Hege Beate Ihle-Hansen

• Ihle-Hansen, Håkon; Ihle-Hansen, Hege Beate; Blauenfeldt, Rolf A.; Dawson, Jesse; Diederichsen, Søren Z. & Hagberg, Guri (2026). Cardiometabolic drugs after stroke: time to embrace SGLT2 inhibitors and incretin-based therapies? Frontiers in stroke. 5. doi: 10.3389/fstro.2026.1918465. Fulltekst i vitenarkiv
• Iversen, Emil; Ihle-Hansen, Hege Beate; Halle, Kari Krizak; Lundervold, Alexander Selvikvåg; Myrmel, Lars & Vestbø, Anders Strand [Vis alle 11 forfattere av denne artikkelen] (2026). Multimodal artificial intelligence-based decision support for stroke classification in medical emergency calls using call transcripts and patient health records: A retrospective diagnostic accuracy study. International Journal of Medical Informatics. ISSN 1386-5056. 222. doi: 10.1016/j.ijmedinf.2026.106713. Fulltekst i vitenarkiv Vis sammendrag

  Background: Identifying stroke during medical emergency calls is challenging because of unstructured information, communication barriers, and heterogeneous symptoms. Artificial intelligence (AI) may improve early stroke recognition; however, evidence from emergency call settings remains limited, and the value of combining call transcripts with structured clinical data is unclear. We developed and internally validated a multimodal AI-based decision-support system for stroke classification during medical emergency calls and compared its performance with the Emergency Medical Communication Centre (EMCC) operator baseline. Methods: We performed a retrospective diagnostic accuracy study using data from Bergen EMCC from 2019 and 2022. Two datasets were used: (1) 473 EMCC audio files with paired manual transcripts for fine-tuning a Norwegian Whisper–based automatic speech recognition (ASR) model (2019), and (2) 2,627 labelled emergency calls for classification model development and evaluation (2022). Structured clinical data included hospital data, laboratory measurements, and medications. Performance was assessed using area under the receiver operating characteristic curve (AUC), precision, recall, and F1-score. A streaming evaluation at 30, 60, and 90 s simulated real-time use. Results: Fine-tuning improved ASR accuracy, reducing word error rate from 8.3% to 7.2%. The multimodal classification model achieved a stroke-class F1-score of 0.77, exceeding that of both the transcript-only model and the operator baseline (0.73). The macro-averaged F1-score was 0.87 and the AUC was 0.86. At an assumed 1.2% stroke prevalence, the model was estimated to generate approximately 26 false alerts per 1,000 calls, compared with 36 for the operator baseline. In the streaming evaluation, stroke F1-score increased from 0.68 at 30 s to 0.85 at 90 s, stabilising performance during the first minute. Conclusions: A multimodal AI-based decision-support system integrating emergency call transcripts with patient health records improved stroke classification performance and may support EMCC operators during stroke triage. External validation in larger datasets is required before clinical implementation.

• Romero-Ortuño, Román; Barbagallo, Mario; Bonin-Guillaume, Sylvie; Clarfield, A. Mark; Dhesi, Jugdeep & Duque, Sofia [Vis alle 26 forfattere av denne artikkelen] (2026). The development of the European Geriatric Medicine Specialty Exam. European Geriatric Medicine. ISSN 1878-7649. doi: 10.1007/s41999-026-01600-0. Fulltekst i vitenarkiv
• Vahedi, Ali; Eriksdotter, Maria; Ihle-Hansen, Hege Beate; Wyller, Torgeir Bruun; Øksengård, Anne Rita & Fure, Brynjar (2026). Impact of Acute Functional Decline on Frailty and Mortality in Acutely Hospitalized Older Persons. Aging Medicine. ISSN 2475-0360. s. 1–10. doi: 10.1002/agm2.70104. Fulltekst i vitenarkiv
• Iversen, Emil; Ihle-Hansen, Hege Beate; Halle, Kari Krizak; Lundervold, Alexander Selvikvåg; Myrmel, Lars & Vestbø, Anders Strand [Vis alle 10 forfattere av denne artikkelen] (2026). Stroke detection in medical emergency calls: a retrospective analysis and exploratory evaluation of an AI decision support model. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 34(1). doi: 10.1186/s13049-026-01645-x. Fulltekst i vitenarkiv Vis sammendrag

  Background Timely identification of acute stroke during medical emergency calls is critical for optimizing patient outcomes. We aimed to (i) characterize the prehospital trajectories of patients with stroke and (ii) explore the ability of an artificial intelligence (AI) model developed within the Artificial Intelligence Support in Medical Emergency Calls project to support decision-making at Emergency Medical Communication Centres (EMCCs). Methods We conducted a retrospective analysis using data from 1,164 patients diagnosed with stroke from an EMCC (2018–2019), focusing on those primarily assessed by EMCC operators. We categorized patients into optimal and nonoptimal trajectory groups and applied logistic regression to explore the factors associated with an optimal trajectory. An AI model was trained using a dataset of 2,980 emergency calls (2019 and 2022), integrating transcribed audio logs and structured clinical data. The model was evaluated on the full dataset and subgroups that were incorrectly assessed by the EMCC. Results Aphasia/dysarthria was the only factor associated with optimal trajectories. The AI model achieved a sensitivity of 81.0%, specificity of 79.6%, and F1-score of 64.7%. The subgroup analysis included 14 false-negative and 41 false-positive cases. The model correctly predicted stroke in 9 of 14 false-negative cases and ruled out stroke in 9 of 41 false-positive cases. Conclusions This explorative evaluation indicates that a multimodal AI pipeline combining audio and structured clinical data may show potential to support decision making in medical emergency calls. Internal results are promising, but studies on larger and external datasets are needed to validate these findings.

• Eilertsen, Helle; Larsen, Kristin Tveitan; Forfang, Elisabeth; Pennlert, Johanna; Glader, Eva Lotta & Kruuse, Christina [Vis alle 19 forfattere av denne artikkelen] (2026). Study of Antithrombotic Treatment After Intracerebral Haemorrhage-Antiplatelets: A Randomized Trial. Stroke. ISSN 0039-2499. 57(8), s. 2287–2294. doi: 10.1161/STROKEAHA.125.054990. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Patients surviving spontaneous intracerebral hemorrhage (ICH) who have indications for antithrombotic treatment face increased risks of both hemorrhagic and ischemic events. The aim of STATICH (Study of Antithrombotic Treatment After Intracerebral Haemorrhage) was to assess the safety and efficacy of long-term antithrombotic treatment after ICH. METHODS: STATICH Antiplatelets (EudraCT 2014-002636-13; Unique identifier: NCT03186729) was a randomized, multicenter, open, blinded end point parallel-group trial, including adults with an indication for antiplatelet treatment to either start or avoid antiplatelet treatment. The target sample size was 500 participants. Patients were allocated 1:1 by a Web-based randomization system and followed for a minimum of 2 years. Outcome assessments were done by personnel blinded to treatment. Participants were not blinded. The primary safety outcome was recurrent symptomatic ICH. RESULTS: The trial was stopped early due to slow recruitment. Sixty-nine patients were included between August 2018 and December 2022: 34 were randomized to start antiplatelet treatment, and 35 were randomized to avoid antiplatelet treatment. No patients were excluded from analyses. The median age was 75 (Q1–Q3, 66–80) years, and 43 (75%) had previous ischemic stroke or transient ischemic attack. Five patients in the start antiplatelet treatment group (15% [95% CI, 6%–31%]), and 1 in the avoid group (3% [95% CI, 0%–18%]) experienced recurrent ICH, while 3 (9% [95% CI, 3%–24%]) and 7 (20% [95% CI, 10%–37%]), respectively, experienced a major ischemic event. A total of 88 serious adverse events and no suspected unexpected serious adverse reactions were registered. CONCLUSIONS: There were numerically more recurrent ICHs and fewer ischemic events in patients starting antiplatelet treatment after ICH compared with those avoiding antiplatelet treatment. The slow recruitment might be due to clinicians being certain of the best treatment strategy or patients being too frail to participate. STATICH will contribute to a planned collaborative individual patient-data meta-analysis to resolve this dilemma.

• Ihle-Hansen, Håkon; Walle-Hansen, Marte; Berge, Trygve; Ihle-Hansen, Hege Beate; Rønningen, Peter Selmer & Omland, Torbjørn [Vis alle 16 forfattere av denne artikkelen] (2026). Burden of atherosclerosis, cardiovascular risk factors and atrial fibrillation in individuals with covert brain infarcts in late midlife: the Akershus Cardiac Examination 1950 Study. BMJ Open. 16(3). doi: 10.1136/bmjopen-2025-114232. Fulltekst i vitenarkiv Vis sammendrag

  Background Current expert consensus statements generally suggest cardiovascular risk assessment, including atrial fibrillation (AF) screening, on detection of covert brain infarctions (CBIs). However, evidence to guide management of CBI remains limited. In the absence of randomised clinical trials specifically targeting CBI populations, observational studies comparing individuals with and without CBI can provide insights into the prevalence and burden of cardiovascular risk factors. Objectives We aimed to compare the burden of atherosclerosis and cardiovascular risk factors in participants with CBI to those without, and to explore the yield of AF screening in individuals with CBI. Design A prospective population-based birth cohort study including men and women born in 1950 and resident in Akershus County, Norway. Setting The two hospitals serving the population of Akershus county, Norway. Participants Participants included in the Akershus Cardiac Examination (ACE) 1950 study who also underwent a subsequent MRI examination were eligible for this study. Outcome measures Cardiovascular risk assessment was performed at study inclusion (2012–2015). Carotid ultrasound was used to quantify atherosclerosis through a carotid plaque score, and CHA₂DS₂-VA and Systematic COronary Risk Evaluation 2 (SCORE2) scores were calculated to estimate cardiovascular risk. Brain MRI was performed in a randomly selected, blood pressure-stratified subset of participants (2016–2024). CBI was defined as focal lesions consistent with ischaemia in the absence of clinical stroke. Participants with CBI were offered 72-hour ambulatory ECG monitoring for AF detection. Results MRI was performed in 414 of 3706 (11%) participants in the ACE 1950 Study. The mean age at the time of the MRI examination was 70.2±2.3 years, and 165 (41%) were women. CBI was identified in 54 participants (13%), of whom 45 (83%) completed 72-hour ambulatory ECG monitoring. There were no differences in mean carotid plaque score, SCORE2 or CHA₂DS₂-VA score between participants with CBI compared with those with normal MRI findings. AF was detected in one (2%) participant with CBI. Conclusions In this community-based cohort of individuals in late midlife, individuals with CBI did not have an increased cardiovascular risk compared with those without, as indicated by SCORE2, CHA₂DS₂-VA score, age-appropriate carotid plaque burden and a low prevalence of AF. Trial registration number URL: https://www.clinicaltrials.gov . Unique identifier: NCT01555411 .

• Simpson, Dawn B.; Gay, Caryl L.; Berg, Søren; English, Coralie; Ihle-Hansen, Hege Beate & Helland, Gisle Berg [Vis alle 11 forfattere av denne artikkelen] (2026). Sleep quality, not sleep apnoea, is associated with post-stroke fatigue in acute ischemic stroke: a cross-sectional Norwegian study (NORFAST). Disability and Rehabilitation. ISSN 0963-8288. s. 11–11. doi: 10.1080/09638288.2026.2620503. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Post-stroke fatigue affects rehabilitation, daily activities, and quality of life. Its relationship with sleep remains unclear. We aimed in the acute stroke phase to (a) describe fatigue and sleep using self-reported and objective sleep measures, (b) describe sleep apnoea and (c) explore the associations between sleep measures and post-stroke fatigue. Material and methods This cross-sectional study examined Norwegian adults within 14 days of first ischaemic stroke. Fatigue was assessed with the Fatigue Severity Scale. Self-reported sleep factors (Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale) and objective WatchPAT measures (apnoea-hypopnea, sleep time, efficiency, REM/deep sleep) served as exposure variables. Multivariable regression models, adjusted for age, sex, mRS, and depression or anxiety symptoms, were used to examine associations between sleep and fatigue. Results Participants (n = 107, mean age 65 (SD14) years, n = 65(61%) male) had a mean NIHSS score of 2.5 [SD3.3], Fatigue Severity Scale score of 3.11 [SD1.82], and n = 71 (66%) scored as having disturbed sleep (PSQI). Mean total sleep time (n = 81) was 7.04 [SD1.46] hours and 54 (71%) had sleep apnoea. In the final multivariable model, only poor sleep quality (b = 0.45, p = 0.010) was associated with post-stroke fatigue. Conclusions Addressing sleep quality in the acute stroke phase may benefit post-stroke fatigue.

• Helland, Gisle Berg; Ihle-Hansen, Håkon; Aamodt, Anne Hege; Leonardsen, Esten Høyland; Kaufmann, Tobias Herbert & Enriquez, Brian Anthony [Vis alle 13 forfattere av denne artikkelen] (2026). Brain age trajectories and cognition after stroke in two longitudinal cohorts. Brain Communications. 8(1). doi: 10.1093/braincomms/fcaf509. Fulltekst i vitenarkiv Vis sammendrag

  Brain age is a promising neuroimaging biomarker, reflecting biological aging, but long-term trajectories and predictive value for cognitive outcomes post-stroke remains unclear. This study aimed to characterize brain aging trajectories over 8 years following a first-ever stroke and to evaluate the predictive value of brain age estimates for long-term cognitive outcomes. We analysed data from working-age (<65 years) ischaemic stroke patients with small- and medium-sized strokes (lesion volumes <70 ml), using two longitudinal stroke cohorts. T1-weighted MRI was acquired in the acute phase and at multiple time points up to 8 years post-stroke. Montreal cognitive assessment (MoCA) was assessed at follow-up sessions. Brain age was estimated using a state-of-the-art deep learning model. Brain-predicted age difference (Brain-PAD) was calculated as estimated brain age minus chronological age and corrected by regressing on age, age² and sex. Linear mixed-effects models examined Brain-PAD over multiple time points (whole-brain, ipsilesional and contralesional). Normalized brain volume was derived from FreeSurfer and included in the whole-brain analysis. Linear regression models evaluated whether brain age was associated with cognitive performance (MoCA) at long-term follow-up. We included 120 patients [n = 50 (42%) female, mean ± SD age at discharge was 54.9 ± 9 and National Institutes of Health Stroke Scale was 3.7 ± 6.4], with a mean follow-up of 3.4 ± 2.5 years. The mean MoCA score at follow-up was 24.7 ± 3.7. Brain-PAD increased significantly over time in the whole-brain analysis (β = 0.6/year, P < 0.01), indicating 60% acceleration in brain aging after stroke, with the association remaining significant after adjusting for normalized brain volume (β = 0.5/year, P < 0.01). Accelerated brain aging was observed in the ipsilesional hemisphere (β = 0.7/year, P < 0.01), but not the contralesional hemisphere (β = 0.3/year, P = 0.12). Higher brain age in the acute phase of stroke predicted lower MoCA scores at follow-up (β = −0.12, P < 0.05), whereas chronological age was not a significant predictor (P = 0.12). The association between brain age estimations and cognitive performance remained significant after adjusting for age, sex and education (β = −0.42, P < 0.01). In this longitudinal study, we found accelerated brain aging following stroke. Furthermore, brain age was associated with cognitive outcomes several years later, highlighting its potential as an early biomarker for long-term cognitive prognosis.

• Hagberg, Guri; Ihle-Hansen, Håkon; Abzhandadze, Tamar; Reinholdsson, Malin; Viktorisson, Adam & Pesonen, Eerikki Henri [Vis alle 8 forfattere av denne artikkelen] (2025). Association of reperfusion therapy in acute ischemic stroke on PROMs after one year; a registry-based case-control study. Journal of the Neurological Sciences. ISSN 0022-510X. 473. doi: 10.1016/j.jns.2025.123517. Fulltekst i vitenarkiv
• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 14 forfattere av denne artikkelen] (2025). Blood pressure at age 40 and key features of cerebral small vessel disease at age 70: data from the ACE 1950 Study. BMC Cardiovascular Disorders. 25(1). doi: 10.1186/s12872-025-05140-6. Fulltekst i vitenarkiv Vis sammendrag

  Background The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. Methods We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012–2015) who had previously participated in the Age 40 Program (1990–1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130–139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016–2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70–79 mmHg), high elevated (80–89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. Results A total of 414 participants (167 [40%] women) were included. Participants were 70.2 ± 2.3 years when undergoing brain MRI. Mean Fazekas scale was 1.3 ± 0.8, and 54 (13%) had lacunes. SBP and DPB were not associated with lacunes. DPB of 80–89 mmHg (adjusted OR [95% CI], 1.91 [1.01–3.62]) and ≥ 90 mmHg (2.11 [1.06–4.19]) at age 40 were associated with WMHs. Conclusions Elevated DBP (80–89 mmHg) and diastolic hypertension (> 90 mmHg) at age 40 were associated with WMH burden at age 70, suggesting a long-term association between midlife DBP and cerebrovascular health.

