024), glycosylated hemoglobin (r=0.274, P=0.004), MMSE (r=-0.261, P=0.007) and Montreal Cognitive Assessment (MoCA) (r=-0.272, P=0.005) had a weak correlation with WGS scores. Multivariate analysis showed age (95% CI: 0.042~0.188, P=0.002), admission NIHSS score (95% CI: 2.405~3.137, P<0.001) and multiple sites infarction (95% CI: 0.044~2.983, P=0.044) were independent risk factors of WGS scores. WGS scores of both observation and control groups gradually decreased after admission (P<0.001). At 3 months after admission, WGS score of the observation group was significantly lower than the control group (t=2.468, P=0.015). There were no significant differences between observation and control group at admission and 1 month after admission (P>0.05) and WGS scores of both single site and multiple sites infarction gradually decreased at one month and three months after admission (P<0.001), while there was no significant difference between two groups (P>0.05).

Conclusion: Admission NIHSS score, age and multiple sites infarction were independent risk factors of WGS score. Donepezil could improve gait performance in patients with acute cerebral infarction.

Keywords: Donepezil, cerebral infarction, gait performance, WGS, risk factors, NIHSS.

[1]
Feigin VL, Krishnamurthi RV, Parmar P, et al. GBD 2013 Writing Group. GBD 2013 Stroke Panel Experts Group. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 study. Neuroepidemiology 2015; 45(3): 161-76.
[http://dx.doi.org/10.1159/000441085] [PMID: 26505981]
[2]
Batchelor FA, Williams SB, Wijeratne T, et al. Balance and gait impairment in transient ischemic attack and minor stroke. J Stroke Cerebrovasc Dis 2015; 24(10): 2291-7.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.014]
[3]
Chen IH, Novak V, Manor B. Infarct hemisphere and noninfarcted brain volumes affect locomotor performance following stroke. Neurology 2014; 82(10): 828-34.
[http://dx.doi.org/10.1212/WNL.0000000000000186] [PMID: 24489132]
[4]
Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochim Biophys Acta 2016; 1862(5): 915-25.
[http://dx.doi.org/10.1016/j.bbadis.2016.01.015] [PMID: 26806700]
[5]
Jokinen H, Melkas S, Ylikoski R, et al. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol 2015; 22(9): 1288-94.
[http://dx.doi.org/10.1111/ene.12743] [PMID: 26040251]
[6]
Rosa MC, Marques A, Demain S, Metcalf CD. Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke--a preliminary study. Disabil Rehabil 2015; 37(2): 129-34.
[http://dx.doi.org/10.3109/09638288.2014.911969] [PMID: 24754638]
[7]
Ben Assayag E, Shenhar-Tsarfaty S, Korczyn AD, et al. Gait measures as predictors of poststroke cognitive function: evidence from the TABASCO study. Stroke 2015; 46(4): 1077-83.
[http://dx.doi.org/10.1161/STROKEAHA.114.007346] [PMID: 25677599]
[8]
Guzik A, Drużbicki M, Wolan-Nieroda A, Przysada G, Kwolek A. The Wisconsin gait scale - The minimal clinically important difference. Gait Posture 2019; 68: 453-7.
[http://dx.doi.org/10.1016/j.gaitpost.2018.12.036] [PMID: 30599331]
[9]
Guzik A, Drużbicki M, Przysada G, Kwolek A, Brzozowska-Magoń A, Wolan-Nieroda A. Analysis of consistency between temporospatial gait parameters and gait assessment with the use of Wisconsin Gait Scale in post-stroke patients. Neurol Neurochir Pol 2017; 51(1): 60-5.
[http://dx.doi.org/10.1016/j.pjnns.2016.11.004] [PMID: 27916248]
[10]
Hong JS, Kim JM, Kim HS. Correlation between ambulatory function and clinical factors in hemiplegic patients with intact single lateral corticospinal tract: A pilot study. Medicine (Baltimore) 2016; 95(31): e4360
[http://dx.doi.org/10.1097/MD.0000000000004360] [PMID: 27495041]
