Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Tuesday, January 17, 2017

Saskatchewan Acute Stroke Pathway hastens care for stroke patients

Somehow I missed the time limit for tPA going to 12 hours. Still just talking about care, not results.
Stroke patients should receive better and quicker care with the launch of the Saskatchewan Acute Stroke Pathway.
Formally launched Monday at the Regina General Hospital, although it has been up and running since summer in most places, the pathway streamlines care for stroke patients.
“This gets people provincewide to the right stroke centre,” said Dr. Michael Kelly, a neurosurgeon from Saskatoon who helped lead the charge on improving stroke care.
“Stroke’s a major disease that sometimes take a backseat to other diseases, but it’s the No. 3 killer of Canadians and it’s the No. 1 cause of long-term disability in Canada, so it’s a major problem.”
With early rehabilitation by a stroke team, there’s “significant reduction” in the length of hospital stay and, so far, about 30 fewer patients requiring permanent institutionalization.
Allison Kesler, CEO of the Saskatchewan Heart & Stroke Foundation, emphasizes the importance of knowing the signs of a stroke: face drooping, inability to raise arms, and slurred or jumbled speech.
If someone is having a stroke, it’s important to call 9-1-1 immediately and say that the patient may be having a stroke. That way, they’ll be transported directly to a stroke care centre in Regina or Saskatoon, or in one of seven smaller cities, including Moose Jaw, Estevan, Yorkton and Swift Current.
Bypassing a smaller rural hospital or care centre, the patient will more quickly obtain proper stroke treatment, which will hasten their recovery. About 1.9 million brain cells die each minute after a stroke.
“It’s time-dependent certainly. That’s one of the problems in a province with such large geography,” said Kelly.
Prior to the pathway, patients who’d shown stroke symptoms for more than 3 ½ hours were considered beyond emergency care, because it was thought a clot-busting drug wouldn’t work on them.
That “always bothered me,” said Kelly.
Now the time limit is 12 hours, which is “one of the big accomplishments” of the pathway.
Stroke patients “need to be cared for by people that have expertise in this, including rehab and therapies and speech language pathology,” said Kelly. “That’s what, by expanding the window, we’ve also been able to implement, is those systems for people that have made a big difference.”
Kelly says about 2,500 people have strokes every year in Saskatchewan.
He said there was minimal cost in creating the pathway; it was more about “implementing best practice to do it better.”

Sonothrombolysis in the management of acute ischemic stroke

Only 6 years old, was this enough to add this procedure to tPA administration in your stroke hospital? Or does no one in your hospital read research at all?

Author information

  • 1Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama, USA.


Multiple in vitro and animal models have demonstrated the efficacy of ultrasound to enhance fibrinolysis. Mechanical pressure waves produced by ultrasound energy improve the delivery and penetration of alteplase (recombinant tissue plasminogen activator [tPA]) inside the clot. In human stroke, the CLOTBUST phase II trial showed that the combination of alteplase plus 2 hours of continuous transcranial Doppler (TCD) increased recanalization rates, producing a trend toward better functional outcomes compared with alteplase alone. Other small clinical trials also showed an improvement in clot lysis when transcranial color-coded sonography was combined with alteplase. In contrast, low-frequency ultrasound increased the symptomatic intracranial hemorrhage rate in a clinical trial. Administration of microbubbles (MBs) may further enhance the effect of ultrasound on thrombolysis by lowering the ultrasound-energy threshold needed to induce acoustic cavitation. Initial clinical trials have been encouraging, and a multicenter international study, TUCSON, determined a dose of newly developed MBs that can be safely administered with alteplase and TCD. Even in the absence of alteplase, the ultrasound energy, with or without MBs, could increase intrinsic fibrinolysis. The intra-arterial administration of ultrasound with the EKOS NeuroWave catheter is another ultrasound application for acute stroke that is currently being studied in the IMS III trial. Operator-independent devices, different MB-related techniques, and other ultrasound parameters for improving and spreading sonothrombolysis are being tested.

NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population

No clue what the point of this ultrasound treatment was for. It is safe but why use it? Explained here:

Sonothrombolysis in the management of acute ischemic stroke

Nacu A, Kvistad C, Naess H, Øygarden H, Logallo N, Assmus J, Waje-Andreassen U, Kurz K, Neckelmann G, Thomassen L; Stroke (Dec 2016)