• Rønning, Ole Morten; Nordby, Linn Marie; Logallo, Nicola; Kvistad, Christopher Elnan; Kristoffersen, Espen Saxhaug & Ihle-Hansen, Håkon [Vis alle 12 forfattere av denne artikkelen] (2025). Association between blood pressure and outcome in patients with acute ischemic stroke treated with alteplase. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 35(1). doi: 10.1016/j.jstrokecerebrovasdis.2025.108518. Fulltekst i vitenarkiv Vis sammendrag

  Background The role of blood pressure (BP) in acute stroke remains unclear. We investigated the impact of BP trajectories during the first 24 hours (h) after hospital admission on outcomes in acute ischemic stroke patients treated with intravenous alteplase. Methods In 424 ischemic stroke patients from the NOR-TEST I trial treated with alteplase, we assessed systolic BP (sBP) at baseline, change in sBP between 0 h and 24 h, and increase in sBP over the same period. Outcomes included modified Rankin Scale (mRS) at 3 months, NIHSS at 24 h, and symptomatic intracerebral haemorrhage (sICH) within 48 h. Logistic and linear regression analyses were used to explore the association of blood pressure trajectories and outcome adjusted for age, sex, time from onset of symptoms to intravenous thrombolysis (IVT) and NIHSS at admittance (NIHSSadm). Results Mean sBP at baseline (admittance), 2 h and 24 h were 155, 147 and 142 mmHg, respectively. An increase in sBP from baseline to 24 h was seen in 115 patients (27 %), while 409 showed an overall change. In unadjusted analyses, sBP increase (but not baseline sBP or change in sBP) was associated with worse mRS at 3 months. This remained significant after adjustment (OR 0.933, 95 %CI 0.876 – 0.993). Higher baseline sBP and sBP increase predicted worse NIHSS at 24 h. sBP increase and baseline sBP were also associated with sICH within 48 h, but only baseline sBP remained significant after adjustment (OR 1.022, 95 % CI 1.003–1.042). Conclusions An increase in sBP within the first 24 h was associated with worse neurological and functional outcomes at 3 months, while higher baseline sBP was linked to worse neurological outcomes and sICH in acute ischemic stroke patients treated with alteplase.

• Ihle-Hansen, Håkon; Walle-Hansen, Marte; Hagberg, Guri; Berge, Trygve; Ihle-Hansen, Hege Beate & Rønningen, Peter Selmer [Vis alle 11 forfattere av denne artikkelen] (2025). Applying the 2024 European Society of Cardiology Guidelines for the management of elevated blood pressure and hypertension to a Norwegian general population cohort from age 40: data from the Akershus Cardiac Examination 1950 study. Heart. ISSN 1355-6037. 111(23), s. 1119–1123. doi: 10.1136/heartjnl-2025-325770. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Hagberg, Guri; Ihle-Hansen, Hege Beate; Munthe-Kaas, Ragnhild; Aam, Stina & Aamodt, Eva Birgitte [Vis alle 11 forfattere av denne artikkelen] (2025). Impact of Insufficient or Excessive Sleep Duration on Cognitive Function After Stroke: The Norwegian Cognitive Impairment After Stroke Study. Journal of the American Heart Association (JAHA). 14(8). doi: 10.1161/JAHA.124.038125. Fulltekst i vitenarkiv Vis sammendrag

  Background The impact of sleep duration on cognition, particularly in the context of poststroke cognitive impairment, is not fully understood. Therefore, our objective was to investigate how sleep duration after stroke predicts poststroke cognitive impairment. Methods and Results Patients admitted with acute stroke between 2015 and 2017 were consecutively recruited to the Nor‐COAST (Norwegian Cognitive Impairment After Stroke) study and invited to follow‐up assessments at 3 and 18 months. Time in bed, used as a surrogate for sleep duration at 3 months post stroke, was measured using the activPAL thigh‐worn sensor over a 3‐day period. Sleep duration was categorized into 3 groups: <7 hours (insufficient), 7 to 9 hours (reference), and ≥9 hours (excessive). Cognitive impairment was assessed based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria at 3‐ and 18‐month follow‐up. Out of the 815 patients, we included 443 (54%) prestroke cognitive healthy with valid activPAL registration in this analysis. Mean±SD age was 71.2±11.4 years, 185 (42%) were women, 363 (82%) had prestroke modified Rankin Scale score <2, and 345 (78%) suffered a minor stroke (National Institutes of Health Stroke Scale score ≤5). On average, participants spent 8.3±1.4 hours in bed each night, 17.2% had a sleep duration <7 hours, and 25% slept more than 9 hours. Insufficient (odds ratio [OR], 3.6 [95% CI, 1.3–10.2], and OR, 1.4 [95% CI, 0.5–3.8]) and excessive (OR, 2.8 [95% CI, 1.1–7.5], and OR, 3.3 [95% CI, 1.3–8.1]) sleep duration were associated with an increased risk of cognitive impairment at 3‐ and 18‐month follow‐up, respectively. Conclusions Insufficient or excessive sleep duration was associated with poststroke cognitive impairment.

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Hagen, Milada [Vis alle 7 forfattere av denne artikkelen] (2025). Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 34(6). doi: 10.1016/j.jstrokecerebrovasdis.2025.108297. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months poststroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke. Materials and methods: In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers. Results: Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]). Conclusion: There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

• Iversen, Emil; Ihle-Hansen, Hege Beate; Halle, Kari Krizak; Lundervold, Alexander Selvikvåg; Myrmel, Lars & Vestbø, Anders Strand [Vis alle 9 forfattere av denne artikkelen] (2025). Stroke Sensitivity Calculation in Medical Emergency Calls and Factors Associated With Stroke Suspicion: A Retrospective Registry-Based Study. Annals of Emergency Medicine. ISSN 0196-0644. 86(5), s. 533–540. doi: 10.1016/j.annemergmed.2025.04.028. Fulltekst i vitenarkiv Vis sammendrag

  Study objective: Sensitivity for stroke detection in emergency medical communication centers (EMCCs) varies widely. Few studies offer detailed insights into the out-of-hospital pathways of patients with stroke. This study explored the ability of EMCCs to detect strokes in medical emergency calls using an alternative method for estimating stroke sensitivity in EMCCs, thereby laying the foundation for developing artificial intelligence decision-support tools. It also identified factors associated with stroke recognition in medical emergency calls. Methods: Overall, 1,164 patients with stroke in the catchment area of Bergen EMCC in 2018 and 2019 were included, and a data set from the EMCC was established manually and linked with data from the Norwegian Stroke Registry for analysis. Descriptive analysis and multivariable logistic regression were performed on data obtained from patients primarily assessed by the EMCC (n=838). Results: Stroke detection sensitivity was 76.8% in our study using the alternative method compared with 63.4% with traditional methods. Logistic regression analysis showed a positive association between stroke suspicion and ischemic strokes (odds ratio [OR]=0.317 [0.209 to 0.481]) and wake-up strokes (OR=1.716 [1.110 to 2.653]). Among Norwegian Stroke Registry symptoms, only aphasia/dysarthria was positively associated with stroke suspicion (OR=1.600 [1.087 to 2.353]), whereas leg paresis (OR=0.609 [0.390 to 0.953]) and vertigo (OR=0.376 [0.204 to 0.694]) were negatively associated. Conclusion: We employed an alternative method for estimating EMCC stroke sensitivity and identified factors of particular interest for future EMCC research, relevant when developing and testing decision-support tools, such as artificial intelligence.

• Larsen, Kristin Tveitan; Jahr, Silje Holt; Selseth, Maiken Nordahl; Lied-Herland, Trine; Hillestad, Vigdis & Ihle-Hansen, Hege Beate [Vis alle 9 forfattere av denne artikkelen] (2025). Impact of white matter lesions on associations between prehospital blood pressure and outcomes in spontaneous intracerebral hemorrhage. European Stroke Journal. ISSN 2396-9873. 10(4), s. 1402–1412. doi: 10.1177/23969873251343495. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: There are concerns about the safety of intensive blood pressure (BP) lowering in intracerebral hemorrhage (ICH) patients with white matter lesions (WML). We explored the impact of WML on associations between i) prehospital BP, and ii) BP change, and outcomes in acute, spontaneous ICH. Patients and methods: This retrospective study included consecutive patients with acute spontaneous ICH, admitted 2011–2020. WML on non-contrast computed tomography were categorized as none-to-mild (0–1) or moderate-to-severe (2–3) on the Fazekas scale. The first systolic BP (SBP) and mean arterial pressure (MAP) from the ambulance and admission, and absolute BP change between these time points, were collected. The outcomes were in-hospital mortality, mortality at 180 days, modified Rankin Scale (mRS) scores at 3 months, and hematoma expansion. Results: Of 548 patients, 260 (47%) had moderate-to-severe WML. Compared to patients with none-to-mild WML, these patients had a stronger association between higher prehospital MAP and in-hospital mortality (p interaction 0.017). WML did not modify associations between prehospital BP and other outcomes. WML modified associations between MAP change and in-hospital mortality (p interaction 0.049), MAP change and mRS score 3–6 at 3 months (p interaction 0.032), and SBP change and mRS score 3–6 at 3 months (p interaction 0.022). These outcomes were poorer with greater BP decrease in patients with moderate-to-severe compared to none-to-mild WML. Discussion and conclusion: In acute ICH, WML modified the influence of prehospital BP and BP change on clinical outcomes, with a trend toward worse outcomes associated with higher prehospital BP and greater spontaneous BP decrease.

• Ihle-Hansen, Håkon; Hagberg, Guri; Ihle-Hansen, Hege Beate; Sandset, Else Charlotte; Andrade, Jason G. & Mandrola, John [Vis alle 7 forfattere av denne artikkelen] (2024). What Do We Really Know about the Effect of Prolonged Heart Rhythm Monitoring after Stroke? Stroke. ISSN 0039-2499. 55(4), s. 1136–1140. doi: 10.1161/STROKEAHA.123.045843. Fulltekst i vitenarkiv
• Navickaite, Egle; Saltvedt, Ingvild Tina; Lydersen, Stian; Munthe-Kaas, Ragnhild; Ihle-Hansen, Hege Beate & Grambaite, Ramune [Vis alle 7 forfattere av denne artikkelen] (2024). Diagnostic accuracy of the Clock Drawing Test in screening for early post-stroke neurocognitive disorder: the Nor-COAST study. BMC Neurology. 24(1). doi: 10.1186/s12883-023-03523-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Post-stroke neurocognitive disorder, though common, is often overlooked by clinicians. Moreover, although the Montreal Cognitive Assessment (MoCA) has proven to be a valid screening test for neurocognitive disorder, even more time saving tests would be preferred. In our study, we aimed to determine the diagnostic accuracy of the Clock Drawing Test (CDT) for post-stroke neurocognitive disorder and the association between the CDT and MoCA. Methods This study is part of the Norwegian Cognitive Impairment After Stroke study, a multicentre prospective cohort study following patients admitted with acute stroke. At the three-month follow-up, patients were classified with normal cognition, mild neurocognitive disorder, or major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Any neurocognitive disorder compromised both mild- and major neurocognitive disorder. The CDT at the three-month assessment was given scores ranging from 0 to 5. Patients able to complete the CDT and whose cognitive status could be classified were included in analyses. The CDT diagnostic accuracy for post-stroke neurocognitive disorder was identified using receiver operating characteristic curves, sensitivity, specificity, positive predictive value, and negative predictive value. The association between the MoCA and CDT was analysed with Spearman’s rho. Results Of 554 participants, 238 (43.0%) were women. Mean (SD) age was 71.5 (11.8) years, while mean (SD) National Institutes of Health Stroke Scale score was 2.6 (3.7). The area under the receiver operating characteristic curve of the CDT for major neurocognitive disorder and any neurocognitive disorder was 0.73 (95% CI, 0.68–0.79) and 0.68 (95% CI, 0.63–0.72), respectively. A CDT cutoff of < 5 yielded 68% sensitivity and 60% specificity for any neurocognitive disorder and 78% sensitivity and 53% specificity for major neurocognitive disorder. Spearman’s correlation coefficient between scores on the MoCA and CDT was 0.50 (95% CI, 0.44–0.57, p < .001). Conclusions The CDT is not accurate enough to diagnose post-stroke neurocognitive disorder but shows acceptable accuracy in identifying major neurocognitive disorder. Performance on the CDT was associated with performance on MoCA; however, the CDT is inferior to MoCA in identifying post-stroke neurocognitive disorder.

• Helland, Gisle Berg; Beyer, Mona K.; Enriquez, Brian Anthony; Ihle-Hansen, Hege Beate; Ihle-Hansen, Håkon & Andersson, Stein [Vis alle 13 forfattere av denne artikkelen] (2024). Lesion Volume as a Predictor for Return to Work After Endovascular Treatment: A 4‐Year Prospective Cohort Study. Stroke: Vascular and Interventional Neurology. 4(6). doi: 10.1161/SVIN.124.001494. Fulltekst i vitenarkiv Vis sammendrag

  Background There are no known objective biomarkers for predicting return to work (RTW) in ischemic stroke survivors. This study aims to explore the predictive utility and defines a cutoff value of lesion volume on RTW after endovascular treatment. Methods We included patients aged <65 years undergoing endovascular treatment at Oslo University Hospital between January 2017 and May 2019. Employment status was obtained at both baseline and a 4‐year follow‐up. Stroke lesion volumes were segmented using magnetic resonance imaging scans 24 hours after endovascular treatment. Logistic regression models were conducted to assess the impact of lesion volume on RTW status at follow‐up, adjusted for patients’ characteristics, stroke‐related factors, and treatment. We calculated the receiver operating characteristic curve to determine the optimal lesion volume cutoff. Machine learning regression models were used to assess the predictive abilities of baseline clinical and imaging variables for RTW. Results Of the 109 individuals treated, 81 (74%) were employed at baseline. Among these, 60 completed 4‐year follow‐up with magnetic resonance imaging available for stroke lesion segmentation and were included in the analyses. Mean age at stroke onset was 51.8 years (range, 23.5–64.9 years), and 50% were female. Median lesion volume was 18 mL (interquartile ranges, 45—47 mL). After 4 years, 34 (57%) had successfully RTW. The odds for not RTW increased by 5% for every 1 mL increase in lesion volume (adjusted odds ratio, 1.05 [95% CI, 1.02–1.11]; P = 0.02). A lesion volume cutoff value of 29 cm3 yielded a sensitivity of 0.91 and specificity of 0.65 for predicting RTW. Notably, the most influential feature in the machine learning model for predicting RTW was lesion volume. Conclusion Lesion volume was the most robust predictor of RTW 4 years after endovascular treatment. Our findings suggest that a cutoff of 29 cm3 is suitable to distinguish between those with high and low chance of RTW.

• Ihle-Hansen, Hege Beate; Pedersen, Reidar; Westbye, Siri Færden; Sævareid, Trygve Johannes Lereim; Brøderud, Linn Benita & Larsen, Marie Hamilton [Vis alle 9 forfattere av denne artikkelen] (2024). Patient preferences in geriatric wards, a survey of health care professionals’ practice, experience and attitudes. European Geriatric Medicine. ISSN 1878-7649. 15, s. 153–158. doi: 10.1007/s41999-023-00922-7. Fulltekst i vitenarkiv Vis sammendrag

  Purpose We aimed to identify whether health care professionals (HCP) examine their patient and next-of-kin preferences, and to study whether medical decisions follow these preferences. Method A cross-sectional web-based survey was conducted with multidisciplinary HCP from 12 geriatric wards in the South-Eastern Norway Regional Health Authority. Results Of the 289 HCPs responding (response rate 61%), mean age 37.8 years (SD 11.3), 235 (81.3%) women, 12.4 (SD 9.6) years of experience and 67 (23.2%) medical doctors, only half report clarifying patients’ preferences. The majority reported that they did not inform, involve and treat in line with such preferences. However, 53% believe that HCP, patients and next-of-kin should make clinical decisions together. Discussion Our findings indicate a lack of engagement in conversation and inclusion of patient preferences when providing health interventions in geriatric wards. Measures for change of culture are needed.

• Ihle-Hansen, Hege Beate (2024). Forhåndssamtaler om livets siste livsfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate; Einvik, Gunnar; Hagberg, Guri; Thommessen, Bente; Rønning, Ole Morten & Vigen, Thea [Vis alle 11 forfattere av denne artikkelen] (2024). Sleep Duration and Cognitive Function: The Akershus Cardiac Examination 1950 Study. Dementia and Geriatric Cognitive Disorders. ISSN 1420-8008. 53(6), s. 338–344. doi: 10.1159/000540273. Fulltekst i vitenarkiv
• Hagberg, Guri; Ihle-Hansen, Håkon; Abzhandadze, Tamar; Reinholdsson, Malin; Viktorisson, Adam & Ihle-Hansen, Hege Beate [Vis alle 7 forfattere av denne artikkelen] (2024). The precision by the Face Arm Speech Time (FAST) algorithm in stroke capture, sex and age differences: a stroke registry study. BMJ Neurology Open. 6(1). doi: 10.1136/bmjno-2023-000574. Fulltekst i vitenarkiv
• Amundsen, Erik Koldberg; Ihle-Hansen, Hege Beate; Kraglund, Kristian Lundsgaard & Hagberg, Guri (2024). Acute ischemic stroke and measurement of apixaban and rivaroxaban: an observational cohort implementation study. Research and Practice in Thrombosis and Haemostasis (RPTH). 8(1). doi: 10.1016/j.rpth.2023.102307. Fulltekst i vitenarkiv
• Ibsen, Jørgen; Hov, Maren Ranhoff; Tokerud, Gunn Eli; Fuglum, Julia; Krogstad, Marianne Linnerud & Stugaard, Marie [Vis alle 9 forfattere av denne artikkelen] (2024). Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke. European Stroke Journal. ISSN 2396-9873. doi: 10.1177/23969873241267084. Fulltekst i vitenarkiv Vis sammendrag

  Background: Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times. Methods: Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017–2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group). Results: A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups. Conclusion: Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.

