Abstract Objective The aims of the study were to (1) characterize the findings of flexible endoscopic evaluation of swallowing (FEES) in stroke patients undergoing mechanical thrombectomy (MT); (2) analyse the screening performance of the Standardized Swallowing Assessment (SSA); and (3) study the impact of FEES‐defined dysphagia on 3‐month outcomes. Methods This single‐centre study was based on a local registry of consecutive acute ischaemic stroke patients undergoing MT during a 1‐year period. Patients received FEES within 5 days of admission regardless of the result of dysphagia screening. We compared baseline demographic and clinical characteristics of patients with and without FEES‐defined dysphagia. We collected 3‐month modified Rankin Scale (mRS) and individual index values of the European Quality of Life 5 Dimensions (EQ‐5D‐iv). Using univariable and multivariable regression analyses we predicted 3‐month outcomes for presence of dysphagia and for FEES‐defined dysphagia severity. Results We included 137 patients with a median age of 74 years, 43.1% were female, median NIHSS was 12 and successful recanalization was achieved in 92.7%. Stroke‐associated pneumonia occurred in 8% of patients. FEES‐defined dysphagia occurred in 81% of patients. Sensitivity of the SSA as a dysphagia screening was 67%. Presence of dysphagia and increasing severity of dysphagia were independently associated with increasing 3‐month mRS score. Increasing dysphagia severity dysphagia was independently associated with lower EQ‐5D‐iv. Interpretation Early FEES‐defined dysphagia occurs in four in every five patients undergoing MT. SSA has a suboptimal dysphagia screening performance. Presence of dysphagia and increasing dysphagia severity predict worse functional outcome and worse health‐related quality‐of‐life.

Background Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting.Methods Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated.Results A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response.Discussion Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.

Introduction: Frailty is a syndrome depicting the vulnerability of multiple physiological systems to stressors. Frailty measures, such as Hospital Frailty Risk Score (HFRS), can be used to identify frailty and predict outcomes more reliably. Our aim was to analyze a blood-based frailty index (FI-B) at admission for prediction outcomes of patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). Methods: We conducted a retrospective study of consecutive AIS patients undergoing EVT in a single tertiary center during a period of 5 years. A set of eighteen blood parameters at admission were collected and nine of these were utilized to calculate FI-B. We analyzed the relationship between FI-B and HFRS. We examined the baseline characteristics of the study population based on FI-B-tertiles. Multivariable regression models were employed to ascertain the association between FI-B and in-hospital mortality, 3-month mortality and 3-month functional outcome. Results: The final study population comprised 489 patients, with a median age of 75.6 years, 49.5% of patients were male. The FI-B exhibited a weak positive correlation with HFRS (rho = 0.113, p = 0.016). Patients in higher FI-B-tertiles were older and more frequently presented with pre-stroke functional dependence and comorbidities. Moreover, an increasing FI-B was independently associated with increased likelihood of in-hospital mortality (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [95% CI] = 1.14-1.47), 3-month mortality (aOR = 1.26, 95% CI = 1.11-1.43), and of increasing 3-month functional disability measured by utility-weighted modified Rankin Scale (common aOR = 0.84, 95% CI = 0.76-0.93). Conclusion: A frailty index based on blood values at admission was able to identify frailty in AIS patients undergoing EVT and was an independent predictor of short- and medium-term outcome after stroke.

Processing of quantifiers such as “many” and “few” relies on number knowledge, linguistic abilities, and working memory. Negative quantifiers (e.g., “few,” “less than half”) induce higher processing costs than their positive counterparts. Furthermore, the meaning of some quantifiers is flexible and thus adaptable. Importantly, in neurotypical individuals, changing the meaning of one quantifier also leads to a generalized change in meaning for its polar opposite (e.g., the change of the meaning of “many” leads to the change of that of “few”). Here, we extended this research to patients with fluent and non-fluent aphasia after stroke. In two experiments, participants heard sentences of the type “Many/few of the circles are yellow/blue,” each followed by a picture with different quantities of blue and yellow circles. The participants judged whether the sentence adequately described the picture. Each experiment consisted of three blocks: a baseline block to assess the participants’ criteria for both quantifiers, a training block to shift the criteria for “many,” and a test block, identical to the baseline to capture any changes in quantifier semantics. In Experiment 1, the change of the meaning of “many” was induced by using adaptation to small numbers (20–50%) of circles of the named color. In Experiment 2, explicit feedback was given in the training block after each response to rate proportions of 40% (or higher) as “many,” whereas 40% is normally rather rated as “few.” The objective was to determine whether people with fluent or non-fluent aphasia were able to process quantifiers appropriately and whether generalized semantic flexibility was present after brain damage. Sixteen out of 21 patients were able to perform the task. People with fluent aphasia showed the expected polarity effect in the reaction times and shifted their criteria for “many” with generalization to the untrained quantifier “few.” This effect, however, was only obtained after explicit feedback (Experiment 2) but not by mere adaptation (Experiment 1). In contrast, people with non-fluent aphasia did not change the quantifier semantics in either experiment. This study contributes to gaining new insights into quantifier processing and semantic flexibility in people with aphasia and general underlying processing mechanisms.