BACKGROUND AND PURPOSE The NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study) aimed to assess effect and safety of contrast-enhanced ultrasound treatment in an unselected acute ischemic stroke population.
METHODS Patients treated with intravenous thrombolysis within 4.5 hours after symptom onset were randomized 1:1 to either contrast-enhanced sonothrombolysis (CEST) or sham CEST. A visible arterial occlusion on baseline computed tomography angiography was not a prerequisite for inclusion. Pulse-wave 2 MHz ultrasound was given for 1 hour and contrast (SonoVue) as an infusion for ≈30 minutes. Magnetic resonance imaging and angiography were performed after 24 to 36 hours. Primary study end points were neurological improvement at 24 hours defined as National Institutes of Health Stroke Scale score 0 or reduction of ≥4 National Institutes of Health Stroke Scale points compared with baseline National Institutes of Health Stroke Scale and favorable functional outcome at 90 days defined as modified Rankin scale score 0 to 1.
RESULTS A total of 183 patients were randomly assigned to either CEST (93 patient) or sham CEST (90 patients). The rates of symptomatic intracerebral hemorrhage, asymptomatic intracerebral hemorrhage, or mortality were not increased in the CEST group. Neurological improvement at 24 hours and functional outcome at 90 days was similar in the 2 groups both in the intention-to-treat analysis and in the per-protocol analysis.
CONCLUSIONS CEST is safe among unselected ischemic stroke patients with or without a visible occlusion on computed tomography angiography and with varying grades of clinical severity. There was, however, statistically no significant clinical effect of sonothrombolysis in this prematurely stopped trial.
CLINICAL TRIAL REGISTRATION URL: Unique identifier: NCT01949961.

Optimal Timing of Anticoagulant Treatment After Intracerebral Hemorrhage in Patients With Atrial Fibrillation

For discussions with your doctor if this applies to you.

Pennlert J, Overholser R, Asplund K, Carlberg B, Van Rompaye B, Wiklund P, Eriksson M; Stroke (Dec 2016)

BACKGROUND AND PURPOSE This study aims to provide observational data on the relationship between the timing of antithrombotic treatment and the competing risks of severe thrombotic and hemorrhagic events in a cohort of Swedish patients with atrial fibrillation and intracerebral hemorrhage (ICH).
METHODS Patients with atrial fibrillation and a first-ever ICH were identified in the Swedish Stroke Register, Riksstroke, 2005 to 2012. Riksstroke was linked with other national registers to find information on treatment, comorbidity, and outcome. The optimal timing of treatment in patients with low and high thromboembolic risk was described through cumulative incidence functions separately for thrombotic and hemorrhagic events and for the combined end point vascular death or nonfatal stroke.
RESULTS The study included 2619 ICH survivors with atrial fibrillation with 5759 person-years of follow-up. Anticoagulant treatment was associated with a reduced risk of vascular death and nonfatal stroke in high-risk patients with no significantly increased risk of severe hemorrhage. The benefit seemed to be greatest when treatment was started 7 to 8 weeks after ICH. For high-risk women, the total risk of vascular death or stroke recurrence within 3 years was 17.0% when anticoagulant treatment was initiated 8 weeks after ICH and 28.6% without any antithrombotic treatment (95% confidence interval for difference, 1.4%-21.8%). For high-risk men, the corresponding risks were 14.3% versus 23.6% (95% confidence interval for difference, 0.4%-18.2%).
CONCLUSIONS This nationwide observational study suggests that anticoagulant treatment may be initiated 7 to 8 weeks after ICH in patients with atrial fibrillation to optimize the benefit from treatment and minimize risk.

Adapted cold shower as a potential treatment for depression

Only 9 years old and I bet your doctor has never considered prescribing this for your post-stroke depression. The bolded line would seem to be an excellent reason for using this as part of your enriched environment as talked about by Dr. Dale Corbett in 2011. This would seem to be similar to the Szechuan pepper that sends the equivalent of 50 light taps to the brain per second.


Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of "thermal exercise" may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people. To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 degrees C, 2-3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months. The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.

Drink for your heart: Caffeine may counter age-related inflammation, cardiovascular disease