• Jamtli, Bjørn; Hov, Maren Ranhoff; Jørgensen, Trine Møgster; Kramer-Johansen, Jo; Ihle-Hansen, Hege Beate & Sandset, Else Charlotte [Vis alle 8 forfattere av denne artikkelen] (2024). Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study. BMC Emergency Medicine. 24(1). doi: 10.1186/s12873-024-00962-7. Fulltekst i vitenarkiv Vis sammendrag

  Objectives In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. Materials and methods We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. Results We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. Conclusions This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.

• Munthe-Kaas, Ragnhild; Lydersen, Stian; Quinn, Terry J.; Aam, Stina; Pendlebury, Sarah T. & Ihle-Hansen, Hege Beate (2024). Impact of Pre-Stroke Frailty on Outcome Three Years after Acute Stroke: The Nor-COAST Study. Cerebrovascular Diseases. ISSN 1015-9770. doi: 10.1159/000541565. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: We aimed to explore the predictive value of pre-stroke frailty index (FI) on functional dependency and mortality 3 years after stroke. Methods: Based on the Rockwood 36-item FI score, we calculated the pre-stroke FI from medical conditions recorded at baseline in the multicenter prospective Nor-COAST study 2015–2017. Participants with a FI score and a modified Rankin scale (mRS) 0–6 3 years post-stroke were included in this study. We used logistic regression analysis with unfavorable mRS (over 2 vs. 0–2) at 3 years, or dead within 3 years, as dependent variable, and frailty and pre-stroke mRS, one at a time, and simultaneously, as predictors. The analyses were carried out unadjusted and adjusted for the following variables one at a time: Age, sex, years of education, stroke severity at admission, infections treated with antibiotics and stroke progression. We report odds ratio (OR) per 0.10 increase in FI. Results: At baseline, the 609 included patients had mean age 72.8 (standard deviation [SD] 11.8), 261 (43%) were females, and had a FI mean score of 0.16 (SD 0.12), range 0–0.69. During 3 years, 138 (23%) had died. Both the FI, and pre-stroke mRS, were strong predictors for unfavorable mRS (OR 4.1 and 2.7) and dead within 3 years (OR 2.2 and 1.7). Only adjusting for age affected the result. The OR for pre-stroke mRS decreased relatively more than the OR for FI when entered as predictors simultaneously. Conclusions: FI is a stronger predictor than premorbid mRS for prognostication after stroke.

• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Vis alle 13 forfattere av denne artikkelen] (2024). Systolic blood pressure at age 40 and 30-year stroke risk in men and women. Open heart. 11(2). doi: 10.1136/openhrt-2024-002805. Fulltekst i vitenarkiv Vis sammendrag

  Background American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences. Methods We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012–2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990–1993. We categorised participants by systolic blood pressure (SBP) at age 40 (<120 mm Hg (reference), 120–129 mm Hg, 130–139 mm Hg and ≥140 mm Hg) and compared stroke risk using Cox proportional hazard regressions adjusted for age, sex, smoking, cholesterol, physical activity, obesity and education. Fatal and non-fatal strokes were obtained from the Norwegian Cardiovascular Disease Registry from 1 January 2012 to 31 December 2020, in addition to self-reported strokes. Results The mean age was 40.1±0.3 years (50.4% women) and mean SBP was 128.3±13.5 mm Hg (mean±SD). Stroke occurred in 115 (4.4%) individuals (32 (28%) women and 83 (72%) men) during 29.4±2.9 years of follow-up. SBP between 130 and 139 mm Hg was not associated with stroke (adjusted HR 1.71, 95% CI 0.87 to 3.36) while SBP ≥140 mm Hg was associated with increased stroke risk (adjusted HR 3.11, 95% CI 1.62 to 6.00). The adjusted HR of stroke was 4.32 (95% CI 1.66 to 11.26) for women and 2.66 (95% CI 1.03 to 6.89) for men, with non-significant sex interactions. Conclusions SBP ≥140 mm Hg was significantly associated with 30-year stroke risk in both sexes. A small subgroup of women had SBP ≥140 mm Hg and systolic hypertension was a strong risk factor for stroke in these women.

• Sanders, Anne-Marthe; Richard, Geneviève; Kolskår, Knut-Kristian; Ulrichsen, Kristine Moe; Alnæs, Dag & Dørum, Erlend Solberg [Vis alle 10 forfattere av denne artikkelen] (2024). Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients. Brain and Behavior. 14(2). doi: 10.1002/brb3.3406. Fulltekst i vitenarkiv Vis sammendrag

  Background: Post-stroke attentional and working memory deficits are common and represent relevant predictors of long-term functional recovery and outcome. The individual responses to cognitive rehabilitation and interventions vary between patients and are influenced by multiple factors. Recently, a link between the level of engagement in physical activities and cognitive rehabilitation has been suggested. However, few previous studies have tested the predictive value of physical activity on cognitive performance and response to cognitive training among chronic stroke patients. There is also a lack of knowledge concerning the prognostic value of index stroke characteristics on physical activity in chronic phase. Method: In this cross-sectional and longitudinal study, including stroke survivors suffering mild-to-moderate strokes (n = 52, mean age = 70 years), we used Bayesian regression to test the association between cognitive performance and response to a 3-week intervention with a commonly used computerized cognitive training (CCT) system and baseline physical activity level measured with International Physical Activity Questionnaire. We also tested the association between physical activity level in chronic phase and stroke characteristics, including stroke severity (National Institutes of Health Stroke Scale), ischemic stroke etiology (Trial of Org 10172 in Acute Stroke Treatment), and stroke location (n = 66, mean age = 68 years). For descriptive purposes, we included 104 sex- and age-matched healthy controls (mean age = 69 years). Results: The analyses revealed anecdotal evidence of a positive association between overall cognitive performance and daily minutes of sedentary behavior, indicating that better cognitive performance was associated with more daily hours of sitting still. We found no support for an association between cognitive performance and response to CCT with activity level. In addition, the analysis showed group differences in sedentary behavior between patients with small-vessel disease (n = 20) and cardioembolism (n = 7), indicating more sedentary behavior in patients with small-vessel disease. There was no further support for a predictive value of index stroke characteristics on physical activity level. Conclusion: The results do not support that baseline physical activity level is a relevant predictor of the overall performance or response to CCT in this sample of chronic stroke patients. Similarly, the analyses revealed little evidence for an association between index stroke characteristics and future activity level in patients surviving mild-to-moderate stroke.

• Ihle-Hansen, Hege Beate; Ihle-Hansen, Håkon; Rostoft, Siri; Munkhaugen, John; Westbye, Siri Færden & Romøren, Maria [Vis alle 13 forfattere av denne artikkelen] (2024). Forhåndssamtaler om siste livsfase. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(13). doi: 10.4045/tidsskr.24.0105. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Det foreligger nye nasjonale faglige råd om forhåndssamtaler om siste livsfase. Trygghet i kommunikasjon er viktig for implementering. Formålet med denne studien var å kartlegge helsepersonells selvopplevde trygghet i kommunikasjon om fremtidig helsehjelp og pasientens ønsker i livets sluttfase. Materiale og metode: Helsepersonell ved tolv geriatriske enheter i Helse Sør-Øst besvarte en nettbasert spørreundersøkelse høsten 2022. De fire svaralternativene for selvrapportert trygghet – «lite trygg», «nokså trygg», «meget trygg» og «svært trygg» – er slått sammen til to kategorier: «begrenset trygghet» («lite trygg» og «nokså trygg») og «høy trygghet» («meget trygg» og «svært trygg»). Resultater: Vi fikk svar fra 289 av 470 (61,5 %) av de inviterte, med en gjennomsnittsalder på 37,8 ± 11,3 år, hvorav 217 av 289 (75 %) hadde mer enn fem års yrkeserfaring. Blant legene rapporterte 15 av 67 (22 %) begrenset trygghet i kommunikasjon om «fremtidig forverring av pasientens helsetilstand», 20 av 67 (30 %) om «livsforlengende behandling» og 13 av 67 (19 %) om «ønsker for livets sluttfase». For annet helsepersonell var tilsvarende responser 119 av 222 (54 %), 140 av 222 (63 %) og 109 av 222 (49 %). Fortolkning: Egenvurdert trygghet i kommunikasjon om fremtidig forverring, fremtidig helsehjelp og pasientens egne ønsker i livets sluttfase varierer, og er begrenset blant mye helsepersonell i geriatriske enheter. Det synes nødvendig med tiltak for å øke tryggheten i kommunikasjon og implementering av forhåndssamtaler i helsetjenesten. Hovedfunn: Blant leger oppga 20 av 67 (30 %) begrenset trygghet i kommunikasjon om «fremtidig helsehjelp», mens av annet helsepersonell svarte 140 av 222 (63 %) det samme. For kommunikasjon om «ønsker for livets siste fase» fant vi at 13 av 67 (19 %) av legene og 109 av 222 (49 %) av annet helsepersonell oppga begrenset trygghet.

• Hagberg, Guri; Ihle-Hansen, Håkon; Abzhandadze, Tamar; Reinholdsson, Malin; Ihle-Hansen, Hege Beate & Sunnerhagen, Kathrina Stibrant (2023). Prognostic value of acute National Institutes of Health Stroke Scale Items on disability: a registry study of first-ever stroke in the western part of Sweden. BMJ Open. 13(12), s. e080007–e080007. doi: 10.1136/bmjopen-2023-080007. Fulltekst i vitenarkiv
• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, Riadh Ibrahim Mahmud; Arntzen, Kathrine Grønning; Bakkejord, Grete & Bekkeseth, Hanna Marie Otterholt [Vis alle 32 forfattere av denne artikkelen] (2023). Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study. Journal of Neurology. ISSN 0340-5354. 270, s. 4049–4059. doi: 10.1007/s00415-023-11680-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study. Method The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. Results In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7. Conclusion Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.

• Lambert, Anna Tancin; Ratajczak-Tretel, Barbara; Al-Ani, Riadh Ibrahim Mahmud; Arntzen, Kathrine Grønning; Bakkejord, Grete & Bekkeseth, Hanna Marie Otterholt [Vis alle 35 forfattere av denne artikkelen] (2023). Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study. European Journal of Neurology. ISSN 1351-5101. 30(5), s. 1352–1363. doi: 10.1111/ene.15746. Fulltekst i vitenarkiv Vis sammendrag

  Background There are currently no biomarkers used to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF. Methods Eligible CS and cryptogenic transient ischemic attack (TIA) patients underwent 12-month monitoring with ICMs, clinical follow-up, and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n=74) during monitoring and those without AF (n=185). Receiver operating characteristic (ROC) curves were created. Biomarkers reaching area under ROC curve (AUC) ≥ 0.7 were dichotomized by finding optimal cut-off values and used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models. Results B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer, high-sensitivity cardiac Troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached predefined AUC level, 0.755 and 0.725 respectively. Optimal cut-off values were 33.5 ng/L for BNP, and 87 ng/L for NT-proBNP. Regression analysis showed that NT-proBNP was a predictor of AF in both unadjusted, odds ratio (OR) 7.72 (95% confidence interval [CI] 3.16–18.87), and age and sex adjusted models, OR 4.82 (95% CI 1.79–12.96). Conclusion Several clinically established biomarkers were associated with AF. NT-proBNP performed best as AF predictor and could be used for selecting patients for long-term monitoring with ICMs.

• Ihle-Hansen, Håkon; Vigen, Thea; Berge, Trygve; Walle-Hansen, Marte; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 12 forfattere av denne artikkelen] (2023). Carotid Plaque Score for Stroke and Cardiovascular Risk Prediction in a Middle-Aged Cohort From the General Population. Journal of the American Heart Association (JAHA). 12(17), s. 1–10. doi: 10.1161/JAHA.123.030739. Fulltekst i vitenarkiv Vis sammendrag

  Background We aimed to explore the predictive value of the carotid plaque score, compared with the Systematic Coronary Risk Evaluation 2 (SCORE2) risk prediction algorithm, on incident ischemic stroke and major adverse cardiovascular events and establish a prognostic cutoff of the carotid plaque score. Methods and Results In the prospective ACE 1950 (Akershus Cardiac Examination 1950 study), carotid plaque score was calculated with ultrasonography at inclusion in 2012 to 2015. The largest plaque diameter in each extracranial segment of the carotid artery on both sides was scored from 0 to 3 points. The sum of points in all segments provided the carotid plaque score. The cohort was followed up by linkage to national registries for incident ischemic stroke and major adverse cardiovascular events (nonfatal ischemic stroke, nonfatal myocardial infarction, and cardiovascular death) throughout 2020. Carotid plaque score was available in 3650 (98.5%) participants, with mean±SD age of 63.9±0.64 years at inclusion. Only 462 (12.7%) participants were free of plaque, and and 970 (26.6%) had a carotid plaque score of >3. Carotid plaque score predicted ischemic stroke (hazard ratio [HR], 1.25 [95% CI, 1.15–1.36]) and major adverse cardiovascular events (HR, 1.21 [95% CI, 1.14–1.27]) after adjustment for SCORE2 and provided strong incremental prognostic information to SCORE2. The best cutoff value of carotid plaque score for ischemic stroke was >3, with positive predictive value of 2.5% and negative predictive value of 99.3%. Conclusions The carotid plaque score is a strong predictor of ischemic stroke and major adverse cardiovascular events, and it provides incremental prognostic information to SCORE2 for risk prediction. A cutoff score of >3 seems to be suitable to discriminate high‐risk subjects.

• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, Riadh Ibrahim Mahmud; Bekkeseth, Hanna Marie Otterholt; Bakkejord, Grete & Bjerkeli, Vigdis [Vis alle 31 forfattere av denne artikkelen] (2023). Underlying causes of cryptogenic stroke and TIA in the nordic atrial fibrillation and stroke (NOR-FIB) study – the importance of comprehensive clinical evaluation. BMC Neurology. 23(1), s. 1–10. doi: 10.1186/s12883-023-03155-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management. Methods Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis. Results After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger (p<0.001), had lower CHA2DS2-VASc score (p<0.001) on admission, and lower NIHSS score (p=0.031) and mRS (p=0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic (p=0.014), while dyslipidaemia was less prevalent (p=0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, (p=0.091). Conclusion Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal. Trial registration ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23

• Ihle-Hansen, Håkon; Bøås, Håkon; Tapia, German; Hagberg, Guri; Ihle-Hansen, Hege Beathe & Berild, Jacob Dag [Vis alle 10 forfattere av denne artikkelen] (2023). Stroke After SARS-CoV-2 mRNA Vaccine: A Nationwide Registry Study. Stroke. ISSN 0039-2499. 54(5), s. e190–e193. doi: 10.1161/STROKEAHA.122.040430. Fulltekst i vitenarkiv
• Guterud, Mona; Bugge, Helge Fagerheim; Røislien, Jo; Kramer-Johansen, Jo; Toft, Mathias & Ihle-Hansen, Hege Beathe [Vis alle 11 forfattere av denne artikkelen] (2023). Prehospital screening of acute stroke with the National Institutes of Health Stroke Scale (ParaNASPP): a stepped-wedge, cluster-randomised controlled trial. Lancet Neurology. ISSN 1474-4422. 22(9), s. 800–811. doi: 10.1016/S1474-4422(23)00237-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Timely treatment of acute stroke depends on early identification and triage. Improved methods for recognition of stroke in the prehospital setting are needed. We aimed to assess whether use of the National Institutes of Health Stroke Scale (NIHSS) by paramedics in the ambulance could improve communication with the hospital, augment triage, and enhance diagnostic accuracy of acute stroke. Methods The Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) was a stepped-wedge, single-blind, cluster-randomised controlled trial. Patients with suspected acute stroke, who were evaluated by paramedics from five ambulance stations in Oslo, Norway, were eligible for inclusion. The five ambulance stations (defined as clusters) all initially managed patients according to a standard stroke protocol (control group), with randomised sequential crossover of each station to the intervention group. The intervention consisted of supervised training on NIHSS scoring, a mobile application to aid scoring, and standardised communication with stroke physicians. Random allocation was done via a simple lottery draw by administrators at Oslo University Hospital, who were independent of the research team. Allocation concealment was not possible due to the nature of the intervention. The primary outcome was the positive predictive value (PPV) for prehospital identification of patients with a final discharge diagnosis of acute stroke, analysed by intention to treat. Prespecified secondary safety outcomes were median prehospital on-scene time and median door-to-needle time. This trial is registered with ClinicalTrials.gov, NCT04137874, and is completed. Findings Between June 3, 2019, and July 1, 2021, 935 patients were evaluated by paramedics for suspected acute stroke. 134 patients met exclusion criteria or did not consent to participate. The primary analysis included 447 patients in the intervention group and 354 in the control group. There was no difference in PPV for prehospital identification of patients with a final discharge diagnosis of acute stroke between the intervention group (48·1%, 95% CI 43·4–52·8) and control group (45·8%, 40·5–51·1), with an estimated percentage points difference between groups of 2·3 (95% CI –4·6 to 9·3; p=0·51). Median prehospital on-scene time increased by 5 min in the intervention group (29 min [IQR 23–36] vs 24 min [19–31]; p<0·0001), whereas median door-to-needle time was similar between groups (26 min [21–36] vs 27 min [20–36]; p=0·90). No prehospital deaths were reported in either group. Interpretation The intervention did not improve diagnostic accuracy in patients with suspected stroke. A general increase in prehospital time during the pandemic and the identification of smaller strokes that require more deliberation are possible explanations for the increased on-scene time. The ParaNASPP model is to be implemented in Norway from 2023, and will provide real-life data for further research.

