The Charted Care Collection (09/07/2021)

September 7, 2021 Jessica Kluetz

The Chartered Care Collection (09/07/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

I think this to myself every month, but wow, how time flies! I am back again to do another summary of the latest research I have found to be applicable to aging and rehabilitation.

The first article I came across looked at the correlation between early apathy after a stroke and the stroke outcome. Post-stroke depression and its correlation with poor outcome after, has been a topic I have often seen studied, but this study delved into apathy’s impact on post-stroke outcomes. Study participants were recruited to the study within 48 hours of having presented to the hospital for treatment of an ischemic stroke or transient ischemic attack (TIA). The partipants were screened for depression and for apathy. They were then divided into four different groups: neither depression nor apathy, without depression and with apathy, with depression and without apathy, and with both depression and apathy. There were 443 total participants. The scores on tests of apathy and depression scales were then compared to functional outcome, which was measured three and 12 months later. The biggest finding from the study was that early signs of apathy after an ischemic stroke were associated with a poorer outcome.

Staying in the same vein of post-stroke complications, the next study, published in the European Journal of Neurology, looked at the effect of intravenous alteplase (a drug that breaks up blood clots) on post-stroke depression. The prevalence of post-stroke depression ranges from 29-43% and has been associated with unfavorable outcomes after stroke. With the chances of a less favorable outcome after a stroke, the goal is to reduce or even eliminate post-stroke depression in patients. This study followed a total of 438 participants, just over half of whom received IV alteplase for treatment of the clot causing the stroke, with the other half of the group who did not receive IV alteplase as the control group. Looking at multiple factors, the study found that those who received IV alteplase had lower rates of post-stroke depression.

(Related blog post: Recovery After Stroke)

I have had countless patients in rehabilitation who recently experienced a myocardial infarction (MI), aka “heart attack.” A large number of these patients underwent stent placement, typically with a drug-eluting stent (DES), which then requires 12 months of treatment with both aspirin and clopidogrel (a blood thinner medication). This is the standard of care. This study, which can be found in The Lancet, then looked at what is the best medication regimen after those first twelve months of dual antiplatelet therapy (aspirin and clopridogrel). The participants received either 75 mg of clopidogrel or 100 mg of aspirin and were then followed for an additional 12 months. Adverse events monitored were stroke, readmission due to recurrent MI, major stroke and death (all causes). 3.7% of those receiving clopidogrel and 5.5% of those receiving aspirin experienced one of the adverse events listed above in the 12 to 24 months post-stent placement. This showed that clopidogrel therapy was statistically superior to aspirin therapy in preventing future cardiac events.

(Related blog post: Options For Medication Management)

The final study I want to highlight this month comes to us from JAMA Neurology. It compared two different treatments for the management of back pain. Chronic low back pain plagues a large number of older adults, and unfortunately there is no clear cut treatment to successfully manage this pain. This particular study compared specific motor skill training (MST) with traditional strength and flexibility exercise (SFE) in managing chronic low back pain. The participants in the study were between the ages of 18 to 60 and had low back pain for at least 12 months. The MST group received person-specific motor skills training while those in the SFE group received traditional exercises not specific to each person. The study showed that the MST group had greater improvements in both function and patient satisfaction when compared to the SFE group.

References:

Lopatkiewicz, A., et al. Early apathetic, but not depressive symptoms are associated with poor outcome after stroke. Europ J Neurol. 20201, June; 28(6): 1949-1957.

Konigsberg, A., et al. Effect of Intravenous Alteplase on Post-Stroke Depression in the WAKE-UP Trial. Europ J Neurol. 2021, June; 28 (6): 2017-2025.

Koo, B., et al. Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised open-label mutlicentre trial. Lancet. 2021: https://doi.org/10.1016/S0140-6736 (21)01063-1.

Van Dillen, L., et al. Effect of motor skill training in functional activities versus strength and flexibility exercise on function in people with chronic low back pain: a randomized clinical trial. JAMA Neurol. 2021, April; 78(4): 385-395.

That sums it up for the Chartered Care Collection for this month. Feel free to read each of these articles in full, and feel free to leave your comments or questions below!