From Stanford Medicine. I go for as much coffee as I can get.How long before your doctor has a coffee protocol?
There’s a clear connection between chronological age, chronic inflammation, cardiovascular disease and… coffee consumption.
More than 90 percent of all noncommunicable diseases of aging are associated with chronic inflammation. And more than 1,000 papers have provided evidence that chronic inflammation contributes to many cancers, Alzheimer’s disease and other dementias, cardiovascular disease, osteoarthritis and even depression.
It’s also well known — well, at least among the scientists who study this kind of thing — that caffeine intake is associated with longevity. Now, Stanford immunologists David Furman, PhD, and Mark Davis, PhD, and their colleagues have revealed a likely reason why this may be so.
In a study published in Nature Medicine, the researchers conducted extensive analyses of blood samples, survey data and medical and family histories obtained from more than 100 human participants in a multiyear study. Their search revealed a fundamental inflammatory mechanism associated with human aging and the chronic diseases that come with it. In short, this mechanism becomes increasingly likely to kick into high gear as the number of candles on our birthday cake marches relentlessly toward infinity.
The study implicates this same inflammatory process as a driver of cardiovascular disease and increased rates of mortality overall. Metabolites, or breakdown products, of nucleic acids — the molecules that serve as building blocks for our genes — circulating in the blood can trigger this inflammatory process big-time, the study found. Injecting these substances into mice produced massive systemic inflammation, sent their blood pressure soaring and wreaked havoc with their kidneys, among other nasty consequences.
Intriguingly, caffeine and its own metabolites — whose molecular structure, intriguingly, bears a strong family resemblance to the nucleic-acid metabolites — blocked the abysmal action of the latter, possibly explaining why coffee drinkers tend to live longer than abstainers.
Now, the good news: Not all older people, as the study showed, are cursed with the age-related inflammatory hyperdrive discovered by the investigators. And when Furman, Davis et al. looked at the extremes — older people with low levels of this type of inflammation were only one-eighth as likely as the high-level older people to have high blood pressure.  They were also eight times as likely to report having at least one close blood relative who had lived to the age of 90 or older. And of the people in the study who were 85 or more years old in 2008, when the long-term longitudinal study began, those with low levels of the identified type of systemic inflammation were substantially more likely to still be alive in 2016, eight years later.
And sure enough: The study participants with the lowest activation levels of the nasty inflammatory mechanism were the ones who, according to extensive questionnaires, reported the highest caffeine intake.
If that doesn’t enable your coffee addiction, nothing will. Oh, and by the way, black tea and dark chocolate contain compounds similar to caffeine.

Treatment for Stroke That Could Permanently Repair Brain Damage Stroke

I bet nothing will come of this because we have NO stroke leadership and NO stroke strategy. This will join the hundreds and thousands of research pieces I have already talked about that are circling the drain, never to be seen again.
Researchers from the University of Manchester have developed a new treatment that could limit the damage caused by treatment for stroke and also promote repair in the affected area of the brain. What’s more, the drug they’re using has already been clinically approved.
The researchers’ study is published in Brain, Behavior and Immunity, and it recounts how they developed their treatment using mice bred to develop ischemic treatment for stroke, the most prevalent type of stroke and one that occurs when an artery that supplies oxygen-rich blood to the brain is blocked. Soon after the mice experienced a stroke, the researchers treated them with interleukin-1 receptor antagonist (IL-1Ra), an anti-inflammatory drug that is already licensed for use in treating rheumatoid arthritis.
They noticed a reduction in the amount of brain damage typically observed after a treatment for stroke and also noted that the drug boosted neurogenesis (the birth of new cells) in the areas that did experience brain damage in the days following the treatment. The mice even regained the motor skills they lost due to the stroke.
The researchers’ study is published in Brain, Behavior and Immunity, and it recounts how they developed their treatment using mice bred to develop ischemic treatment for stroke, the most prevalent type of stroke and one that occurs when an artery that supplies oxygen-rich blood to the brain is blocked. Soon after the mice experienced a stroke, the researchers treated them with interleukin-1 receptor antagonist (IL-1Ra), an anti-inflammatory drug that is already licensed for use in treating rheumatoid arthritis.
They noticed a reduction in the amount of brain damage typically observed after a treatment for stroke and also noted that the drug boosted neurogenesis (the birth of new cells) in the areas that did experience brain damage in the days following the treatment. The mice even regained the motor skills they lost due to the stroke.


Treatment for stroke is the fifth leading cause of death in the United States and about 800,000 people suffer from one each year, according to the Centers for Disease Control and Prevention (CDC). They occur when the flow of blood to the brain is interrupted, usually due to a blood clot or a buildup of fat that broke off from the arteries and traveled to the brain. The condition is extremely dangerous because brain cells can die within a few minutes of the treatment for stroke, causing permanent damage or even death.
Must Read:  What is stroke? Treatment for stroke
We still don’t have a treatment to adequately prevent or reverse the damage to the brain caused by treatment for stroke, but the Manchester researchers believe that their development could change that. Though they are still in early stages of clinical trials, they hope to eventually move on to larger trials and eventually human testing. Together with other research, this new study offers hope to the thousands of people whose lives are impacted by strokes worldwide.

Physical activity mediates the relationship between fruit and vegetable consumption and cognitive functioning: A cross-sectional analysis

To improve your cognitive functioning post-stroke your doctor should tell you the exact amount of physical activity needed along with exact fruit and vegetable consumption. In simple words, an exercise protocol and a diet protocol.  Or you could be a bad patient and do this on your own without your doctors knowledge. That would be living life dangerously.
Journal of Public Health, 01/17/2017
This study investigated the interrelationships between fruit and vegetable consumption (FVC), body mass index (BMI), physical activity (PA) and cognitive functioning in younger and older adults. Higher PA levels were associated with better cognitive functioning in younger and older adults. Also, higher daily FVC and education levels were associated with better cognitive scores.