• Sandvig, Heidi Vihovde; Aam, Stina; Alme, Katinka Nordheim; Askim, Torunn; Beyer, Mona K. & Ellekjær, Hanne [Vis alle 16 forfattere av denne artikkelen] (2023). Plasma Inflammatory Biomarkers Are Associated With Poststroke Cognitive Impairment: The Nor-COAST Study. Stroke. ISSN 0039-2499. 54(5), s. 1303–1311. doi: 10.1161/STROKEAHA.122.041965. Fulltekst i vitenarkiv Vis sammendrag

  Background: Inflammation is proposed to be involved in the pathogenesis of poststroke cognitive impairment. The aim of this study was to investigate associations between concentrations of systemic inflammatory biomarkers after ischemic stroke and poststroke cognitive impairment. Methods: The Nor-COAST study (Norwegian Cognitive Impairment After Stroke) is a prospective observational multicenter cohort study, including patients hospitalized with acute stroke between 2015 and 2017. Inflammatory biomarkers, including the TCC (terminal C5b-9 complement complex) and 20 cytokines, were analyzed in plasma, collected at baseline, 3-, and 18 months poststroke, using ELISA and a multiplex assay. Global cognitive outcome was assessed with the Montreal Cognitive Assessment (MoCA) scale. We investigated the associations between plasma inflammatory biomarkers at baseline and MoCA score at 3-, 18-, and 36-month follow-ups; the associations between inflammatory biomarkers at 3 months and MoCA score at 18- and 36-month follow-ups; and the association between these biomarkers at 18 months and MoCA score at 36-month follow-up. We used mixed linear regression adjusted for age and sex. Results: We included 455 survivors of ischemic stroke. Higher concentrations of 7 baseline biomarkers were significantly associated with lower MoCA score at 36 months; TCC, IL (interleukin)-6, and MIP (macrophage inflammatory protein)-1α were associated with MoCA at 3, 18, and 36 months (P<0.01). No biomarker at 3 months was significantly associated with MoCA score at either 18 or 36 months, whereas higher concentrations of 3 biomarkers at 18 months were associated with lower MoCA score at 36 months (P<0.01). TCC at baseline and IL-6 and MIP-1α measured both at baseline and 18 months were particularly strongly associated with MoCA (P<0.01). Conclusions: Higher concentrations of plasma inflammatory biomarkers were associated with lower MoCA scores up to 36 months poststroke. This was most pronounced for inflammatory biomarkers measured in the acute phase following stroke.

• Vlachos, Georgios; Ihle-Hansen, Hege Beathe; Wyller, Torgeir Bruun; Brækhus, Anne; Mangset, Margrete & Hamre, Charlotta [Vis alle 7 forfattere av denne artikkelen] (2023). Factors Determining Not Returning to Full-Time Work 12 Months After Mild Ischemic Stroke. Archives of Rehabilitation Research and Clinical Translation. 5(1). doi: 10.1016/j.arrct.2022.100245. Fulltekst i vitenarkiv Vis sammendrag

  Objective To evaluate prevalence and factors determining not returning to full-time work 1 year after first-ever mild ischemic stroke. Design Prospective, observational cohort study with 12-month follow-up. Setting Stroke units and outpatient clinics at 2 Norwegian hospitals. Participants We included 84 (N=84) full-time working, cognitively healthy patients aged 70 years or younger who suffered an acute first-ever mild ischemic stroke, defined as National Institutes of Health Stroke Scale (NIHSS) score ≤3 points. Interventions Not applicable. Main Outcome Measures Vascular risk factors, sociodemographic factors, stroke localization, and etiology were recorded at inclusion. Cognitive impairment, anxiety, depression, fatigue, and apathy 12 months after stroke were assessed with validated instruments. Logistic regression analyses were performed to find correlates of not returning to full-time employment. Results Of 78 patients assessed 1 year after stroke, 63 (81%) had returned to work, 47 (60%) to full-time employment status. Modified Rankin scale score >1 (adjusted odds ratio, 12.44 [95% confidence interval, 2.37-65.43], P=.003) at follow-up was significantly associated, and diabetes (adjusted odds ratio, 10.56 [95% confidence interval, 0.98-113.47], P=.052) was borderline significantly associated with not returning to full-time work. Female sex, NIHSS at discharge, anxiety per point on the anxiety scale, depression per point on the depression scale, and fatigue per point on the fatigue scale were significantly associated with not returning to full-time work after 1 year, but these associations were only seen in the unadjusted models. Conclusions Low functional level that persists 12 months after stroke is related to not returning to full-time work. Patients with diabetes mellitus, female patients, and patients with a higher score on fatigue, anxiety, and depression scales may also be at risk of not returning to full-time work post stroke. Working patients should be followed up with a particular focus on factors determining participation in work and social life.

• Hagberg, Guri; Ihle-Hansen, Håkon; Sandset, Else Charlotte; Jacobsen, Dag; Wimmer, Rolf Henning & Ihle-Hansen, Hege (2022). Long Term Cognitive Function After Cardiac Arrest: A Mini-Review. Frontiers in Aging Neuroscience. 14, s. 1–8. doi: 10.3389/fnagi.2022.885226. Fulltekst i vitenarkiv
• Fremstad, Kjell Otto; Lindenskov, Paal Helge H.; Ihle-Hansen, Hege; Jamtli, Bjørn; Kramer-Johansen, Jo & Hardeland, Camilla [Vis alle 8 forfattere av denne artikkelen] (2022). Veien inn til sykehus for pasienter innlagt ved mistanke om akutt hjerneslag. Sykepleien Forskning. ISSN 1890-2936. 17(17). doi: 10.4220/Sykepleienf.2022.89354. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Hjerneslag er en tidskritisk tilstand, men fremdeles ankommer under halvparten av pasientene sykehus innen fire timer fra symptomdebut. En mulig forklaring på forsinkelsen kan være at første kontakt med helsevesenet er hos legevakten eller fastlegen. Hensikt: Hensikten med denne studien var å kartlegge innleggende instans for pasienter ved mistanke om akutt hjerneslag før de kom til akuttmottaket ved Oslo universitetssykehus (OUS) på Ullevål. Vi ville også kartlegge hvorvidt innleggelsesinstans kunne korreleres til slagdiagnose ved utskrivelse. Metode: En retrospektiv observasjonsstudie identifiserte alle pasienter der mistanke om hjerneslag var innleggelsesårsaken på akuttmottaket ved Ullevål i 2018. Vi grupperte pasientene etter innleggende instans: ambulanse, legevakt, fastlege eller direkte kontakt. Vi sammenliknet utskrivelsesdiagnoser «hjerneslag» eller «ikke hjerneslag» etter innleggende instans og fordelte på alder ved å bruke kjikvadrattest. Resultat: Totalt 1399 pasienter med mistanke om hjerneslag ble innlagt, hvorav 594 (42 prosent) fikk en hjerneslagdiagnose. Medianalderen var 72 år, og 52 prosent var kvinner. Halvparten ble innlagt direkte med ambulanse, en tredel via legevakten og 12 prosent fra fastlegen. Signifikant flere pasienter av de som ble innlagt med ambulanse (51 prosent), fikk hjerneslag som utskrivelsesdiagnose sammenliknet med pasienter som kom via henholdsvis legevakt (29 prosent) eller fastlege (40 prosent) (kjikvadrat p < 0,001). Pasientene som ble innlagt med ambulanse, var signifikant eldre enn pasientene som kom via legevakten (72 år versus 65 år, p < 0,001). Konklusjon: Kun halvparten av pasientene med symptomer på mistenkt hjerneslag ble innlagt med ambulanse. Pasientene som ble innlagt direkte med ambulanse, ble oftere utskrevet med en hjerneslagdiagnose. Vi trenger mer kunnskap om årsakene til at de resterende pasientene kom via fastlegen eller legevakten.

• Munthe-Kaas, Ragnhild; Aam, Stina; Saltvedt, Ingvild; Wyller, Torgeir Bruun; Pendlebury, Sarah T. & Lydersen, Stian [Vis alle 10 forfattere av denne artikkelen] (2022). Is Frailty Index a better predictor than pre-stroke modified Rankin Scale for neurocognitive outcomes 3-months post-stroke? BMC Geriatrics. 22(1). doi: 10.1186/s12877-022-02840-y. Fulltekst i vitenarkiv Vis sammendrag

  Background The prognostic value of frailty measures for post-stroke neurocognitive disorder (NCD) remains to be evaluated. Aims The aim of this study was to compare the predictive value of pre-stroke FI with pre-stroke modified Rankin Scale (mRS) for post-stroke cognitive impairment. Further, we explored the added value of including FI in prediction models for cognitive prognosis post-stroke. Methods We generated a 36-item Frailty Index (FI), based on the Rockwood FI, to measure frailty based on pre-stroke medical conditions recorded in the Nor-COAST multicentre prospective study baseline assessments. Consecutive participants with a FI score and completed cognitive test battery at three months were included. We generated Odds Ratio (OR) with NCD as the dependent variable. The predictors of primary interest were pre-stroke frailty and mRS. We also measured the predictive values of mRS and FI by the area (AUC) under the receiver operating characteristic curve. Results 598 participants (43.0% women, mean/SD age = 71.6/11.9, mean/SD education = 12.5/3.8, mean/SD pre-stroke mRS = 0.8/1.0, mean/SD GDS pre-stroke = 1.4/0.8, mean/SD NIHSS day 1 3/4), had a FI mean/SD score = 0.14/0.10. The logistic regression analyses showed that FI (OR 3.09), as well as the mRS (OR 2.21), were strong predictors of major NCD. When FI and mRS were entered as predictors simultaneously, the OR for mRS decreased relatively more than that for FI. AUC for NCD post-stroke was higher for FI than for mRS, both for major NCD (0.762 vs 0.677) and for any NCD (0.681 vs 0.638). Conclusions FI is a stronger predictor of post-stroke NCD than pre-stroke mRS and could be a part of the prediction models for cognitive prognosis post-stroke.

• Strømsnes, Torbjørn Austveg; Hagen, Truls Jørgen Kaugerud; Ouyang, Menglu; Wang, Xia; Chen, Chen & Rygg, Silje-Emilie Soltvedt [Vis alle 20 forfattere av denne artikkelen] (2022). Pressor therapy in acute ischaemic stroke: an updated systematic review. European Stroke Journal. ISSN 2396-9873. 7(2), s. 99–116. doi: 10.1177/23969873221078136. Fulltekst i vitenarkiv Vis sammendrag

  Background Low blood pressure (BP) in acute ischaemic stroke (AIS) is associated with poor functional outcome, death, or severe disability. Increasing BP might benefit patients with post-stroke hypotension including those with potentially salvageable ischaemic penumbra. This updated systematic review considers the present evidence regarding the use of vasopressors in AIS. Methods We searched the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE and trial databases using a structured search strategy. We examined reference lists of relevant publications for additional studies examining BP elevation in AIS. Results We included 27 studies involving 1886 patients. Nine studies assessed increasing BP during acute reperfusion therapy (intravenous thrombolysis, mechanical thrombectomy, intra-arterial thrombolysis or combined). Eighteen studies tested BP elevation alone. Phenylephrine was the most commonly used agent to increase BP (n = 16 studies), followed by norepinephrine (n = 6), epinephrine (n = 3) and dopamine (n = 2). Because of small patient numbers and study heterogeneity, a meta-analysis was not possible. Overall, BP elevation was feasible in patients with fluctuating or worsening neurological symptoms, large vessel occlusion with labile BP, sustained post-stroke hypotension and ineligible for intravenous thrombolysis or after acute reperfusion therapy. The effects on functional outcomes were largely unknown and close monitoring is advised if such intervention is undertaken. Conclusion Although theoretical arguments support increasing BP to improve cerebral blood flow and sustain the ischaemic penumbra in selected AIS patients, the data are limited and results largely inconclusive. Large, randomised controlled trials are needed to identify the optimal BP target, agent, duration of treatment and effects on clinical outcomes.

• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, Riadh Ibrahim Mahmud; Arntzen, Kathrine Grønning; Bakkejord, Grete & Bekkeseth, Hanna Marie Otterholt [Vis alle 33 forfattere av denne artikkelen] (2022). Atrial fibrillation in cryptogenic stroke and TIA patients in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study: Main results. European Stroke Journal. ISSN 2396-9873. 8(1), s. 148–156. doi: 10.1177/23969873221123122. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Secondary stroke prevention depends on proper identification of the underlying etiology and initiation of optimal treatment after the index event. The aim of the NOR-FIB study was to detect and quantify underlying atrial fibrillation (AF) in patients with cryptogenic stroke (CS) or transient ischaemic attack (TIA) using insertable cardiac monitor (ICM), to optimise secondary prevention, and to test the feasibility of ICM usage for stroke physicians. Patients and methods: Prospective observational international multicenter real-life study of CS and TIA patients monitored for 12 months with ICM (Reveal LINQ) for AF detection. Results: ICM insertion was performed in 91.5% by stroke physicians, within median 9 days after index event. Paroxysmal AF was diagnosed in 74 out of 259 patients (28.6%), detected early after ICM insertion (mean 48 ± 52 days) in 86.5% of patients. AF patients were older (72.6 vs 62.2; p< 0.001), had higher pre-stroke CHA₂DS₂-VASc score (median 3 vs 2; p< 0.001) and admission NIHSS (median 2 vs 1; p= 0.001); and more often hypertension (p = 0.045) and dyslipidaemia (p = 0.005) than non-AF patients. The arrhythmia was recurrent in 91.9% and asymptomatic in 93.2%. At 12-month follow-up anticoagulants usage was 97.3%.Discussion and conclusions: ICM was an effective tool for diagnosing underlying AF, capturing AF in 29% of the CS and TIA patients. AF was asymptomatic in most cases and would mainly have gone undiagnosed without ICM. The insertion and use of ICM was feasible for stroke physicians in stroke units. © The Author(s) 2022.

• Bugge, Helge Fagerheim; Guterud, Mona; Røislien, Jo; Larsen, Karianne; Ihle-Hansen, Hege & Toft, Mathias [Vis alle 8 forfattere av denne artikkelen] (2022). National Institutes of Health Stroke Scale scores obtained using a mobile application compared to the conventional paper form: A randomised controlled validation study. BMJ Innovations. ISSN 2055-8074. 9(1), s. 57–63. doi: 10.1136/bmjinnov-2022-000968. Fulltekst i vitenarkiv Vis sammendrag

  Background Prehospital delay contributes to treatment delay in acute stroke. Numerous prehospital stroke scales exist for stroke identification, but they lack the diagnostic accuracy of the in-hospital National Institutes of Health Stroke Scale (NIHSS). We have developed a mobile application to aid paramedics assessing prehospital NIHSS. This study explores agreement between NIHSS scores obtained using the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) application compared with conventional assessment. Methods 25 physicians working with stroke were randomised to an application group or control. 20 unique videos portraying acute stroke symptoms were scored by both groups. 95% limits of agreement (LoA) were calculated using Bland-Altman’s method, comparing the groups to predefined scores, and each other. LoAs within ±3 NIHSS points were considered acceptable. Cohen’s kappa was calculated on dichotomised NIHSS scores. Results The ParaNASPP application group had 95% LoA of −2.33 to 2.71. The control group had LoA of −2.60 to 2.55. Direct comparison between the groups gave LoA of −3.12 to 3.55. When compared with the dichotomised predefined scores kappa was 0.93 in the application group and 0.89 in the control group. Kappa was 0.84 for direct comparison between the groups. Discussion There was very good agreement between the application and both the predefined score and the control group. Scores from the ParaNASPP application differ slightly more than our predefined goal when compared with the control group, but is well within when compared with the predefined NIHSS scores. We consider this acceptable and the ParaNASPP application validated for further clinical studies.