BACKGROUND:Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post-stroke dysphagia, little is known about the contribution of other acute stroke-unrelated factors. We aimed to analyse the impact of swallowing and non-swallowing muscles measurements on swallowing function after large vessel occlusion stroke. METHODS:This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5 days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross-sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non-swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate-to-severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters. RESULTS:The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74 years (interquartile range 62-83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7-16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho = -0.391, P < 0.001 and rho = -0.525, P < 0.001, respectively). Total CSA of the swallowing muscles was independently associated with FOIS (common adjusted odds ratio = 1.08, 95% confidence interval = 1.01-1.16, P = 0.029), and with the presence of moderate-to-severe pharyngeal residues for puree consistencies (adjusted odds ratio = 0.90, 95% confidence interval = 0.81-0.99, P = 0.036). We found no independent association of SMI with any of the FEES parameters. CONCLUSIONS:Baseline swallowing muscle mass contributes to the pathophysiology of post-stroke dysphagia. Decreasing swallowing muscle mass is independently associated with increasing severity of early post-stroke dysphagia and with increased likelihood of moderate-to-severe pharyngeal residues.

Introduction Mechanical thrombectomy (MT) is an established treatment approach in acute ischemic stroke patients with large vessel occlusion (LVO). Recent studies suggest that the prevalence of dysphagia and pneumonia risk is increased in this patient population. The aim of this study was to systematically evaluate the prevalence, predictors, and influence of neurogenic dysphagia for 3-month outcome in a large population of patients receiving MT and to elucidate the relationship between dysphagia, stroke-associated pneumonia (SAP) and medium-term functional outcome. Materials and methods Data of a prospective collected registry of patients with LVO and MT between 2016 and 2019 were analyzed retrospectively. Binary logistic regression was carried out to determine predictors for dysphagia and 3-month outcome as measured by the modified Rankin Scale, respectively. A mediation analysis was performed to investigate the mediating influence of intercurrent SAP. Results A total of 567 patients were included in the study. Mean age was 73.4 years, 47.8% of the patients were female, and median NIHSS was 15.0. The prevalence of dysphagia was 75.1% and 23.3% of all patients developed SAP. In the regression analysis, dysphagia was one of the main independent predictors for poor functional outcome at 3 months. The mediator analysis revealed that the effect of dysphagia on the functional outcome at 3 months was not mediated by the occurrence of SAP. Discussion The prevalence of dysphagia is high and exerts both negative short- and medium-term effects on patients with large vessel occlusion who undergo MT.

Early-life bilingualism (i.e., second language acquisition before the age of 30) has been shown to confer benefits in separate cognitive domains later in life, possibly contributing to the concept of cognitive reserve. However, the effects of early-life bilingualism on cognitive performance and gray matter volume (GMV) in the elderly have been studied scarcely. In an ongoing cohort, we examined the influence of early-life bilingualism on cognitive performance (e.g., phonemic fluency as tested by the Regensburg word fluency test (RWT), among others) as well as age-related brain gray matter volume in older adults. We analysed 3-Tesla T1-weighted Multi-Echo MPRAGE and cognitive data from 25 healthy adults (72.8±7.69 years, 10 female) in our new cohort established within the CRC1436 (https://sfb1436.de/). Assessment of bilingualism was conducted using the Lifetime of Experiences Questionnaire (LEQ). MRI data were preprocessed and analysed using FSL-VBM. We performed a whole-brain analysis looking for an interaction between age and bilingualism on GMV values, postulating that early bilingualism might contribute to a preservation of gray matter along the age trajectory. We extracted GMV values from significant regions of interest (ROIs) and looked for correlations with cognitive performance. Due to the small cohort and the preliminary nature of these analyses, we chose an exploratory threshold of p<0.001 (uncorrected) for the whole brain analysis. ROIs were defined by a threshold of p<0.1 cluster-corrected (z>3.1). Participants with early-life bilingualism (n = 7) had significantly more years of education (p<0.05) and performed better in the RWT (p<0.05) than monolinguals (n = 18). The age-bilingualism interaction term across the whole brain (adjusted for education) identified the head of left caudate nucleus as being protected from age-related GMV loss by early-life bilingualism (Fig. 1). The age-GMV-relationship for both groups is shown in Fig. 2. We observed no significant relationship between GMV in the left caudate and performance in any cognitive tests. These preliminary results hint at a role of early-life bilingualism in modulating GMV in older adults. How these relate to better cognitive performance remains to be elucidated. Moreover, considering brain areas not typically studied in cognitive aging, such as the basal ganglia, seems worthwhile.