  • Cross–sectional information of 45522 participants (≥30 years) were analyzed from the 2012 annual component of the Canadian Community Health Survey.
  • Cognitive function was evaluated utilizing a single 6–level question of the Health Utilities Index.
  • PA was classified according to the Physical Activity Index kilocalories per kilogram every day as active, moderately active and inactive; BMI was measured in kg/m2 and FVC (servings/day) was classified as low, moderate or high.
  • To evaluate the interrelationship between FVC, BMI, PA, age and cognitive functioning, general linear models and mediation investigations were utilized.


  • Higher BMIs, lower PA and FVC were connected with poorer cognitive functioning.
  • Furthermore, PA statistically mediated the association between FVC and cognitive function (Sobel test: t = –3.15; P < 0.002); and higher education levels and daily FVC were connected with better cognitive function (P < 0.001).
Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Monday, January 16, 2017

Science will be Blockchained by 2025

This would be very useful for stroke but will not occur until we destroy the fucking failures of stroke associations we have now and replace it with a great stroke association.
By 2025, all key scientific data will be verifiable by blockchain processes, because science faces a crisis of trust, and blockchain technology is maturing at the right time to fix it.
Coming Crisis. At the foundation of the scientific process is the expectation of reproducible results. This comes from trust in the integrity and verifiability of the data. Unfortunately, the pace of scientific advancement and the current incentive systems have led to numerous problems: falsified data, lack of reproducibility, and limitations of peer-review to name a few.

More at link.

Care suffers when patients berate docs, other medical professionals

Ok, maybe you don't want to follow my suggestion of screaming at your doctor. Then redirect it at the stroke hospital president and the board of directors. You are still getting lousy care if you don't get to 100% recovery and someone needs to step up to the needed leadership skills and solve the problems. How much worse than 10% full recovery rate will you get if you berate your doctor for not knowing anything about stroke recovery?
Warning to patients, parents and caregivers: Mind your manners.
While much has been written about the need to put an end to some doctors’ rude and bullying behavior, a new study shows the need for patients and families to also control their behavior.
Parents and caregivers who are rude to medical professionals may find it backfires. Indeed, doctors who are subjected to rude behavior may actually provide worse care to their patients even if they don't intend to, according to a study by University of Florida researchers.
Emotions can run high in hospitals, so it's not uncommon for patients or their loved ones to be rude to medical professionals if they think care is inadequate. But that type of bad behavior can lead to worse care for a child, the researchers warn.
Berating a child’s doctors or other medical professionals who provide care has “devastating effects on medical performance,” according to the findings of the study, published in Pediatrics.
A Johns Hopkins study estimated that more than 250,000 deaths are attributed to medical errors in the U.S. each year. The effects of rudeness account for more than 40% of the variance in practitioner performance that can lead to medical errors, according to management professor Amir Erez, Ph.D., one of the study authors.
“People may think that doctors should just 'get over' the insult and continue doing their job. However, the study shows that even if doctors have the best intentions in mind, as they usually do, they cannot get over rudeness because it interferes with their cognitive functioning without an ability to control it," Erez said in an announcement about the study.
In the study, researchers compared teams made up of two doctors and two nurses in 39 neonatal intensive care units in Israel. They simulated five scenarios in which the teams treated infant medical mannequins in emergency situations. An actress playing the baby’s mother scolded some of the teams, while the others were not subjected to rude behavior.
Teams who experienced rudeness performed poorly and were deficient in all of the study’s 11 measures, which included diagnostic accuracy, information sharing, therapy plan and communication. The behavior continued to affect the team members the entire day.
However, teams that participated in a pretest intervention—a computer game intended to raise the threshold of sensitivity to anger and aggression—recognized the mother’s rudeness and were not affected by it. In addition to training healthcare professionals on how to improve their interpersonal skills, the study suggests that hospital administrators should also make it a priority to teach medical professionals how to handle rudeness more effectively.

Millions in Donations Expanding Stroke and Brain Aneurysm Research and Education - Baptist Health, Jacksonville FL

YOU will need to get involved to make sure these donations actually are used to solve some of these problems in stroke. You can't let the researchers decide this on their own they need to be following your strategy, actually doing research that helps survivors. None should go for education, that is just conscience laundering.