• Walle-Hansen, Marte; Berge, Trygve; Vigen, Thea; Myrstad, Marius; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Vis alle 14 forfattere av denne artikkelen] (2022). Systolic blood pressure at age 40 and cognitive function 25 years later: The Akershus Cardiac Examination (ACE) 1950 Study. Journal of Hypertension. ISSN 0263-6352. 41(1), s. 132–139. doi: 10.1097/HJH.0000000000003312. Fulltekst i vitenarkiv
• Kolskår, Knut-Kristian; Ulrichsen, Kristine Moe; Richard, Geneviève; Dørum, Erlend Solberg; Schotten, Michel Thiebaut de & Rokicki, Jaroslav [Vis alle 12 forfattere av denne artikkelen] (2022). Structural disconnectome mapping of cognitive function in poststroke patients. Brain and Behavior. doi: 10.1002/brb3.2707. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose Sequalae following stroke represents a significant challenge in current rehabilitation. The location and size of focal lesions are only moderately predictive of the diverse cognitive outcome after stroke. One explanation building on recent work on brain networks proposes that the cognitive consequences of focal lesions are caused by damages to anatomically distributed brain networks supporting cognition rather than specific lesion locations. Methods To investigate the association between poststroke structural disconnectivity and cognitive performance, we estimated individual level whole-brain disconnectivity probability maps based on lesion maps from 102 stroke patients using normative data from healthy controls. Cognitive performance was assessed in the whole sample using Montreal Cognitive Assessment, and a more comprehensive computerized test protocol was performed on a subset (n = 82). Results Multivariate analysis using Partial Least Squares on the disconnectome maps revealed that higher disconnectivity in right insular and frontal operculum, superior temporal gyrus and putamen was associated with poorer MoCA performance, indicating that lesions in regions connected with these brain regions are more likely to cause cognitive impairment. Furthermore, our results indicated that disconnectivity within these clusters was associated with poorer performance across multiple cognitive domains. Conclusions These findings demonstrate that the extent and distribution of structural disconnectivity following stroke are sensitive to cognitive deficits and may provide important clinical information predicting poststroke cognitive sequalae.

• Vlachos, Georgios; Ihle-Hansen, Hege; Wyller, Torgeir Bruun; Brækhus, Anne; Mangset, Margrete & Hamre, Sophia Charlotta [Vis alle 7 forfattere av denne artikkelen] (2022). Predictors of cognitive and emotional symptoms 12 months after first-ever mild stroke. Neuropsychological Rehabilitation. ISSN 0960-2011. doi: 10.1080/09602011.2022.2038211. Fulltekst i vitenarkiv Vis sammendrag

  Even mild strokes may affect the patients’ everyday life by impairing cognitive and emotional functions. Our aim was to study predictors of such impairments one year after first-ever mild stroke. We included cognitively healthy patients ≤ 70 years with acute mild stroke. Vascular risk factors, sociodemographic factors and stroke classifications were recorded. At one-year post-stroke, different domains related to cognitive and emotional function were assessed with validated instruments. Logistic regression analyses were performed to identify predictors of cognitive and emotional outcome. Of 117 patient assessed at follow-up, only 21 patients (18%) scored within the reference range on all cognitive and emotional assessments. Younger age, multiple infarcts, and being outside working life at stroke onset were independent predictors of cognitive impairments (psychomotor speed, attention, executive and visuospatial function, memory). Female gender and a higher National Institutes of Health Stroke Scale (NIHSS) score at discharge were significantly associated with emotional impairments (anxiety, depressive symptoms, fatigue, apathy, emotional lability) after one year, but these associations were only seen in the unadjusted models. In conclusion, patients in working age may profit from a follow-up during the post-stroke period, with extra focus on cognitive and emotional functions.

• Nerdal, Vilde Kristine; Gjestad, Elise Ødegård; Saltvedt, Ingvild; Munthe-Kaas, Ragnhild; Ihle-Hansen, Hege & Ryum, Truls [Vis alle 8 forfattere av denne artikkelen] (2022). The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study. BMC Neurology. 22(1). doi: 10.1186/s12883-022-02756-5. Fulltekst i vitenarkiv Vis sammendrag

  Objective Delirium, a common complication after stroke, is often overlooked, and long-term consequences are poorly understood. This study aims to explore whether delirium in the acute phase of stroke predicts cognitive and psychiatric symptoms three, 18 and 36 months later. Method As part of the Norwegian Cognitive Impairment After Stroke Study (Nor-COAST), 139 hospitalized stroke patients (49% women, mean (SD) age: 71.4 (13.4) years; mean (SD) National Institutes of Health Stroke Scale (NIHSS) 3.0 (4.0)) were screened for delirium with the Confusion Assessment Method (CAM). Global cognition was measured with the Montreal Cognitive Assessment (MoCA), while psychiatric symptoms were measured using the Hospital Anxiety and Depression Scale (HADS) and the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Data was analyzed using mixed-model linear regression, adjusting for age, gender, education, NIHSS score at baseline and premorbid dementia. Results Thirteen patients met the criteria for delirium. Patients with delirium had lower MoCA scores compared to non-delirious patients, with the largest between-group difference found at 18 months (Mean (SE): 20.8 (1.4) versus (25.1 (0.4)). Delirium was associated with higher NPI-Q scores at 3 months (Mean (SE): 2.4 (0.6) versus 0.8 (0.1)), and higher HADS anxiety scores at 18 and 36 months, with the largest difference found at 36 months (Mean (SE): 6.2 (1.3) versus 2.2 (0.3)). Conclusions Suffering a delirium in the acute phase of stroke predicted more cognitive and psychiatric symptoms at follow-up, compared to non-delirious patients. Preventing and treating delirium may be important for decreasing the burden of post-stroke disability.

• Vahedi, Ali; Eriksdotter, Maria; Ihle-Hansen, Hege; Wyller, Torgeir Bruun; Øksengård, Anne Rita & Fure, Brynjar (2022). Cognitive impairment in people with physical frailty using the phenotype model: A systematic review and meta analysis. International Journal of Geriatric Psychiatry. ISSN 0885-6230. 37(11), s. 1–12. doi: 10.1002/gps.5822. Fulltekst i vitenarkiv Vis sammendrag

  Objective We performed a systematic review and meta-analysis to study the relationship between cognitive functioning and phenotypic frailty status. Methods We searched Pubmed, Cochrane Library and Epistemonikos from 2000 until March 2022, and used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Samples included both sexes, age ≥55 years, assessed with standardized measures of the different cognitive domains and the frailty phenotype model and analyzing the relationship between the frailty subtypes pre-frail, frail and robust and specific cognitive function. Results Eleven studies published from 2008 until March 2022 fulfilled the inclusion criteria, and 10 were included in our meta-analyses. Sample sizes varied from 104 to 4649 individuals. Mean Mini-Mental State Examination (MMSE) scores ranged from 17.0 to 27.6, with mean difference (MD) of −2.55 (95% confidence interval [CI] −3.32, −1.78) in frail compared to robust, MD −1.64 (95% CI −2.21, −1.06) in frail compared to prefrail and MD −0.68 (95% CI −0.94, −0.43) in prefrail compared to robust. In subgroup analyses, frail persons had lower scores in the memory domain with standardized mean difference (SMD) −1.01 (95% CI −1.42, −0.59). Conclusion MMSE scores were significantly lower in frail compared to robust and prefrail persons and in prefrail compared to robust persons. Subgroup analysis of memory revealed significantly poorer scores in frail compared to robust. The results indicate a strong relationship between physical frailty and cognitive impairment suggesting incorporation of cognitive function in frailty assessments.

• Ulrichsen, Kristine Moe; Kolskår, Knut-Kristian; Richard, Geneviève; Pedersen, Mads Lund; Alnæs, Dag & Dørum, Erlend Solberg [Vis alle 13 forfattere av denne artikkelen] (2022). No add-on effect of tDCS on fatigue and depression in chronic stroke patients: A randomized sham-controlled trial combining tDCS with computerized cognitive training. Brain and Behavior. 12(7). doi: 10.1002/brb3.2643. Fulltekst i vitenarkiv Vis sammendrag

  Background Fatigue and emotional distress rank high among self-reported unmet needs in life after stroke. Transcranial direct current stimulation (tDCS) may have the potential to alleviate these symptoms for some patients, but the acceptability and effects for chronic stroke survivors need to be explored in randomized controlled trials. Methods Using a randomized sham-controlled parallel design, we evaluated whether six sessions of 1 mA tDCS (anodal over F3, cathodal over O2) combined with computerized cognitive training reduced self-reported symptoms of fatigue and depression. Among the 74 chronic stroke patients enrolled at baseline, 54 patients completed the intervention. Measures of fatigue and depression were collected at five time points spanning a 2 months period. Results While symptoms of fatigue and depression were reduced during the course of the intervention, Bayesian analyses provided evidence for no added beneficial effect of tDCS. Less severe baseline symptoms were associated with higher performance improvement in select cognitive tasks, and study withdrawal was higher in patients with more fatigue and younger age. Time-resolved symptom analyses by a network approach suggested higher centrality of fatigue items (except item 1 and 2) than depression items. Conclusion The results reveal no add-on effect of tDCS on fatigue or depression but support the notion of fatigue as a relevant clinical symptom with possible implications for treatment adherence and response.

• Langhammer, Birgitta; Ihle-Hansen, Hege; Indredavik, Bent & Askim, Torunn (2022). Perceived Caregiver Strain, 3- and 18-Month Poststroke, in a Cohort of Caregivers from the Life after Stroke Trial (LAST). Nursing Research and Practice. ISSN 2090-1429. 2022. doi: 10.1155/2022/2619893. Fulltekst i vitenarkiv Vis sammendrag

  Aim: to gain more knowledge of caregiver strain in the Life After Stroke (LAST) population. Methods: This is a sub-study of the LAST study, including all caregivers reports of perceived Caregiver strain index (CSI) at inclusion and at 18 months follow-up irrespective of group allocation. The checklist “STROBE Statement—Checklist of items that should be included in reports of cohort studies” was used. Caregivers to adults (age ≥18 years), here defined as the person living with, a patient with a first-ever or recurrent stroke, community dwelling, with modified Rankin Scale (mRS)<5 and no serious comorbidities, was invited to fill out the Caregiver Strain Index at three months (10-16 weeks) post-stroke. Domains indicating differences of change in perceived strain in the total sample were analyzed in a linear regression analysis. Results: Caregiver strain (n=147) varying from 5% to 27% was reported by the caregivers at baseline and between 2% to18% at 18-months follow-up. The Items indicating the highest level of strain at baseline and 18-months were: “Caregiving is confining”, “There have been changes in personal plans”, and “There have been emotional adjustments” and “I feel completely overwhelmed”. The sample divided in age 0-79 years age 80 –100 years, indicated a higher strain on the caregiver for persons 80-100 years at 18-months. Conclusion: Caregiver strain was relatively low both at baseline and at 18-months follow-up. Main caregiver strains were reported in terms of; a sense of confinement, a tendency of emotional strain and the altering of plans at both timepoints. Depression was one of the main explanatory factors for perceived caregiver strain. The perception of caregiver strain was higher in age groups 80-100 years than age groups 0-79 years.

• Dahl, Fredrik Andreas; Barra, Mathias; Faiz, Kashif Waqar; Ihle-Hansen, Hege; Næss, Halvor & Rand, Kim [Vis alle 10 forfattere av denne artikkelen] (2022). Stroke unit demand in Norway – present and future estimates. BMC Health Services Research. 22(1). doi: 10.1186/s12913-021-07385-1. Fulltekst i vitenarkiv Vis sammendrag

  Background All stroke patients should receive timely admission to a stroke unit (SU). Consequently, most patients with suspected strokes – including stroke mimics (SM) are admitted. The aim of this study was to estimate the current total demand for SU bed capacity today and give estimates for future (2020–2040) demand. Methods Time trend estimates for stroke incidence and time constant estimates for length of stay (LOS) were estimated from the Norwegian Patient Registry (2010–2015). Incidence and LOS models for SMs were based on data from Haukeland University Hospital (2008–2017) and Akershus University Hospital (2020), respectively. The incidence and LOS models were combined with scenarios from Statistic Norway’s population predictions to estimate SU demands for each health region. A telephone survey collected data on the number of currently available SU beds. Results In 2020, 361 SU beds are available, while demand was estimated to 302. The models predict a reduction in stroke incidence, which offsets projected demographic shifts. Still, the estimated demand for 2040 rose to 316, due to an increase in SMs. A variation of this reference scenario, where stroke incidence was frozen at the 2020-level, gave a 2040-demand of 480 beds. Conclusions While the stroke incidence is likely to continue to fall, this appears to be balanced by an increase in SMs. An important uncertainty is how long the trend of decreasing stroke incidence can be expected to continue. Since the most important uncertainty factors point toward a potential increase, which may be as large as 50%, we would recommend that the health authorities plan for a potential increase in the demand for SU bed capacity.

• Efjestad, Anne; Ihle-Hansen, Hege; Hjellvik, Vidar; Engedal, Knut & Blix, Hege Salvesen (2022). Use of Drugs With Risk of Heart Rate-Related Problems is Common in Norwegian Dementia Patients Treated With Acetylcholinesterase Inhibitors: A Prevalence Study Based on the Norwegian Prescription Database. Frontiers in Pharmacology. 12, s. 1–12. doi: 10.3389/fphar.2021.791578. Fulltekst i vitenarkiv Vis sammendrag

  Background: Drugs commonly prescribed for heart rate control may induce adverse drug reactions in Alzheimer patients treated with acetylcholinesterase inhibitors (AChEIs). We have studied use of drugs with a known risk of Torsades de pointes (TdP) and drugs used to treat behavioral and psychological symptoms of dementia, as well as a combination of drugs with a known risk of TdP and drugs with a known heart rate-lowering effect, before and after initiating treatment with AChEIs. Methods: The study applied data from the Norwegian Prescription Database for the period 2004-2016. Prescriptions of concomitant use of drugs in persistent users of AChEIs was studied in a follow-up period from 4 years before to 2 years after AChEI initiation in men and women of two age groups: 37-80 and 81-88 years. Results: A small number of patients were prescribed haloperidol (∼1.5% The second year after AChEI initiation), digoxin/digitoxin (∼3%), and verapamil (∼1.3%), while a substantial proportion of the patients were prescribed betablockers (∼28%) and citalopram/escitalopram (∼17%). During follow-up, up to 6% of the study population were prescribed both betablockers and citalopram/citalopram in addition to AChEIs, a combination that increased over the follow-up period and was observed most frequently in women in the oldest age group. Conclusions: A large proportion (∼44%) of patients treated with AChEIs were prescribed drugs that could cause bradycardic and prolonged time from the start of the Q wave to the end of the T wave (QT interval). Thus, action should be taken to reduce the combination of drugs with risk of bradycardia and prolonged QT interval. Medication review on a regular basis could be an option as an important risk-reducing intervention.

• Hamre, Sophia Charlotta; Fure, Brynjar; Helbostad, Jorunn L.; Wyller, Torgeir Bruun; Ihle-Hansen, Hege & Vlachos, Georgios [Vis alle 8 forfattere av denne artikkelen] (2021). Factors Associated with Level of Physical Activity After Minor Stroke. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 30(4). doi: 10.1016/j.jstrokecerebrovasdis.2021.105628. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To explore factors from the acute phase, and after three and 12 months, associated with level of self-reported physical activity 12 months after a minor ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤ 3 in persons 70 years or younger. Materials and method: In this longitudinal cohort study patients were recruited consecutively from two stroke units. Activity level were measured with three sets of questions addressing the average number of frequency (times exercising each week), the average intensity, and duration (the average time), and a sum score was constructed. The association between physical activity 12 months after stroke and sociodemographic factors, NIHSS, body mass index, balance, and neuropsychiatric symptoms were explored using multiple linear regression. Results: This study included 101 patients, with mean age (SD) 55.5 (11.4) years, NIHSS median (Q1, Q3) 0.0 (0.0, 1.0), and 20 % were female. Multiple linear regression analyses showed sick leave status at stroke onset, balance at three and 12 months, and anxiety, depression, apathy, and fatigue at 12 months to be factors associated with physical activity at 12 months after stroke. Conclusion: We found that pre-stroke sick leave, post-stroke balance, and neuropsychiatric symptoms were associated with the level of physical activity one year after minor stroke. This might be of importance when giving information about physical activity and deciding about post-stroke follow-up.

