25 lines
4.5 KiB
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25 lines
4.5 KiB
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editor: visual
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# State of the art report {#sota}
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Life expectancy and the impact of age-related diseases such as stroke and dementia are increasing. In Denmark, stroke incidence is 12,000 per year, and stroke doubles the risk of dementia. Functional outcome after stroke has improved in recent years with the introduction of new treatment options and increased specialization in the health care systems.[@berkhemer2015] Complications other than motor deficits such as depression, cognitive impairment, and physical impairment still pose great challenges and reduce patients' quality of life.[@damsbo2020; @Hackett2014] Vascular causes remain the most significant preventable risk factor of cognitive decline in the elderly.[@hachinski2015] Early identification of pathological changes and risk factors are key to the development of possible intervention strategies.
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## Physical activity
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The idea of beneficial effects of \acr{PA} on cardio-vascular risk factors was introduced 70 years ago.[@Morris1953] Since then, \acr{PA} has been shown to reduce the risk of stroke, and recent studies showed that patients with a higher pre-stroke \acr{PA} level experienced decreased infarct growth[@blauenfeldt2017], fewer depressive symptoms[@Cumming2012; @Pahlman2012; @Bovim2019] as well as better cognitive outcome.[@Damsbo2020a] Also, \acr{PA} is important in the prevention of recurrent vascular events and neuro-psychiatric disorders.[@Billinger2014] Motor and neuro-psychiatric sequelae may all lead to reduced \acr{PA} after stroke despite repeated and intensive interventions.[@boysen2009; @Nicholson2013] Identifying predictors of decline in \acr{PA} after stroke may improve interventions.
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After stroke, many different factors influence the long term risk of new cardiovascular event as recurrent stroke, \acr{TIA}, \acr{MI} or death (vascular or by any cause). The trajectories of \acr{PA} after stroke has recently been associated to functional outcome suggesting that physical activity is not only an indirect measure of functional impairment.[@buvarp2023]
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Despite recent years' spike in the general awareness of the beneficial effects of exercise and active lifestyles, and despite repeated and intensive interventions, preventing low PA or sedentary behaviour after stroke has proven difficult.[@saunders2021; @aguiar2020; @boysen2009] Part of the explanation to this paradox may be \acr{SES}. Lower socio-economic status has been associated to increased risk of stroke and decreased chance of getting timely stroke treatment.[@addo2012; @buus2022] In addition, a recent large study found that lower \acr{SES} is correlated to lower levels of \acr{PA}.[@stalling2022] Other explanations may be stroke severity, fear of falling and pre-stroke physical inactivity which were all associated with low post-stroke PA.[@botö2021]
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The group of patients with a low level of \acr{PA} both before and after stroke, has not been studied well, but may constitute a group of patients at increased risk and is in need for new interventional strategies. We wish to investigate prediction of which patients increase \acr{PA} after stroke, and analyse the long-term risk stratification between different \acr{PA} trajectories after stroke.
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## Cerebral Small Vessel Disease
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\acr{cSVD} is a syndrome associated with increased stroke risk and neuropsychiatric disorders including dementia.[@Wardlaw2013a] The prevalence of \acr{cSVD} increases with age, and different lifestyle factors are thought to be important to the development a progression, including diabetes, hypertension and (low) \acr{PA}.[@Cannistraro2019; @clancy2021]
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Among elderly patients, \acr{cSVD} is the cause of stroke in one of four cases.[@wafa2018] Recently, rating tools to assist in quantifying \acr{cSVD} burden from acute \acr{MRI} scans have been suggested, and \acr{cSVD} burden have been shown to correlate to development of cognitive impairment among stroke patients.[@huijts2013; @olama2020] We have previously shown that pre-stroke \acr{PA} is correlated to better cognitive outcome six months after stroke,[@Damsbo2020a] but it is not clear how \acr{PA} is correlated to \acr{cSVD} among stroke patients.
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A recently published large long-term follow-up study on \acr{PA} among patients with \acr{cSVD} did not find a correlation between to the progression of \acr{cSVD}[@landman2021], but to our knowledge, the correlation between \acr{cSVD} burden, \acr{PA} and lifestyle factors including diabetes and hypertension, in the stroke population has not been well studied.
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