After interdisciplinary consent, a male patient in his 50s received endovascular treatment of an innocent supraophthalmic aneurysm of the internal carotid artery with a WEB (woven endo bridge) device and stenting. In the medical history, a migraine with aura was reported. A week after intervention, the patient developed an ipsilateral cluster-like headache responsive to classical interventions. Inflammation of the carotid wall near the stent was demonstrated to be associated with the headaches and was responsive to steroid treatment.The presented case demonstrates that postinterventional headache comprises more headache entities than the often reported migraine and tension-type headache with a considerable impact on the patients' quality of life. The case supports the vascular hypothesis of cluster headache pathophysiology, potentially contradicting current models and assumptions.

Abstract Background Several non-motor symptoms are present in Parkinson's disease (PD), including increasing prevalence rates of cognitive impairment during disease progression. Due to its multifaceted nature, PD management involves pharmacotherapy and non-pharmacotherapies, ideally in a multidisciplinary manner. Evidence regarding the impact of multidisciplinary interventions on motor and non-motor symptoms, as well as its impact on quality of life and daily activities of living, is limited. Methods The aim of this real-life exploratory study was to investigate the effectiveness of a three-week clinical multidisciplinary Parkinson complex therapy (Parkinson-Komplexbehandlung, PKB), which is available as standard care for PD in the German health care system. Especially, the effect of neuropsychological attention training of 40 patients with PD was analyzed concerning their impact on motor abilities (UPDRS-III ON state), cognitive profiles and reported depressive symptoms and psychosocial function. Results Neuropsychological data showed an improvement in response inhibition after intervention (z = − 2.611, p = 0.009). Additionally, improvements in verbal memory (z = − 2.318, p = 0.020), motor functions (UPDRS-III-score; z = − 5.163, p < 0.001) and reduction in depression symptoms (BDI-II) (z = − 2.944, p = 0.003) were also present. Conclusions Patients with PD benefited from this multidisciplinary Parkinson complex therapy in terms of improved cognitive functioning, including attention and verbal learning, motor symptoms and emotional well-being.

Background: In hospital, falls are frequent adverse events. Certain drugs affect the fall risk, therefore studying prescriptions may reveal perilous combinations and support falls prevention. As neurologic diseases frequently increase fall risk, neurologic patients require special attention concerning fall prevention. Aim: To analyse the performance of the electronic adverse drug reaction check programmes VERIKO® and SCHOLZ Datenbank® in identifying neurologic patients with a high drug-associated fall risk. Method: Falls in the Department of Neurology in 2016 were matched to fall-free control patients of the same age, sex and principal diagnosis. Their estimated fall risk and other risk factors were compared using univariate and a multifactorial conditional logistic regression. Receiver operating characteristic curves visualised the performance of both programmes. R² for a model with and without software was calculated. Results: Eighty-seven matched pairs were analysed. In the univariate analyses, VERIKO risk estimations showed a significant correlation to fall events (OR=1.448, CI=1.061-1.975). Additionally, the number of comorbidities (OR=1.086, CI=1.013-1.164), the Hospital Frailty Risk Score (OR=1.085, CI=1.025-1.149), impaired balance (OR=3.6, CI=1.337-9.696), gait abnormality (OR=4.75, CI=1.616-13.962), presence of delirium (OR=3.4, CI=1.254-9.216) and previous falls (OR=8.0, CI=1.839-34.793) were related to high fall risk. Polypharmacy and the number of potentially inappropriate medications did not correlate with fall events. In the multivariate analysis, the Hospital Frailty Risk Score was associated to fall risk (OR=1.390, 95%-CI=1.049-1.842). Both programmes showed an area under the receiver operating characteristics curves < 0.6 and improved the model performance slightly (ΔR² ≤ 0.0006). Conclusion: VERIKO risk estimations correlated significantly to fall events. Nevertheless, both programmes showed little accuracy in identifying drug-associated fall risk.