• Hamre, Charlotta; Fure, Brynjar; Helbostad, Jorunn L.; Wyller, Torgeir B.; Ihle-Hansen, Hege & Vlachos, Georgios [Vis alle 8 forfattere av denne artikkelen] (2021). Balance and gait after first minor ischemic stroke in people 70 years of age or younger: A prospective observational cohort study. Physical Therapy. ISSN 0031-9023. 100(5), s. 798–806. doi: 10.1093/PTJ/PZAA010. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients <70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. OBJECTIVE: The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients <=70 years with minor ischemic stroke (National Institutes of Health Stroke Scale score <=3). This study also explored factors predicting impaired balance after 12 months. DESIGN: This study was designed as an explorative longitudinal cohort study. METHODS: Patients were recruited consecutively from 2 stroke units. Balance and gait were assessed with the Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go, and preferred gait speed. Predictors for impaired balance were explored using logistic regression. RESULTS: This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female, and mean (SD) National Institutes of Health Stroke Scale score was 0.6 (0.9) points. The Mini-BESTest, gait speed, and Timed Up and Go improved significantly from the acute phase to 3 months, and gait speed also improved from 3 to 12 months. At 12 months, 26% had balance impairments and 33% walked slower than 1.0 m/s. Poor balance in the acute phase (odds ratio = 0.92, 95% confidence interval = 0.85-0.95) was the only predictor of balance impairments (Mini-BESTest score <=22) at 12 months poststroke. LIMITATIONS: Limitations include lack of information about pre-stroke balance and gait impairment and poststroke exercise. Few women limited the generalizability. CONCLUSION: This study observed improvements in both balance and gait during the follow-up; still, about one-third had balance or gait impairments at 12 months poststroke. Balance in the acute phase predicted impaired balance at 12 months.

• Ulrichsen, Kristine Moe; Kolskår, Knut-Kristian; Richard, Geneviève; Alnæs, Dag; Dørum, Erlend Solberg & Sanders, Anne-Marthe [Vis alle 13 forfattere av denne artikkelen] (2021). Structural brain disconnectivity mapping of post-stroke fatigue. NeuroImage: Clinical. 30. doi: 10.1016/j.nicl.2021.102635. Fulltekst i vitenarkiv Vis sammendrag

  Stroke patients commonly suffer from post stroke fatigue (PSF). Despite a general consensus that brain perturbations constitute a precipitating event in the multifactorial etiology of PSF, the specific predictive value of conventional lesion characteristics such as size and localization remains unclear. The current study represents a novel approach to assess the neural correlates of PSF in chronic stroke patients. While previous research has focused primarily on lesion location or size, with mixed or inconclusive results, we targeted the extended structural network implicated by the lesion, and evaluated the added explanatory value of a structural disconnectivity approach with regards to the brain correlates of PSF. To this end, we estimated individual structural brain disconnectome maps in 84 S survivors in the chronic phase (≥3 months post stroke) using information about lesion location and normative white matter pathways obtained from 170 healthy individuals. PSF was measured by the Fatigue Severity Scale (FSS). Voxel wise analyses using non-parametric permutation-based inference were conducted on disconnectome maps to estimate regional effects of disconnectivity. Associations between PSF and global disconnectivity and clinical lesion characteristics were tested by linear models, and we estimated Bayes factor to quantify the evidence for the null and alternative hypotheses, respectively. The results revealed no significant associations between PSF and disconnectome measures or lesion characteristics, with moderate evidence in favor of the null hypothesis. These results suggest that symptoms of post-stroke fatigue among chronic stroke patients are not simply explained by lesion characteristics or the extent and distribution of structural brain disconnectome, and are discussed in light of methodological considerations.

• Efjestad, Anne; Ihle-Hansen, Hege; Hjellvik, Vidar; Engedal, Knut & Blix, Hege Salvesen (2021). Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors. PLOS ONE. 16(9). doi: 10.1371/journal.pone.0243804. Fulltekst i vitenarkiv Vis sammendrag

  Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

• Ihle-Hansen, Håkon; Sandset, Else Charlotte; Ihle-Hansen, Hege; Hagberg, Guri; Thommessen, Bente & Rønning, Ole Morten [Vis alle 12 forfattere av denne artikkelen] (2021). Sex differences in the Norwegian Tenecteplase Trial (NOR-TEST). European Journal of Neurology. ISSN 1351-5101. 29, s. 609–614. doi: 10.1111/ene.15126. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose Sex differences in acute ischemic stroke is of increasing interest in the era of precision medicine. We aimed to explore sex disparities in baseline characteristics, management and outcomes in patients treated with intravenous thrombolysis included in the Norwegian Tenecteplase trial (NOR-TEST). Methods NOR-TEST was an open-label, randomized, blinded endpoint trial, performed from 2012 to 2016, comparing treatment with tenecteplase to treatment with alteplase within 4.5 h after acute ischemic stroke symptom onset. Sex differences at baseline, treatment and outcomes were compared using multivariable logistic regression models. Heterogeneity in treatment was evaluated by including an interaction term in the model. Results Of 1100 patients enrolled, 40% were women, and in patients aged >80 years, the proportion of women was greater than men (19% vs. 14%; p = 0.02). Women had a lower burden of cardiovascular risk factors, such as diabetes mellitus (11% vs. 15%; p = 0.05) and a higher mean high-density lipoprotein cholesterol level (1.7 ± 0.6 mmol/L vs. 1.3 ± 0.4 mmol/L; p < 0.001), and a higher proportion of women had never smoked (45% vs. 33%; p < 0.001) compared with men. While there was no sex difference in time from onset of symptoms to admission, door to needle time or in-hospital workup, women were admitted with more severe stroke (National Institutes of Health Stroke Scale [NIHSS] score 6.2 ± 5.6 vs. 5.3 ± 5.1; p = 0.01). Stroke mimic diagnosis was more common in women (21% vs. 15%; p = 0.01). There were no significant sex differences in clinical outcome, measured by the NIHSS, the modified Rankin Scale, intracranial hemorrhage and mortality. Conclusion Women were underrepresented in number in NOR-TEST. The included women had a lower cardiovascular risk factor burden and more severe strokes.

• Einstad, Marte Stine; Saltvedt, Ingvild; Lydersen, Stian; Ursin, Marie Helene; Munthe-Kaas, Ragnhild & Ihle-Hansen, Hege [Vis alle 13 forfattere av denne artikkelen] (2021). Associations between post-stroke motor and cognitive function: a cross-sectional study. BMC Geriatrics. 21(1), s. 1–10. doi: 10.1186/s12877-021-02055-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Motor and cognitive impairments are frequently observed following stroke, but are often managed as distinct entities, and there is little evidence regarding how they are related. The aim of this study was to describe the prevalence of concurrent motor and cognitive impairments 3 months after stroke and to examine how motor performance was associated with memory, executive function and global cognition. Methods: The Norwegian Cognitive Impairment After Stroke (Nor-COAST) study is a prospective multicentre cohort study including patients hospitalized with acute stroke between May 2015 and March 2017. The National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission. Level of disability was assessed by the Modified Rankin Scale (mRS). Motor and cognitive functions were assessed 3 months post-stroke using the Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (TMT-B), 10-Word List Recall (10WLR), Short Physical Performance Battery (SPPB), dual-task cost (DTC) and grip strength (Jamar®). Cut-offs were set according to current recommendations. Associations were examined using linear regression with cognitive tests as dependent variables and motor domains as covariates, adjusted for age, sex, education and stroke severity. Results: Of 567 participants included, 242 (43%) were women, mean (SD) age was 72.2 (11.7) years, 416 (75%) had an NIHSS score ≤ 4 and 475 (84%) had an mRS score of ≤2. Prevalence of concurrent motor and cognitive impairment ranged from 9.5% for DTC and 10WLR to 22.9% for grip strength and TMT-B. SPPB was associated with MoCA (regression coefficient B = 0.465, 95%CI [0.352, 0.578]), TMT-B (B = -9.494, 95%CI [− 11.726, − 7.925]) and 10WLR (B = 0.132, 95%CI [0.054, 0.211]). Grip strength was associated with MoCA (B = 0.075, 95%CI [0.039, 0.112]), TMT-B (B = -1.972, 95%CI [− 2.672, − 1.272]) and 10WLR (B = 0.041, 95%CI [0.016, 0.066]). Higher DTC was associated with more time needed to complete TMT-B (B = 0.475, 95%CI [0.075, 0.875]) but not with MoCA or 10WLR.

• Ihle-Hansen, Håkon; Hagberg, Guri; Sandset, Else Charlotte; Ihle-Hansen, Hege; Amundsen, Erik Koldberg & Sandset, Per Morten [Vis alle 7 forfattere av denne artikkelen] (2021). Reversering av antikoagulerende legemidler ved hjerneblødning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(14), s. 1–6. doi: 10.4045/tidsskr.21.0063. Fulltekst i vitenarkiv Vis sammendrag

  Antikoagulerende legemidler kan effektivt forebygge og behandle blodpropper, men gir samtidig økt risiko for hjerneblødning. Ved hjerneblødning anbefales rask reversering av den antikoagulerende effekten. Reverserende behandling må imidlertid velges ut ifra antikoagulasjonsmidlenes ulike virkningsmekanismer, og spesifikk antidot foretrekkes hvis tilgjengelig.

• Schellhorn, Till; Zucknick, Manuela; Askim, Torunn; Munthe-Kaas, Ragnhild; Ihle-Hansen, Hege & Seljeseth, Yngve Müller [Vis alle 13 forfattere av denne artikkelen] (2021). Pre-stroke cognitive impairment is associated with vascular imaging pathology: a prospective observational study. BMC Geriatrics. 21:362(362), s. 1–10. doi: 10.1186/s12877-021-02327-2. Fulltekst i vitenarkiv Vis sammendrag

  Background: Chronic brain pathology and pre-stroke cognitive impairment (PCI) is predictive of post-stroke dementia. The aim of the current study was to measure pre-stroke neurodegenerative and vascular disease burden found on brain MRI and to assess the association between pre-stroke imaging pathology and PCI, whilst also looking for potential sex differences. Methods: This prospective brain MRI cohort is part of the multicentre Norwegian cognitive impairment after stroke (Nor-COAST) study. Patients hospitalized with acute ischemic or hemorrhagic stroke were included from five participating stroke units. Visual rating scales were used to categorize baseline MRIs (N = 410) as vascular, neurodegenerative, mixed, or normal, based on the presence of pathological imaging findings. Pre-stroke cognition was assessed by interviews of patients or caregivers using the Global Deterioration Scale (GDS). Stroke severity was assessed with the National Institute of Health Stroke Scale (NIHSS). Univariate and multiple logistic regression analyses were performed to investigate the association between imaging markers, PCI, and sex. Results: Patients’ (N = 410) mean (SD) age was 73.6 (±11) years; 182 (44%) participants were female, the mean (SD) NIHSS at admittance was 4.1 (±5). In 68% of the participants, at least one pathological imaging marker was found. Medial temporal lobe atrophy (MTA) was present in 30% of patients, white matter hyperintensities (WMH) in 38% of patients and lacunes in 35% of patients. PCI was found in 30% of the patients. PCI was associated with cerebrovascular pathology (OR 2.5; CI = 1.4 to 4.5, p = 0.001) and mixed pathology (OR 3.4; CI = 1.9 to 6.1, p = 0.001) but was not associated with neurodegeneration (OR 1.0; CI = 0.5 to 2.2; p = 0.973). Pathological MRI markers, including MTA and lacunes, were more prevalent among men, as was a history of clinical stroke prior to the index stroke. The OR of PCI for women was not significantly increased (OR 1.2; CI = 0.8 to 1.9; p = 0.3).

• Ihle-Hansen, Håkon; Ihle-Hansen, Hege; Sandset, Else Charlotte & Hagberg, Guri (2021). Subclinical Carotid Artery Atherosclerosis and Cognitive Function: A Mini-Review. Frontiers in Neurology. 12. doi: 10.3389/fneur.2021.705043. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Ihle-Hansen, Hege; Fure, Brynjar; Thommessen, Bente; Helland, Gisle Berg & Øksengård, Anne Rita [Vis alle 10 forfattere av denne artikkelen] (2021). Carotid Atherosclerosis and Longitudinal Changes of MRI Visual Rating Measures in Stroke Survivors: A Seven-Year Follow-Up Study. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 30(10), s. 1–6. doi: 10.1016/j.jstrokecerebrovasdis.2021.106010. Fulltekst i vitenarkiv Vis sammendrag

  Objectives We aimed to assess longitudinal changes in MRI measures of brain atrophy and white matter lesions in stroke and transient ischemic attack (TIA) survivors, and explore whether carotid stenosis predicts progression of these changes, assessed by visual rating scales. Materials and Methods All patients with a first-ever stroke or TIA admitted to Bærum Hospital, Norway, in 2007/2008, were invited in the acute phase and followed for seven years. Carotid ultrasound was performed during the hospital stay. Carotid stenosis was defined as ≥50% narrowing of lumen. MRI was performed one and seven years after the index event and analyzed according to the visual rating scales Fazekas scale (0-3), Medial Temporal Lobe Atrophy (MTLA) (0-4) score, and Global Cortical Atrophy (GCA) scale (0-3). Patients with MRI scans at both time points were included in this sub-study. Results Of 227 patients recruited, 76 had both MRI examinations. Mean age 73.9±10.6, 41% women, and 9% had ≥50% carotid stenosis. Mean Fazekas scale was 1.7±0.9 and 1.8±1.0, mean MTLA score 1.0 ±1.0 and 1.7±1.0, and mean GCA scale score 1.4±0.7 and 1.4±0.6 after one and seven years, respectively. 71% retained the same Fazekas scale score, while 21% showed progression. Deterioration in GCA scale was seen in 20% and increasing MTLA score in 57%. Carotid stenosis was not associated with progression on Fazekas score, MTLA score or GCA scale. Conclusions Three out of five showed progression on the MTLA score. Carotid stenosis was not associated with longitudinal change of visual rating scales.

• Vlachos, Georgios; Ihle-Hansen, Hege; Wyller, Torgeir Bruun; Brækhus, Anne; Mangset, Margrete & Hamre, Sophia Charlotta [Vis alle 7 forfattere av denne artikkelen] (2021). Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments. Journal of Rehabilitation Medicine. ISSN 1650-1977. 53:jrm00135, s. 1–7. doi: 10.2340/16501977-2764. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients Design: Prospective, observational, cohort study. Subjects: A consecutive sample of 117 previously cognitively healthy patients aged 18–70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period. Methods: At 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying. Results: In total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools. Conclusion: Hidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools.

• Aam, Stina; Gynnild, Mari Nordbø; Munthe-Kaas, Ragnhild; Saltvedt, Ingvild; Lydersen, Stian & Knapskog, Anne Brita [Vis alle 10 forfattere av denne artikkelen] (2021). The Impact of Vascular Risk Factors on Post-stroke Cognitive Impairment: The Nor-COAST Study. Frontiers in Neurology. 12, s. 1–11. doi: 10.3389/fneur.2021.678794. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI. Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, previous stroke), time, and the interaction between these. The analyses were adjusted for age, education, and sex. There were between 5 and 25% missing data for the variables for PSCI. Results: Mean age was 71.6 years (SD 11.7); 42% were females; and the mean NIHSS score at admittance was 3.8 (SD 4.8). Regardless of vascular risk factors, global z, MoCA, and all the assessed cognitive domains were impaired at 3 and 18 months, with MoCA being the most severely impaired. Atrial fibrillation (AF) was associated with poorer language at 18 months and coronary heart disease (CHD) with poorer MoCA at 18 months (LR = 12.80, p = 0.002, and LR = 8.32, p = 0.004, respectively). Previous stroke was associated with poorer global z and attention at 3 and 18 months (LR = 15.46, p < 0.001, and LR = 16.20, p < 0.001). In patients without AF, attention improved from 3 to 18 months, and in patients without CHD, executive function improved from 3 to 18 months (LR = 10.42, p < 0.001, and LR = 9.33, p = 0.009, respectively). Discussion: Our findings indicate that a focal stroke lesion might be related to pathophysiological processes leading to global cognitive impairment. The poorer prognosis of PSCI in patients with vascular risk factors emphasizes the need for further research on complex vascular risk factor interventions to prevent PSCI.

• Gynnild, Mari Nordbø; Aakerøy, Rachel; Spigset, Olav; Askim, Torunn; Beyer, Mona Kristiansen & Ihle-Hansen, Hege [Vis alle 15 forfattere av denne artikkelen] (2020). Vascular risk factor control and adherence to secondary preventive medication after ischaemic stroke. Journal of Internal Medicine. ISSN 0954-6820. 289(3), s. 1–14. doi: 10.1111/joim.13161. Fulltekst i vitenarkiv Vis sammendrag

  Background Studies regarding adequacy of secondary stroke prevention are limited. We report medication adherence, risk factor control and factors influencing vascular risk profile following ischaemic stroke. Methods A total of 664 home‐dwelling participants in the Norwegian Cognitive Impairment After Stroke study, a multicenter observational study, were evaluated 3 and 18 months poststroke. We assessed medication adherence by self‐reporting (4‐item Morisky Medication Adherence Scale) and medication persistence (defined as continuation of medication(s) prescribed at discharge), achievement of guideline‐defined targets of blood pressure (BP) (<140/90 mmHg), low‐density lipoprotein cholesterol (LDL‐C) (<2.0 mmol L−1) and haemoglobin A1c (HbA1c) (≤53 mmol mol−1) and determinants of risk factor control. Results At discharge, 97% were prescribed antithrombotics, 88% lipid‐lowering drugs, 68% antihypertensives and 12% antidiabetic drugs. Persistence of users declined to 99%, 88%, 93% and 95%, respectively, at 18 months. After 3 and 18 months, 80% and 73% reported high adherence. After 3 and 18 months, 40.7% and 47.0% gained BP control, 48.4% and 44.6% achieved LDL‐C control, and 69.2% and 69.5% of diabetic patients achieved HbA1c control. Advanced age was associated with increased LDL‐C control (OR 1.03, 95% CI 1.01 to 1.06) and reduced BP control (OR 0.98, 0.96 to 0.99). Women had poorer LDL‐C control (OR 0.60, 0.37 to 0.98). Polypharmacy was associated with increased LDL‐C control (OR 1.29, 1.18 to 1.41) and reduced HbA1c control (OR 0.76, 0.60 to 0.98). Conclusion Risk factor control is suboptimal despite high medication persistence and adherence. Improved understanding of this complex clinical setting is needed for optimization of secondary preventive strategies.