Baptist Health will expand its research and education efforts for stroke and brain aneurysms thanks to recent charitable donations totaling $6 million -- including a $1.1 million gift by a grateful patient. The donation establishes the Ricardo Hanel, MD, and Eric Sauvageau, MD, Chair in Neurovascular Surgery at the Baptist Neurological Institute.
Jacksonville, Fla. (PRWEB) January 12, 2017
Baptist Health will expand its research and education efforts for stroke and brain aneurysms thanks to recent charitable donations totaling $6 million -- including a $1.1 million gift by a grateful patient.
The donation was made by an anonymous patient and spouse to establish the Ricardo Hanel, MD, and Eric Sauvageau, MD, Chair in Neurovascular Surgery at the Baptist Neurological Institute. That donation will be matched by Baptist Health for a total endowment of about $2.5 million, which will provide permanent, ongoing funding for brain treatment and research.
Dr. Hanel, director of the Baptist Neurological Institute, and Dr. Sauvageau, director of the Stroke & Cerebrovascular Center at Baptist Medical Center Jacksonville, are nationally and internationally recognized as leaders in treating brain aneurysms, acute stroke and cerebrovascular conditions using the latest minimally invasive techniques and groundbreaking clinical trials.
"Drs. Hanel and Sauvageau are on a mission to save lives throughout the region," said Hugh Greene, president and CEO of Baptist Health. "Thanks to their tireless efforts, as well the generosity of our donors, Baptist is helping to define the new frontier in stroke and brain aneurysm treatment."
Also funded by the $6 million in donations from corporate and private donors will be endowments focused on clinical program development for treating cerebrovascular conditions in adults and children, as well as expanding community outreach and awareness for stroke and brain aneurysms.
In addition to the anonymous donors, one of the other donations recently came from long-time Beaches residents Cheryl and Tom Rackley who designated $1 million to support neurological needs for Beaches residents and $500,000 to the Baptist Neurological Institute Endowment. Cheryl was treated by Dr. Hanel for a brain aneurysm in 2015.
"The generosity of these gifts are really inspiring," Dr. Hanel said. "The donations allow us to continue doing advanced research and education while providing the best cerebrovascular care in the region for all ages and all socio-economic levels, especially to the under privileged."
"These commitments are truly amazing and will allow us to develop the program further and provide support to educate and reach more people in the community," Dr. Sauvageau added.
Drs. Hanel and Sauvageau, who came to Baptist Health in 2014, helped to establish the Baptist Neurological Institute and Baptist Stroke & Cerebrovascular Center, which leads the region for new minimally invasive treatment of the brain, including clinical trials. Thanks in large part to their leadership, Baptist Jacksonville also now has one of the largest neurointensive care units in the state and the first ER with beds dedicated to neurological needs.

New urine test can quickly detect whether a person has a healthy diet

This won't do you any good since your doctor never setup a stroke diet protocol s/he won't want a test proving that your diet is bad.  And just maybe you want to test for blood clots.

Nanotechnology urine test could detect deadly blood clots

After you pee into the cup ask your doctor for stem cells back.

Turning urine into brain cells could help fight Alzheimer’s, Parkinson’s

Imperial College London Health News
Scientists have developed a urine test that measures the health of a person's diet.

The five–minute test measures biological markers in urine created by the breakdown of foods such as red meat, chicken, fish and fruit and vegetables.

The analysis, developed by researchers from Imperial College London, Newcastle University and Aberystwyth University, also gives an indication of how much fat, sugar, fibre and protein a person has eaten.

Although the work is at an early stage, the team hope that with future development the test will be able to track patients' diets. It could even be used in weight loss programmes to monitor food intake.

Evidence suggests people inaccurately record their own diets, and under–report unhealthy food while over–reporting fruit and vegetable intake – and that the likelihood of inaccuracies in food diaries increases if a person is overweight or obese.

Professor Gary Frost, senior author of the study from the Department of Medicine at Imperial said: "A major weakness in all nutrition and diet studies is that we have no true measure of what people eat. We rely solely on people keeping logs of their daily diets – but studies suggest around 60 per cent of people misreport what they eat to some extent. This test could be the first independent indicator of the quality of a person's diet – and what they are really eating."

In study, published in the journal Lancet Diabetes and Endocrinology and conducted at the MRC–NIHR National Phenome Centre, the researchers asked 19 volunteers to follow four different diets, ranging from very healthy to very unhealthy. These were formulated using World Health Organisation dietary guidelines, which advise on the best diets to prevent conditions such as obesity, diabetes and heart disease.

The volunteers strictly followed these diets for three days while in a London research facility, throughout which the scientists collected urine samples in the morning, afternoon and evening.

The research team then assessed the urine for hundreds of compounds, called metabolites, produced when certain foods are broken down in the body.

These included compounds that indicate red meat, chicken, fish, fruit and vegetables, as well as giving a picture of the amount of protein, fat, fibre and sugar eaten. They also included compounds that point to specific foods such as citrus fruits, grapes and green leafy vegetables.

From this information the researchers were able to develop a urine metabolite profile that indicated a healthy, balanced diet with a good intake of fruit and vegetables. The idea is this 'healthy diet' profile could be compared to the diet profile from an individual's urine, to provide an instant indicator of whether they are eating healthily.

The scientists then tested the accuracy of the test on data from a previous study. This included 225 UK volunteers as well as 66 people from Denmark. All of the volunteers had provided urine samples, and kept information on their daily diets.