Der Aachener Aphasie Test (AAT) erfasst auch die spontansprachlichen Leistungen eines Menschen mit Aphasie. Dieser Teil ist jedoch nur manuell durch geschultes Personal auswertbar. Die vorliegende Arbeit fokussiert auf die automatisierte Bewertung einer der sechs AAT-Spontansprachskalen. Im der vorgestellten Studie wird die Möglichkeit untersucht, künstliche neuronale Netze zur automatisierten Identifikation von Auffälligkeiten der Dimension »Prosodie und Artikulation« zu implementieren und verschiedene Ansätze hierzu werden verglichen. Ziel des Studienprogramms ist es, die Durchführung des AAT durch computergestützte Methoden unter Aufrechterhaltung bestehender Qualitätsanforderungen zu automatisieren. Schlüsselwörter: Aphasie, Aachener Aphasie Test, künstliche neuronale Netze, Prosodie, Dysarthrie Abstract The Aachen Aphasia Test (AAT) also records the spontaneous speech performance of a person with aphasia. However, this part can only be evaluated manually by trained personnel. The present work focuses on the automated scoring of one of the six AAT spontaneous speech scales. The possibility of implementing artificial neural networks for the automated identification of abnormalities of the dimension »prosody and articulation« is investigated and different approaches to this are compared. The aim of the study program is to automate the performance of the AAT using computerized methods while maintaining existing quality requirements. Keywords: aphasia, Aachen Aphasia Test, artificial neural networks, prosody, dysarthria

Oral stereognosis is the ability to recognize, discriminate and localize a bolus in the oral cavity. Clinical observation indicates deficits in oral stereognosis in patients with vascular or neurodegenerative diseases particularly affecting the parietal lobes. However, the precise neural representation of oral stereognosis remains unclear whereas the neural network of manual stereognosis has already been identified. We hypothesize that oral and manual stereognosis share common neuronal substrates whilst also showing somatotopic distribution. Functional magnetic resonance images (fMRI; Siemens Prisma 3 T) from 20 healthy right-handed participants (11 female; mean age 25.7 years) using a cross-modal task of oral and manual spatial object manipulation were acquired. Data were analyzed using FSL software using a block design and standard analytical and statistical procedures. A conjunction analysis targeted the common neuronal substrate for stereognosis. Activations associated with manual and oral stereognosis were found in partially overlapping fronto-parietal networks in a somatotopic fashion, where oral stereognosis is located caudally from manual stereognosis. A significant overlap was seen in the left anterior intraparietal sulcus. Additionally, cerebellar activations were shown particularly for the oral condition. Spatial arrangement of shaped boli in the oral cavity is associated with neuronal activity in fronto-parietal networks and the cerebellum. These findings have significant implications for clinical diagnostics and management of patients with lesions or atrophy in parietal lobule (e.g. Alzheimer's disease, stroke). More studies are required to investigate the clinical effect of damage to these areas, such as loss of oral stereognosis or an impaired oral phase.

INTRODUCTION Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST). METHODS We performed a retrospective study of patients with AIS of the anterior circulation submitted to EST between 2012 and 2017, based on a prospectively collected local registry of consecutive patients. The Hospital Frailty Risk Score (HFRS) at discharge was calculated for each patient. We compared groups of patients with and without favourable 3-month outcome after index AIS (modified Rankin Scale 0-2 and 3-6, respectively). A multivariable logistic regression model was used to identify variables independently associated with favourable 3-month outcome. Diagnostic test statistics were used to compare HFRS with other prognostic scores for AIS. RESULTS We included 489 patients with median age 75.6 years (interquartile range [IQR] = 65.3-82.3) and median NIHSS 15 (IQR = 11-19). About 29.7% presented a high frailty risk (HFRS >15 points). Patients with favourable 3-month outcome presented lower HFRS and lower prevalence of high frailty risk. High frailty risk was independently associated with decreased likelihood of favourable 3-month outcome (adjusted odds ratio = 0.48, 95% confidence interval = 0.26-0.89). Diagnostic performances of HFRS and other prognostic scores (THRIVE and PRE scores, SPAN-100 index) for outcome at 3-months were similar. DISCUSSION Frailty is an independent predictor of outcome in AIS patients submitted to EST.