• Richard, Geneviève; Petersen, Anders; Ulrichsen, Kristine Moe; Kolskår, Knut-Kristian; Alnæs, Dag & Sanders, Anne-Marthe [Vis alle 10 forfattere av denne artikkelen] (2020). TVA-based modeling of short-term memory capacity, speed of processing and perceptual threshold in chronic stroke patients undergoing cognitive training: Case-control differences, reliability, and associations with cognitive performance. PeerJ. 8:e9948, s. 1–21. doi: 10.7717/peerj.9948. Fulltekst i vitenarkiv Vis sammendrag

  Attentional deficits following stroke are common and pervasive, and are important predictors for functional recovery. Attentional functions comprise a set of specific cognitive processes allowing to attend, filter and select among a continuous stream of stimuli. These mechanisms are fundamental for more complex cognitive functions such as learning, planning and cognitive control, all crucial for daily functioning. The distributed functional neuroanatomy of these processes is a likely explanation for the high prevalence of attentional impairments following stroke, and underscores the importance of a clinical implementation of computational approaches allowing for sensitive and specific modeling of attentional sub-processes. The Theory of Visual Attention (TVA) offers a theoretical, computational, neuronal and practical framework to assess the efficiency of visual selection performance and parallel processing of multiple objects. Here, in order to assess the sensitivity and reliability of TVA parameters reflecting short-term memory capacity ( K ), processing speed ( C ) and perceptual threshold ( t 0 ), we used a whole-report paradigm in a cross-sectional case-control comparison and across six repeated assessments over the course of a three-week computerized cognitive training (CCT) intervention in chronic stroke patients (&gt; 6 months since hospital admission, NIHSS ≤ 7 at hospital discharge). Cross-sectional group comparisons documented lower short-term memory capacity, lower processing speed and higher perceptual threshold in patients ( n  = 70) compared to age-matched healthy controls ( n  = 140). Further, longitudinal analyses in stroke patients during the course of CCT ( n  = 54) revealed high reliability of the TVA parameters, and higher processing speed at baseline was associated with larger cognitive improvement after the intervention. The results support the feasibility, reliability and sensitivity of TVA-based assessment of attentional functions in chronic stroke patients.

• Hamre, Sophia Charlotta; Fure, Brynjar; Helbostad, Jorunn L.; Wyller, Torgeir Bruun; Ihle-Hansen, Hege & Vlachos, Georgios [Vis alle 8 forfattere av denne artikkelen] (2020). Impairments in spatial navigation during walking in patients 70 years or younger with mild stroke. Topics in Stroke Rehabilitation. ISSN 1074-9357. 27, s. 601–609. doi: 10.1080/10749357.2020.1755814. Fulltekst i vitenarkiv Vis sammendrag

  Background: Spatial navigation, the ability to determine and maintain a route from one place to another, is needed for independence in everyday life. Knowledge about impairments in spatial navigation in people with mild stroke is scarce. Objectives: To explore impairments in spatial navigation in patients ≤70 years after first-ever mild ischemic stroke (NIHSS≤3) and to explore which variables are associated with these impairments 12 months later. Methods: Patients were examined in the acute phase, and after 3 and 12 months. To assess impairments in spatial navigation, we used the Floor Maze Test (FMT), with time and FMT-errors as outcomes. Patients’ perceived navigational skills were collected using self-report. Logistic regression was used to explore which variables (sociodemographic data, stroke characteristics, cognition, and mobility) were associated with impaired navigation ability. Results: Ninety-seven patients (20 females) were included. The mean (SD) age was 55.5 (11.4) years. Timed FMT improved significantly from the acute phase to 12 months (p = <.001). At 12 months, 24 (24.7%) of the participants walked through the maze with errors, and 22 (22.7%) reported spatial navigational problems. The Trail Making Test (TMT)-B was the only variable from the acute phase associated with FMT-errors at 12 months, and being female was the only variable associated with self-reported navigational problems at 12 months. Conclusion: Nearly one in four patients experienced spatial navigation problems 12 months after a mild stroke. Executive function (TMT-B), measured in the acute phase, was associated with navigational impairments (FMT-errors) at 12 months, and being female was associated with self-reported navigational problems

• Hagberg, Guri; Ihle-Hansen, Hege; Fure, Brynjar; Thommessen, Bente; Ihle-Hansen, Håkon & Øksengård, Anne Rita [Vis alle 11 forfattere av denne artikkelen] (2020). No evidence for amyloid pathology as a key mediator of neurodegeneration post-stroke - A seven-year follow-up study. BMC Neurology. 20, s. 1–11. doi: 10.1186/s12883-020-01753-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol (18F-Flut) positron emission tomography (PET), is common in seven-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18F-Flut-PET uptake after 7 years correlates with amyloid-β peptide (Aβ42) levels in cerebrospinal fluid (CSF) at 1 year, and with measures of neurodegeneration and cognition at 7 years post-stroke. Methods 208 patients with first-ever stroke or transient Ischemic Attack (TIA) without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or normal. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At 7 years, patients were offered 18F-Flut-PET, and amyloid-positivity was assessed visually and semi-quantitatively. The associations between 18F-Flut-PET standardized uptake value ratios (SUVr) and measures of neurodegeneration (medial temporal lobe atrophy (MTLA), global cortical atrophy (GCA)) and cognition (Mini-Mental State Exam (MMSE), Trail-making test A (TMT-A)) and CSF Aβ42 levels were assessed using linear regression. Results In total, 111 patients completed 7-year follow-up, and 26 patients agreed to PET imaging, of whom 13 had CSF biomarkers from 1 year. Thirteen out of 26 patients were diagnosed with CI 7 years post-stroke, but only one had visually assessed amyloid positivity. CSF Aβ42 levels at 1 year, MTA grade, GCA scale, MMSE score or TMT-A at 7 years did not correlate with 18F-Flut-PET SUVr in this cohort. Conclusions Amyloid binding was not common in 7-year stroke survivors diagnosed with CI. Quantitatively assessed, cortical amyloid deposition did not correlate with other measures related to neurodegeneration or cognition. Therefore, amyloid pathology may not be a key mediator of neurodegeneration 7 years post-stroke. Trial registration Clinicaltrials.gov (NCT00506818). July 23, 2007. Inclusion from February 2007, randomization and intervention from May 2007 and trial registration in July 2007.

• Munthe-Kaas, Ragnhild; Aam, Stina; Saltvedt, Ingvild; Wyller, Torgeir Bruun; Pendlebury, Sarah T. & Lydersen, Stian [Vis alle 7 forfattere av denne artikkelen] (2020). Test Accuracy of the Montreal Cognitive Assessment in Screening for Early Poststroke Neurocognitive Disorder. Stroke. ISSN 0039-2499. 52(1), s. 317–320. doi: 10.1161/STROKEAHA.120.031030. Fulltekst i vitenarkiv Vis sammendrag

  Background. Human immunodeficiency virus (HIV)–infected immunological nonresponders (INRs) fail to reconstitute their CD4+ T-cell pool after initiation of antiretroviral therapy, and their prognosis is inferior to that of immunological responders (IRs). A prevailing hypothesis is that the INR phenotype is caused by a persistently disrupted mucosal barrier, but assessments of gut mucosal immunology in different anatomical compartments are scarce. Methods. We investigated circulating markers of mucosal dysfunction, immune activation, mucosal Th17 and Th22 cells, and mucosa-adherent microbiota signatures in gut mucosal specimens from sigmoid colon and terminal ileum of 19 INRs and 20 IRs in addition to 20 HIV-negative individuals. Results. INRs had higher blood levels of the enterocyte damage marker intestinal fatty acid–binding protein than IRs. In gut mucosal biopsies, INRs had lower fractions of CD4+ T cells, higher fractions of interleukin 22, and a tendency to higher fractions of interleukin 17–producing CD4+ T cells. These findings were all restricted to the colon and correlated to circulating markers of enterocyte damage. There were no observed differences in gut microbial composition between INRs and IRs. Conclusions. Restricted to the colon, enterocyte damage and mucosal immune dysfunction play a role for insufficient immune reconstitution in HIV infection independent of the gut microbiota.

• Ulrichsen, Kristine Moe; Alnæs, Dag; Kolskår, Knut-Kristian; Richard, Geneviève; Sanders, Anne-Marthe & Dørum, Erlend Solberg [Vis alle 11 forfattere av denne artikkelen] (2020). Dissecting the cognitive phenotype of post-stroke fatigue using computerized assessment and computational modeling of sustained attention. European Journal of Neuroscience. ISSN 0953-816X. 52(7), s. 3828–3845. doi: 10.1111/ejn.14861. Fulltekst i vitenarkiv Vis sammendrag

  Post‐stroke fatigue (PSF) is prevalent among stroke patients, but its mechanisms are poorly understood. Many patients with PSF experience cognitive difficulties, but studies aiming to identify cognitive correlates of PSF have been largely inconclusive. With the aim of characterizing the relationship between subjective fatigue and attentional function, we collected behavioral data using the attention network test (ANT) and self‐reported fatigue scores using the fatigue severity scale (FSS) from 53 stroke patients. In order to evaluate the utility and added value of computational modeling for delineating specific underpinnings of response time (RT) distributions, we fitted a hierarchical drift diffusion model (hDDM) to the ANT data. Results revealed a relationship between fatigue and RT distributions. Specifically, there was a positive interaction between FSS score and elapsed time on RT. Group analyses suggested that patients without PSF increased speed during the course of the session, while patients with PSF did not. In line with the conventional analyses based on observed RT, the best fitting hDD model identified an interaction between elapsed time and fatigue on non‐decision time, suggesting an increase in time needed for stimulus encoding and response execution rather than cognitive information processing and evidence accumulation. These novel results demonstrate the significance of considering the sustained nature of effort when defining the cognitive phenotype of PSF, intuitively indicating that the cognitive phenotype of fatigue entails an increased vulnerability to sustained effort, and suggest that the use of computational approaches offers a further characterization of specific processes underlying behavioral differences.

• Munthe-Kaas, Ragnhild; Aam, Stina; Ihle-Hansen, Hege; Lydersen, Stian; Knapskog, Anne Brita & Wyller, Torgeir Bruun [Vis alle 15 forfattere av denne artikkelen] (2020). Impact of different methods defining post-stroke neurocognitive disorder: The Nor-COAST study. Alzheimer's and Dementia: Translational Research and Clinical Interventions. 6:e12000(1), s. 1–9. doi: 10.1002/trc2.12000. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Post‐stroke neurocognitive disorder (NCD) is common; prevalence varies between studies, partially related to lack of consensus on how to identify cases. The aim was to compare the prevalence of post‐stroke NCD using only cognitive assessment (model A), DSM‐5 criteria (model B), and the Global Deterioration Scale (model C) and to determine agreement among the three models. Methods In the Norwegian Cognitive Impairment After Stroke study, 599 patients were assessed 3 months after suffering a stroke. Results The prevalence of mild NCD varied from 174 (29%) in model B to 83 (14%) in model C; prevalence of major NCD varied from 249 (42%) in model A to 68 (11%) in model C. Cohen's kappa and Cohen's quadratic weighted kappa showed fair to very good agreement among models; the poorest agreement was found for identification of mild NCD. Discussion The findings indicate a need for international harmonization to classify post‐stroke NCD.

• Døhl, Øystein; Halsteinli, Vidar; Askim, Torunn; Gunnes, Mari; Ihle-Hansen, Hege & Indredavik, Bent [Vis alle 9 forfattere av denne artikkelen] (2020). Factors contributing to post-stroke health care utilization and costs, secondary results from the life after stroke (LAST) study. BMC Health Services Research. 20. doi: 10.1186/s12913-020-05158-w. Fulltekst i vitenarkiv
• Dørum, Erlend Solberg; Kaufmann, Tobias; Alnæs, Dag; Richard, Geneviève; Kolskår, Knut-Kristian & Engvig, Andreas [Vis alle 11 forfattere av denne artikkelen] (2020). Functional brain network modeling in sub-acute stroke patients and healthy controls during rest and continuous attentive tracking. Heliyon. 6:e04854(9), s. 1–11. doi: 10.1016/j.heliyon.2020.e04854. Fulltekst i vitenarkiv Vis sammendrag

  A cerebral stroke is characterized by compromised brain function due to an interruption in cerebrovascular blood supply. Although stroke incurs focal damage determined by the vascular territory affected, clinical symptoms commonly involve multiple functions and cognitive faculties that are insufficiently explained by the focal damage alone. Functional connectivity (FC) refers to the synchronous activity between spatially remote brain regions organized in a network of interconnected brain regions. Functional magnetic resonance imaging (fMRI) has advanced this system-level understanding of brain function, elucidating the complexity of stroke outcomes, as well as providing information useful for prognostic and rehabilitation purposes. We tested for differences in brain network connectivity between a group of patients with minor ischemic strokes in sub-acute phase (n = 44) and matched controls (n = 100). As neural network configuration is dependent on cognitive effort, we obtained fMRI data during rest and two load levels of a multiple object tracking (MOT) task. Network nodes and time-series were estimated using independent component analysis (ICA) and dual regression, with network edges defined as the partial temporal correlations between node pairs. The full set of edgewise FC went into a cross-validated regularized linear discriminant analysis (rLDA) to classify groups and cognitive load. MOT task performance and cognitive tests revealed no significant group differences. While multivariate machine learning revealed high sensitivity to experimental condition, with classification accuracies between rest and attentive tracking approaching 100%, group classification was at chance level, with negligible differences between conditions. Repeated measures ANOVA showed significantly stronger synchronization between a temporal node and a sensorimotor node in patients across conditions. Overall, the results revealed high sensitivity of FC indices to task conditions, and suggest relatively small brain network-level disturbances after clinically mild strokes.

• Aam, Stina; Einstad, Marte Stine; Munthe-Kaas, Ragnhild; Lydersen, Stian; Ihle-Hansen, Hege & Knapskog, Anne Brita [Vis alle 9 forfattere av denne artikkelen] (2020). Post-stroke Cognitive Impairment—Impact of Follow-Up Time and Stroke Subtype on Severity and Cognitive Profile: The Nor-COAST Study. Frontiers in Neurology. 11:699, s. 1–10. doi: 10.3389/fneur.2020.00699. Fulltekst i vitenarkiv Vis sammendrag

  Background: Post-stroke cognitive impairment (PSCI) is common, but evidence of cognitive symptom profiles, course over time, and pathogenesis is scarce. We investigated the significance of time and etiologic stroke subtype for the probability of PSCI, severity, and cognitive profile. Methods: Stroke survivors (n = 617) underwent cognitive assessments of attention, executive function, memory, language, perceptual-motor function, and the Montreal Cognitive Assessment (MoCA) after 3 and/or 18 months. PSCI was classified according to DSM-5 criteria. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). Stroke subtype was categorized as intracerebral hemorrhage (ICH), large artery disease (LAD), cardioembolic stroke (CE), small vessel disease (SVD), or un-/other determined strokes (UD). Mixed-effects logistic or linear regression was applied with PSCI, MoCA, and z-scores of the cognitive domains as dependent variables. Independent variables were time as well as stroke subtype, time, and interaction between these. The analyses were adjusted for age, education, and sex. The effects of time and stroke subtype were analyzed by likelihood ratio tests (LR). Results: Mean age was 72 years (SD 12), 42% were females, and mean NIHSS score at admittance was 3.8 (SD 4.8). Probability (95% CI) for PSCI after 3 and 18 months was 0.59 (0.51–0.66) and 0.51 (0.52–0.60), respectively and remained constant over time. Global measures and most cognitive domains were assessed as impaired for the entire stroke population and for most stroke subtypes. Executive function and language improved for the entire stroke population (LR) = 9.05, p = 0.003, and LR = 10.38, p = 0.001, respectively). After dividing the sample according to stroke subtypes, language Aam et al. Post-stroke Cognitive Impairment improved for ICH patients (LR = 18.02, p = 0.003). No significant differences were found in the severity of impairment between stroke subtypes except for attention, which was impaired for LAD and CE in contrast to no impairment for SVD (LR = 56.58, p < 0.001). Conclusions: In this study including mainly minor strokes, PSCI is common for all subtypes, both early and long-term after stroke, while executive function and language improve over time. The findings might contribute to personalizing follow-up and offer new insights into underlying mechanisms. Further research is needed on underlying mechanisms, PSCI prevention and treatment, and relevance for rehabilitation.

