3 articles
Post-stroke depression (PSD) and anxiety are common neuropsychiatric sequelae of stroke, occurring in roughly one-third of survivors. Cognitive impairment is also frequently observed, affecting up to half of stroke patients. These conditions adversely impact rehabilitation and quality of life. This study aimed to determine the prevalence and severity of depression, anxiety, and cognitive deficits in patients with acute ischemic stroke.
We conducted an observational study involving 99 patients with acute ischemic stroke, assessed within approximately two weeks of symptom onset, who were admitted to a tertiary care unit. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, supplemented by the clinician-rated Hamilton Depression (HAM-D) and Anxiety (HAM-A) scales. Cognitive status was evaluated with the Mini-Mental State Examination (MMSE). Descriptive statistics (proportions, means ± SD) were used to summarize the prevalence and severity of each condition.
The cohort had a mean age of 64.8 ± 8.1 years and was 63.5% male. Vascular risk factors were prevalent, with 88% of patients having hypertension and 33% having diabetes. Based on patient-reported measures, 16% of patients exhibited moderate depressive symptoms (PHQ-9 ≥10), while 42% reported moderate to severe anxiety (GAD-7 ≥10). Clinician-administered assessments identified 35% of patients with moderate to severe depression (HAM-D ≥17) and 35% with clinically significant anxiety (HAM-A ≥18). The vast majority of patients (~92%) reported at least mild depressive symptoms, although only 0–1% met the criteria for severe depression.
Depression, anxiety, and cognitive deficits are highly prevalent in the acute phase of ischemic stroke, with approximately one in three patients experiencing clinically significant depression or anxiety and one in four exhibiting cognitive impairment. These findings underscore the importance of early neuropsychological assessment and intervention as part of acute stroke care to improve rehabilitation outcomes.
Stroke remains a major cause of mortality and disability in Moldova and globally. Rapid prehospital intervention is critical for improving outcomes. The adoption of standardized protocols and checklists has enhanced the efficiency of emergency medical services (EMS), especially in stroke recognition and initial management.
A systematic review of the literature and analysis of statistical data from the National Prehospital Emergency Medical Service were conducted. The study focused on evaluating the use and impact of checklists during prehospital stroke interventions.
Between 2022 and 2023, over 12,000 stroke cases were recorded annually. The implementation of national checklists, in conjunction with the Face, Arm, Speech, Time scale, significantly improved early identification, triage, and transport to specialized centers. Notable outcomes included a higher rate of thrombolysis and thrombectomy, improved coordination, and a modest reduction in overall response time. However, delays due to inter-hospital transfers remain a challenge.
The systematic use of checklists in prehospital stroke management in Moldova proved effective in standardizing care, accelerating intervention, and improving patient outcomes. Continued training and system reorganization are crucial to fully capitalize on these tools and to reduce stroke-related morbidity and mortality.
The Institute of Emergency Medicine from Chisinau has joined the Registry of Stroke Care Quality (RES-Q) in 2017.
We have analyzed the stroke patients’ data introduced in RES-Q between 20172022. Baseline characteristics, stroke-related factors, processes of care, and discharge destination were examined.
Data were available for 489 stroke patients. The proportion of patients with ischemic strokes receiving thrombolysis therapy has substantially increased from 2.78% in 2017 to 20% in 2022, and the median door-to-needle time decreased from 85 minutes (2017) to 48 minutes (2021). Thrombectomy began to be performed in 2018 at the Institute of Emergency Medicine, the rate of stroke patients receiving thrombectomy increased from 3.23% in 2019 to 10% in 2022, median door-to-groin time decreased from 228.5 minutes in 2019 to 102 minutes in 2021. More than 80% of patients received secondary prevention therapies that were level-1 evidence-based processes of care: antihypertensive agents (89.47% – 98.44%), antiplatelet drugs (81.63% – 100%), anticoagulants for patients with atrial fibrillation (25% in 2018 vs 100% in 2021), but cholesterol-lowering medication was prescribed to approximately a half of the participants (44.23% – 60.0%). There were more deaths in the pandemic years (36.67% in 2021 vs 18.99% in 2017).
Most hospitalized stroke patients admitted to the Institute of Emergency Medicine received evidence-based care. The COVID-19 pandemic has left its mark on the number of stroke hospitalizations, but the quality of in-hospital stroke care was not dramatically affected.