Analysis of these urine samples enabled the researchers in the current study to accurately predict the diet of the 291 volunteers.

Benzodiazepine-like drugs linked to increased stroke risk among Alzheimer's disease patients

You'll have to ask your doctor what the risk for stroke is for you since you have a likely chance of getting dementia. Is this risk just for actual Alzheimer patients?  Or how long prior to Alzheimers/dementia period where the risk lies? Familiar names are Valium and Xanax.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.

3. A 20% chance in this research.   July 2013.

Benzodiazepine-like drugs linked to increased stroke risk among Alzheimer's disease patients

The use of benzodiazepines and benzodiazepine-like drugs was associated with a 20 per cent increased risk of stroke among persons with Alzheimer's disease, shows a recent study from the University of Eastern Finland. Benzodiazepines were associated with a similar risk of stroke as benzodiazepine-like drugs.
The use of benzodiazepines and benzodiazepine-like drugs was associated with an increased risk of any stroke and ischemic stroke, whereas the association with hemorrhagic stroke was not significant. However, due to the small number of hemorrhagic stroke events in the study population, the possibility of such an association cannot be excluded. The findings are important, as benzodiazepines and benzodiazepine-like drugs were not previously known to predispose to strokes or other cerebrovascular events. Cardiovascular risk factors were taken into account in the analysis and they did not explain the association.
The findings encourage a careful consideration of the use of benzodiazepines and benzodiazepine-like drugs among persons with Alzheimer's disease, as stroke is one of the leading causes of death in this population group. Earlier, the researchers have also shown that these drugs are associated with an increased risk of hip fracture.
The study was based on data from a nationwide register-based study (MEDALZ) conducted at the University of Eastern Finland in 2005-2011. The study population included 45,050 persons diagnosed with Alzheimer's disease, and 22 per cent of them started using benzodiazepines or benzodiazepine-like drugs.
University of Eastern Finland

Sunday, January 15, 2017

Brain-computer interface based motor and cognitive rehabilitation after stroke – state of the art, opportunity, and barriers: summary of the BCI Meeting 2016 in Asilomar

See what state of the art BCI will bring to your stroke rehabilitation. ROFLMAO.

Non-invasive electroencephalographic (EEG) based brain-computer interfaces (BCIs) are a potential tool to support neuronal plasticity after stroke in the sub-acute and even in the chronic state. A few randomized controlled trials have demonstrated the positive effect on motor rehabilitation. Recent data also indicate that BCI training may improve cognitive rehabilitation. However, important questions remain to be addressed for implementing BCI-based rehabilitation in the clinical routine. This translational effort requires an interdisciplinary approach. The current article provides an overview of a stroke rehabilitation workshop of the 6th International Brain-Computer Interface Meeting in Asilomar, Pacific Grove, USA, held from 30 May to 3 June 2016. This workshop provided an overview of the current state of the art in BCI-based motor and cognitive rehabilitation, presented BCI set-ups shown to be effective, and concluded with a discussion of translational issues and barriers.

Standing practice in rehabilitation early after stroke

A research study on standing in the UK. Join if you can.
Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status

Plain English Summary

Background and study aims
A stroke is a serious condition where the blood supply to a part of the brain is cut off, usually by a blood clot blocking an artery (ischaemic stroke) or a bleed (haemorrhagic stroke). A large proportion of stroke victims suffer from long-term complications depending on the area of the brain that is affected, affecting their ability to speak, think and move. People with severe stroke experience significant muscle weakness which means that they spend much of their time in bed or sitting. This inactivity can cause their muscles to become even weaker and stiffer and may lead them to experience sudden drops in blood pressure when they move from lying to standing (orthostatic hypotension (OH). This further interferes with their ability to participate in intensive stroke rehabilitation, overall recovery and quality of life. Currently physiotherapy for people with severe stroke concentrates on practicing tasks such as getting in and out of bed into a chair that are important for independence and achieving safe discharge home. Standing up early after a stroke may help strengthen muscles, reduce OH and minimise or prevent muscles becoming stiff and weaker. A standing frame has the ability to assist people with severe stroke safely into a supported standing posture, however there are not given to patients when discharged and are not often used in stroke rehabilitation units. This study aims to assess whether it is possible for people with severe stroke to use a standing frame to practice functional movements such as standing and moving between sitting and standing during their hospital-based rehabilitation.

Who can participate?
Adults with severe stroke who are patients in participating Stroke Rehabilitation Units in Cornwall and Devon.