• Alme, Katinka Nordheim; Knapskog, Anne Brita; Næss, Halvor; Naik, Mala; Beyer, Mona K. & Ellekjær, Hanne [Vis alle 15 forfattere av denne artikkelen] (2020). Is long-bout sedentary behaviour associated with long-Term glucose levels 3 months after acute ischaemic stroke? A prospective observational cohort study. BMJ Open. 10(11), s. 1–9. doi: 10.1136/bmjopen-2020-037475. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose Sedentary behaviour is a risk factor for vascular disease and stroke patients are more sedentary than their age-matched peers. The association with glucose levels, as a potential mediator, is unclear, and we have investigated the association between long-bout sedentary behaviour and long-term glucose levels in stroke survivors. Methods This study uses data from the Norwegian Cognitive Impairment After Stroke study, a multicentre cohort study. The patients were recruited at hospital admission for acute stroke, and the follow-up was done at the outpatient clinic. Sedentary behaviour—being in a sitting or reclining position—was registered 3 months after stroke using position transition data from the body-worn sensor activPAL attached to the unaffected thigh. A MATLAB script was developed to extract activity data from 08:00 to 10:00 for 4 days and to categorise the data into four bout-length categories. The primary outcome was glycated haemoglobin (HbA1c), analysed at 3 months. Regression models were used to analyse the association between HbA1c and sedentary behaviour in the whole population and stratified based on a diagnosis of diabetes mellitus (DM). Age, body mass index and the use of antidiabetic drugs were added as covariates into the models. Results From a total of 815 included patients, 379 patients fulfilled the inclusion criteria for this study. We found no association between time in sedentary behaviour and HbA1c in the whole stroke population. We found time in sedentary behaviour in bouts of ≥90 min to be associated with a higher HbA1c in patients with DM. Conclusion Long-bout sedentary time is associated with a higher HbA1c in patients with DM 3 months after ischaemic stroke. Future research should investigate the benefit of breaking up sedentary time as a secondary preventive measure. Trial registration number NCT02650531, https://clinicaltrials.gov/ct2/show/NCT02650531

• Kolskår, Knut-Kristian; Richard, Geneviève; Alnæs, Dag; Dørum, Erlend Solberg; Sanders, Anne-Marthe & Ulrichsen, Kristine Moe [Vis alle 10 forfattere av denne artikkelen] (2020). Reliability, sensitivity, and predictive value of fMRI during multiple object tracking as a marker of cognitive training gain in combination with tDCS in stroke survivors. Human Brain Mapping. ISSN 1065-9471. doi: 10.1002/hbm.25284. Fulltekst i vitenarkiv Vis sammendrag

  Computerized cognitive training (CCT) combined with transcranial direct current stimulation (tDCS) has showed some promise in alleviating cognitive impairments in patients with brain disorders, but the robustness and possible mechanisms are unclear. In this prospective double‐blind randomized clinical trial, we investigated the feasibility and effectiveness of combining CCT and tDCS, and tested the predictive value of and training‐related changes in fMRI‐based brain activation during attentive performance (multiple object tracking) obtained at inclusion, before initiating training, and after the three‐weeks intervention in chronic stroke patients (>6 months since hospital admission). Patients were randomized to one of two groups, receiving CCT and either (a) tDCS targeting left dorsolateral prefrontal cortex (1 mA), or (b) sham tDCS, with 40s active stimulation (1 mA) before fade out of the current. Of note, 77 patients were enrolled in the study, 54 completed the cognitive training, and 48 completed all training and MRI sessions. We found significant improvement in performance across all trained tasks, but no additional gain of tDCS. fMRI‐based brain activation showed high reliability, and higher cognitive performance was associated with increased tracking‐related activation in the dorsal attention network and default mode network as well as anterior cingulate after compared to before the intervention. We found no significant associations between cognitive gain and brain activation measured before training or in the difference in activation after intervention. Combined, these results show significant training effects on trained cognitive tasks in stroke survivors, with no clear evidence of additional gain of concurrent tDCS.

• Ihle-Hansen, Håkon; Sandset, Else Charlotte; Hagberg, Guri & Ihle-Hansen, Hege (2020). Antitrombotisk behandling ved etablert cerebrovaskulær sykdom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(12), s. 1–2. doi: 10.4045/tidsskr.20.0651. Fulltekst i vitenarkiv
• Thommessen, Bente; Næss, Halvor; Logallo, Nicola; Kvistad, Christopher Elnan; Waje-Andreassen, Ulrike & Ihle-Hansen, Hege [Vis alle 9 forfattere av denne artikkelen] (2020). Tenecteplase versus alteplase after acute ischemic stroke at high age. International Journal of Stroke. ISSN 1747-4930. doi: 10.1177/1747493020938306. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege; Langhammer, Birgitta; Lydersen, Stian; Gunnes, Mari; Indredavik, Bent & Askim, Torunn (2019). A physical activity intervention to prevent cognitive decline after stroke – Secondary results from the LAST (Life After Stroke) study. An 18-month randomised controlled trial. Journal of Rehabilitation Medicine. ISSN 1650-1977. 51(9), s. 646–651. doi: 10.2340/16501977-2588. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To examine the effects of individualized regular coaching and exercise on post-stroke cognitive and emotional function. Methods: The Life After STroke (LAST) study investigated the differences between intervention and care-as-usual between 3 and 21 months post-stroke. Outcome measures were the Trail Making Test (TMT) A and B, Mini Mental State Examination (MMSE), Hospital Anxiety and Depression Scale (HADS), and adherence to the intervention. Results: Of the 362 patients included in the study, 177 were assigned to the intervention. The mean age was 71.7 (SD 11.3) years and 39.5% were female. The adjusted mean difference between groups for TMT A was 8.54 (CI 0.7 to 16.3), p = 0.032, for TMT B 8.6 (CI –16.5 to 33.6), p = 0.50, for MMSE –0.1 (CI –0.8 to 0. 6), p = 0.77, for HADS A –0.2 (CI –0.9 to 0.5), p = 0.56 and for HADS D –0.1 (CI –0.7 to 0.5), p = 0.76). A higher level of adherence to the intervention was significantly associated with increased MMSE (B = 0.030 (CI 0.005–0.055), p = 0.020) Conclusion: No clinically relevant effects on cognitive or emotional function were found of individualized regular coaching for physical activity and exercise. However, increased adherence to the intervention was associated with improved cognitive function.

• Richard, Geneviève; Kolskår, Knut-Kristian; Ulrichsen, Kristine Moe; Kaufmann, Tobias; Alnæs, Dag & Sanders, Anne-Marthe [Vis alle 12 forfattere av denne artikkelen] (2019). Brain age prediction in stroke patients: Highly reliable but limited sensitivity to cognitive performance and response to cognitive training. NeuroImage: Clinical. 25, s. 1–11. doi: 10.1016/j.nicl.2019.102159. Fulltekst i vitenarkiv Vis sammendrag

  Cognitive deficits are important predictors for outcome, independence and quality of life after stroke, but often remain unnoticed and unattended because other impairments are more evident. Computerized cognitive training (CCT) is among the candidate interventions that may alleviate cognitive difficulties, but the evidence supporting its feasibility and effectiveness is scarce, partly due to the lack of tools for outcome prediction and monitoring. Magnetic resonance imaging (MRI) provides candidate markers for disease monitoring and outcome prediction. By integrating information not only about lesion extent and localization, but also regarding the integrity of the unaffected parts of the brain, advanced MRI provides relevant information for developing better prediction models in order to tailor cognitive intervention for patients, especially in a chronic phase. Using brain age prediction based on MRI based brain morphometry and machine learning, we tested the hypotheses that stroke patients with a younger-appearing brain relative to their chronological age perform better on cognitive tests and benefit more from cognitive training compared to patients with an older-appearing brain. In this randomized double-blind study, 54 patients who suffered mild stroke (>6 months since hospital admission, NIHSS≤7 at hospital discharge) underwent 3-weeks CCT and MRI before and after the intervention. In addition, patients were randomized to one of two groups receiving either active or sham transcranial direct current stimulation (tDCS). We tested for main effects of brain age gap (estimated age – chronological age) on cognitive performance, and associations between brain age gap and task improvement. Finally, we tested if longitudinal changes in brain age gap during the intervention were sensitive to treatment response. Briefly, our results suggest that longitudinal brain age prediction based on automated brain morphometry is feasible and reliable in stroke patients. However, no significant association between brain age and both performance and response to cognitive training were found.

Se alle arbeider i NVA

• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Lerdal, Anners (2025). Physical Activity And Its Association With Physical Performance In The First Month Following First-Ever Ischemic Stroke (NORFAST). International Journal of Stroke. ISSN 1747-4930. Fulltekst i vitenarkiv Vis sammendrag

  This study explored association between physical activity and physical performance in the first month following stroke and found that more time spent in moderate-to-vigorous physical activity was associated with male sex. We found no statistically significant associations between moderate-to-vigorous physical activity and physical performance or age, nor between daily step count and physical performance, age or sex. Small sample size may have affected the results.

• Simpson, Dawn; Gay, Caryl; Berg, Søren; English, Coralie; Ihle-Hansen, Hege Beate & Helland, Gisle Berg [Vis alle 11 forfattere av denne artikkelen] (2025). Self-reported and objective sleep measures: Their role in post-stroke fatigeu among acute stroke patients - (NORFAST). Fulltekst i vitenarkiv
• Simpson, Dawn; Gay, Caryl; Berg, Søren; Ihle-Hansen, Hege Beate; Helland, Gisle Berg & Larsson, Petra [Vis alle 10 forfattere av denne artikkelen] (2025). The relationship between objective and subjective sleep measures and post-stroke fatkgue: Insights from an acute ischaemic stroke cohort (the NORFAST study). Fulltekst i vitenarkiv
• Nerdal, Vilde Kristine; Gjestad, Elise Ødegård; Saltvedt, Ingvild Tina; Munthe-Kaas, Ragnhild; Ihle-Hansen, Hege Beate & Ryum, Truls [Vis alle 8 forfattere av denne artikkelen] (2025). Erratum: Correction: The relationship of acute delirium with cognitive and psychiatric symptoms after stroke: a longitudinal study (BMC neurology (2022) 22 1 DOI: 10.1186/s12883-022-02756-5.). BMC Neurology. 25(1), s. 56–56. doi: 10.1186/s12883-025-04055-1. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate (2024). Forhåndssamtaler og etiske dilemmaer. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate (2024). Patient preferences in geriatric wards, a survey of health care professionals‘ practice, experience and attitudes. Fulltekst i vitenarkiv
• Ihle-Hansen, Håkon; Ihle-Hansen, Hege Beate; Steen, Torkel & Hagberg, Guri (2024). Neppe nyttig å finne subklinisk atrieflimmer etter hjerneslag. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(8), s. 1–4. doi: 10.4045/tidsskr.24.0227. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate (2023). Kartlegger helsepersonell i geriatriske avdelinger pasientenes ønsker om informasjon og behandling? Fulltekst i vitenarkiv
• Ihle-Hansen, Hege Beate & Solberg, Carl Tollef (2023). Prioriteringer i helsetjenesten. Fulltekst i vitenarkiv
• Ihle-Hansen, Hege; Kelly, Peter; Bladin, Christopher & Chaturvedi, Seemant (2022). Editorial: Emerging Areas in Extracranial Carotid Stenosis Evaluation and Management. Frontiers in Neurology. 13. doi: 10.3389/fneur.2022.891883. Fulltekst i vitenarkiv
• Bugge, Helge Fagerheim; Guterud, Mona; Bache, Kristi Cecilie Grønvold; Braarud, Anne-Cathrine; Eriksen, Erik & Fremstad, Kjell Otto [Vis alle 15 forfattere av denne artikkelen] (2022). Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) study protocol: a stepped wedge randomised trial of stroke screening using the National Institutes of Health Stroke Scale in the ambulance. Trials. 23(1). doi: 10.1186/s13063-022-06006-4. Fulltekst i vitenarkiv Vis sammendrag

  Background: Less than 50% of stroke patients in Norway reach hospital within 4 h of symptom onset. Early prehospital identification of stroke and triage to the right level of care may result in more patients receiving acute treatment. Quality of communication between paramedics and the stroke centre directly affects prehospital on-scene time, emphasising this as a key factor to reduce prehospital delay. Prehospital stroke scales are developed for quick and easy identification of stroke, but have poor sensitivity and specificity compared to an in-hospital assessment with the National Institutes of Health Stroke Scale (NIHSS). The aim of the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) is to assess whether a structured learning program, prehospital NIHSS and a mobile application facilitating communication with the stroke physician may improve triage of acute stroke patients. Methods: A stepped wedge cluster randomised controlled intervention design will be used in this trial in Oslo, Norway. Paramedics at five ambulance stations will enrol adult patients with suspected stroke within 24 h of symptom onset. All paramedics will begin in a control phase with standard procedures. Through an e-learning program and practical training, a random and sequential switch to the intervention phase takes place. A mobile application for NIHSS scoring, including vital patient information for treatment decisions, transferring data from paramedics to the on-call stroke physician at the Stroke Unit at Oslo University Hospital, will be provided for the intervention. The primary outcome measure is positive predictive value (PPV) for prehospital identification of patients with acute stroke defined as the proportion of patients accepted for stroke evaluation and discharged with a final stroke diagnosis. One thousand three hundred patients provide a 50% surplus to the 808 patients needed for 80% power to detect a 10% increase in PPV. Discussion: Structured and digital communication using a common scale like NIHSS may result in increased probability for better identification of stroke patients and less stroke mimics delivered to a stroke team for acute diagnostics and treatment in our population.

• Rønning, Ole Morten; Carlsson, Maria Kristin; Ihle-Hansen, Hege; Aamodt, Anne Hege; Tveiten, Arnstein & Eltoft, Agnethe [Vis alle 9 forfattere av denne artikkelen] (2022). Overvåkning etter akutt hjerneslag bør bli bedre. 142(14), s. 1–6. doi: 10.4045/tidsskr.22.0401. Fulltekst i vitenarkiv
• Larsson, Petra; Skogestad, Ingrid Johansen; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene & Mack, Ulrich [Vis alle 9 forfattere av denne artikkelen] (2021). Association between fatigue and physical fitness three months after stroke. Fulltekst i vitenarkiv
• Nerdal, Vilde; Gjestad, Elise Ødegård; Saltvedt, Ingvild; Munthe-Kaas, Ragnhild; Ihle-Hansen, Hege & Ryum, Truls [Vis alle 8 forfattere av denne artikkelen] (2021). The Relationship of Acute Delirium with Cognitive and Psychiatric Symptoms After Stroke: A Longitudinal Study. Fulltekst i vitenarkiv
• Larsen, Kristin Tveitan; Forfang, Elisabeth; Pennlert, Johanna; Glader, Eva-Lotta; Kruuse, Christina & Wester, Per [Vis alle 12 forfattere av denne artikkelen] (2020). STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage: Protocol for a randomised controlled trial. European Stroke Journal. ISSN 2396-9873. 5(4), s. 414–422. doi: 10.1177/2396987320954671. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims - Many patients with prior intracerebral haemorrhage have indications for antithrombotic treatment with antiplatelet or anticoagulant drugs for prevention of ischaemic events, but it is uncertain whether such treatment is beneficial after intracerebral haemorrhage. STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage will assess (i) the effects of long-term antithrombotic treatment on the risk of recurrent intracerebral haemorrhage and occlusive vascular events after intracerebral haemorrhage and (ii) whether imaging findings, like cerebral microbleeds, modify these effects.<p> <p>Methods - STudy of Antithrombotic Treatment after IntraCerebral Haemorrhage is a multicentre, randomised controlled, open trial of starting versus avoiding antithrombotic treatment after non-traumatic intracerebral haemorrhage, in patients with an indication for antithrombotic treatment. Participants with vascular disease as an indication for antiplatelet treatment are randomly allocated to antiplatelet treatment or no antithrombotic treatment. Participants with atrial fibrillation as an indication for anticoagulant treatment are randomly allocated to anticoagulant treatment or no anticoagulant treatment. Cerebral CT or MRI is performed before randomisation. Duration of follow-up is at least two years. The primary outcome is recurrent intracerebral haemorrhage. Secondary outcomes include occlusive vascular events and death. Assessment of clinical outcomes is performed blinded to treatment allocation. Target recruitment is 500 participants.

• Langhammer, Birgitta; Gunnes, Mari; Ihle-Hansen, Hege; Indredavik, Bent & Askim, Torunn (2019). Physical activity influence on arm and hand function post stroke. Fulltekst i vitenarkiv
• Lambert, Anna Tancin; Ratajczak-Tretel, Barbara; Halvorsen, Bente; Bjerkeli, Vigdis; Russell, David & Sandset, Else Charlotte [Vis alle 25 forfattere av denne artikkelen] (2019). Clinically available biomarkers as predictors of atrial fibrillation in patients with cryptogenic stroke the Nordic Atrial Fibrillation and Stroke Study (NOR-FIB). European Journal of Neurology. ISSN 1351-5101. 26, s. 90–90. Fulltekst i vitenarkiv

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