[11]
Kwah LK, Harvey LA, Diong J, Herbert RD. Models containing age and NIHSS predict recovery of ambulation and upper limb function six months after stroke: An observational study. J Physiother 2013; 59(3): 189-97.
[http://dx.doi.org/10.1016/S1836-9553(13)70183-8] [PMID: 23896334]
[12]
Ritzel RM, Lai YJ, Crapser JD, et al. Aging alters the immunological response to ischemic stroke. Acta Neuropathol 2018; 136(1): 89-110.
[http://dx.doi.org/10.1007/s00401-018-1859-2] [PMID: 29752550]
[13]
Mi T, Qu CQ, Wang X, Sun QJ, Sun H, Du YF. [Characteristics of cognitive impairment of different infarct locations among patients after acute ischemic stroke]. Zhonghua Yi Xue Za Zhi 2016; 96(15): 1205-7.
[PMID: 27117369]
[14]
Lim JS, Kim C, Oh MS, et al. Effects of glycemic variability and hyperglycemia in acute ischemic stroke on post-stroke cognitive impairments. J Diabetes Complications 2018; 32(7): 682-7.
[http://dx.doi.org/10.1016/j.jdiacomp.2018.02.006] [PMID: 29793824]
[15]
Pan Y, Cai X, Jing J, et al. CHANCE Investigators. Stress hyperglycemia and prognosis of minor ischemic stroke and transient ischemic attack: The CHANCE Study (Clopidogrel in high-risk patients with acute nondisabling cerebrovascular events). Stroke 2017; 48(11): 3006-11.
[http://dx.doi.org/10.1161/STROKEAHA.117.019081] [PMID: 29051218]
[16]
Luitse MJ, Velthuis BK, Kappelle LJ, et al. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke. Int Stroke 2017; 12(2): 180-6.
[http://dx.doi.org/10.1177/1747493016676619]
[17]
Lin SF, Chao AC, Hu HH, et al. Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study Group. Hyperglycemia predicts unfavorable outcomes in acute ischemic stroke patients treated with intravenous thrombolysis among a Chinese population: A prospective cohort study. J Neurol Sci 2018; 388: 195-202.
[http://dx.doi.org/10.1016/j.jns.2018.03.022] [PMID: 29627022]
[18]
Ntaios G, Abatzi C, Alexandrou M, et al. Persistent hyperglycemia at 24-48 h in acute hyperglycemic stroke patients is not associated with a worse functional outcome. Cerebrovasc Dis 2011; 32(6): 561-6.
[http://dx.doi.org/10.1159/000331924] [PMID: 22104640]
[19]
Johnston KC, Bruno A, Pauls Q, et al. Neurological Emergencies Treatment Trials Network and the SHINE Trial Investigators. Intensive vs. standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke: The SHINE Randomized Clinical Trial. JAMA 2019; 322(4): 326-35.
[http://dx.doi.org/10.1001/jama.2019.9346] [PMID: 31334795]
[20]
Reshi R, Streib C, Ezzeddine M, et al. Hyperglycemia in acute ischemic stroke: Is it time to re-evaluate our understanding? Med Hypotheses 2017; 107: 78-80.
[http://dx.doi.org/10.1016/j.mehy.2017.08.017] [PMID: 28915969]
[21]
Montero-Odasso M, Speechley M, Chertkow H, et al. Donepezil for gait and falls in mild cognitive impairment: a randomized controlled trial. Eur J Neurol 2019; 26(4): 651-9.
[http://dx.doi.org/10.1111/ene.13872] [PMID: 30565793]
[22]
Kollen B, van de Port I, Lindeman E, Twisk J, Kwakkel G. Predicting improvement in gait after stroke: A longitudinal prospective study. Stroke 2005; 36(12): 2676-80.
[http://dx.doi.org/10.1161/01.STR.0000190839.29234.50] [PMID: 16282540]
[23]
Giannotti E, Merlo A, Zerbinati P, et al. Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: Safety and changes in gait parameters. Eur J Phys Rehabil Med 2016; 52(3): 296-303.
[PMID: 26629841]
[24]
Gaynor E, Rohde D, Large M, et al. cognitive impairment, vulnerability, and mortality post ischemic stroke: A Five-year follow-up of the action on secondary prevention interventions and rehabilitation in stroke (ASPIRE-S) cohort. J Stroke Cerebrovasc Dis 2018; 27(9): 2466-73.