What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group take part in the functional standing frame programme. This involves a maximum of 30 minutes using the standing frame plus an additional 15 minutes to provide time for usual physiotherapy where participants may practise transfers, arm activities or activities chosen by participants or guided by physiotherapists. Participants will undertake the functional standing frame programme for ideally up to five days per week for a total of three weeks. Those in the second group practice routine physiotherapy stroke rehabilitation for 45 minutes per day (or as long as a tolerated) ideally up to five days per week for three weeks. Participants in both groups complete a range of assessments and questionnaires at the start of the study and then again after three, six and twelve months to assess their function and ability to undertake activities of daily living.

What are the possible benefits and risks of participating?
Participants who use the standing frame may benefit from improvements to their symptoms and enhanced recovery. There are no notable risks involved with participating.

Where is the study run from?
1. Camborne Redruth Community Hospital (UK)
2. Bodmin Community Hospital (UK)
3. Skylark Ward, Stroke Rehabilitation Unit (UK)
4. Elizabeth Ward, Stroke Rehabilitation Unit (UK)

When is the study starting and how long is it expected to run for?
April 2016 to March 2019

Who is funding the study?
National Institute for Health Research (UK)

Who is the main contact?
Miss Angie Logan

Trial website

Glia, Not Neurons, Most Affected By Brain Aging

You just aged/lost 5 years of your brain due to your stroke. What protocols does your doctor have to catch back up?

The difference between an old brain and a young brain isn’t so much the number of neurons but the presence and function of supporting cells called glia. In Cell Reports on January 10, researchers who examined postmortem brain samples from 480 individuals ranging in age from 16 to 106 found that the state of someone’s glia is so consistent through the years that it can be used to predict someone’s age. The work lays the foundation to better understand glia’s role in late-in-life brain disease.
“We extensively characterized aging-altered gene expression changes across 10 human brain regions and found that, in fact, glial cells experience bigger changes than neurons,” says Jernej Ule, a neurobiologist at the Francis Crick Institute and the University College London, who led the study with departmental colleague Rickie Patani and first author Lilach Soreq. “There’s quite a bit of regional information that will be of interest to different people–for example some will notice a very unique pattern of astrocyte-specific changes in the substantia nigra–and we provide a lot of data that still needs to be analyzed.”
There are three types of glia cells, each providing different kinds of support to neurons: oligodendrocytes insulate, microglia act as immune cells, and astrocytes help with neuron metabolism, detoxification, among many functions. Based on analysis of human brain tissue samples, primarily from the UK Brain Expression Consortium, the researchers show that astrocytes and oligodendrocytes shift their regional gene expression patterns upon aging, (e.g., which genes are turned on or off) particularly in the hippocampus and substantia nigra–important brain regions for memory and movement, respectively–while the expression of microglia-specific genes increases in all brain regions.
The investigators next took a preliminary look at whether these changes in gene expression could relate to changes in brain cell populations. Based on a comparison of tissue samples from 3 young and 3 old brains, they found that the number of oligodendrocytes decreases with age in the frontal cortex. They further established that this likely corresponds with decreased expression of oligodendrocyte specific genes. Other types of cells had more complicated patterns of change.
This graphic depicts the numbers and function of glia and neurons in the aging human brain.
This graphic depicts the numbers and function of glia and neurons in the aging human brain. image is credited to Lilach Soreq.
“We developed a very nice machine learning program and had to go through hundreds of thousands of oligodendrocytes and neurons to get reliable data, but we wanted to understand whether decreased expression causes changes at the molecular or cellular-level,” Ule says. “We did see oligodendrocytes disappearing but with neurons we didn’t see dramatic changes in cellular numbers except for a decrease in the largest neurons. This is of interest because those largest neurons are generally connected to neurodegenerative diseases.”
One unexpected finding was that certain glial gene expression patterns could predict age in the general population. While this can only be done postmortem, and certain people will not fit neatly into these patterns, it does provide scientists one more tool to understand how aging in the brain may be linked to the causes of age-related disorders. The researchers’ ultimate goal is to see whether gene mutations or other variables could affect gene expression in ways that cause disease.
About this neuroscience research article
Funding: This work was supported by the European Research Council; the Marie Curie Intra European Fellowship and Alzheimer’s Society for Junior Investigator award, the Francis Crick Institute, the UK Medical Research Council, the Wellcome Trust; the UK Medical Research Council; and the US National Institute on Aging, NIH.
Source: Joseph Caputo – Cell Press
Image Source: image is credited to Lilach Soreq.
Original Research: Full open access research for “Major Shifts in Glial Regional Identity Are a Transcriptional Hallmark of Human Brain Aging” by Lilach Soreq, UK Brain Expression Consortium, North American Brain Expression Consortium, Jamie Rose, Eyal Soreq, John Hardy, Daniah Trabzuni, Mark R. Cookson, Colin Smith, Mina Ryten, Rickie Patani, and Jernej Ule in Cell Reports. Published online January 10 2017 doi:10.1016/j.celrep.2016.12.011
Cite This Article

Saturday, January 14, 2017

Stroke rehab services to become community-based

You are going to have to be a real bastard and insist that the goals are 100% recovery for every survivor. They are going to scream that it is not possible. FUCK THEM.  That is the goal of every survivor, not the dumbed down goals that your doctor and therapist suggest, Running, not walking, going back to the same job in three months vs. not getting back to work ever, fully talking, not struggling for words. Yes these are BHAGs(Big Hairy Audacious Goals) but they are doable if you set out to solve them.
Inpatient stroke rehabilitation services at Nottingham University Hospitals (NUH) NHS Trust are to be replaced with community-based provision.
Nottinghamshire Healthcare NHS Foundation Trust, which delivers mental health, learning disability and physical health services, will take over the delivery of the £1.5m contract from April 1.
The trust was awarded the contract, which is due to end on March 31, 2021, by Nottingham's three clinical commissioning groups (CCG) – North and East, West and Rushcliffe.
The change means that patients will be rehabilitated in the community after spending time on the acute stroke unit at City Hospital.
A spokeswoman for Nottinghamshire Healthcare said work to develop the service is already underway, and that the trust will work closely with NUH and Nottingham CityCare.
She said: "We will be offering a therapy led multi-disciplinary team approach to providing stroke rehabilitation in a patient's home focused around the achievement of agreed rehabilitation goals. (100% recovery, nothing less)

"We are integrating the early supported discharge and the community rehabilitation elements of the care pathway and aim to improve integration with the acute unit. We will be working with an in-reach clinician supporting joint decision making on discharge and rehabilitation planning.
"Following stroke we will be providing stoke reviews for all patients – an element of the pathway not currently commissioned and provided for county patients who have had a stroke."
The decision to close the inpatient service has caused concern among Nottingham's MPs.
Graham Allen, who represents Nottingham North, Lilian Greenwood, for Nottingham South, and Chris Leslie, who represents Nottingham East, have written a letter to Health Secretary Jeremy Hunt to express their frustration at the decision.
The letter states: "We are worried that pushing stroke patients back into the community and closing specialist stroke beds will mean many who are not fit to leave hospital will be left in hospital, but without a specialist stroke ward for them to stay in."


Survey on plans to close Bideford stroke unit and move everything to Barnstaple

What are their plans on getting better results? Who gives a fuck about delivering high quality care you idiots? Survivors want high quality RESULTS. YOU have to speak up or nothing useful will get done. I would ignore the survey and email Nellie Guttmann at directly
Northern Devon Healthcare Trust appeals for views on proposals to merge North Devon’s stroke services at NDDH
A survey is underway on plans to close the stroke unit at Bideford Hospital and move everything to Barnstaple.
Northern Devon Healthcare NHS Trust has launched an online survey to find out what people think of the plans to merge stroke services at North Devon District Hospital (NDDH).
The survey finishes at the end of January, but the planned changes are nothing to do with the review of stroke services already taking place as part of the controversial sustainability and transformation plan (STP).
At present, patients are generally admitted to the Acute Stroke Unit at NDDH and then are either discharged home or transferred to Bideford Community Hospital for rehabilitation.
The trust says moving the Stroke Rehabilitation Unit to NDDH will mean care is more ‘joined-up’ for patients and will reduce any delays which currently take place when transferring their care to Bideford.
It says the move will also create a more effective stroke clinical team at NDDH by combining the expertise of the stroke teams and will ensure every patient receives the specialist care they need.
The trust has claimed stroke clinicians feel strongly this is the right thing to do to improve their ability to deliver high-quality care to stroke patients.
Information about what is being proposed is available on the Northern Devon Healthcare Trust website
You can complete the survey HERE.
Alternatively, if you have any particular comments, you can email Nellie Guttmann at or write to her at: North Devon District Hospital, Raleigh Park, Barnstaple, EX31 4JB.

Paired Stimuli Offers Rehabilitation Hope for Stroke Survivors

Sounds intriguing, paired is shocks to the arm plus loud clicks. Only 2.22 minute video. I can't even get close to opening my hand wide enough to grab a mug, letting go will never occur. You might be able to duplicate this with eStim and a metronome clicker. So send your doctor after the protocol. No need to wait for the clinical trial to finish.

Multiregional brain on a chip

Your doctor, IF ANY GOOD AT ALL, should be contacting these researchers to determine how this could be used to determine the connectivity problems you have post-stroke and what can be done to reconnect them properly.  But that will never occur so you will need to contact the researchers yourselves. 10 million survivors a year contacting them  might show how important this is to stroke recovery.  Or we could have a great stroke association do it once and distribute the information worldwide. ROFLMAO.
Harvard University researchers have developed a multiregional brain-on-a-chip that models the connectivity between three distinct regions of the brain. The in vitro model was used to extensively characterize the differences between neurons from different regions of the brain and to mimic the system’s connectivity.
The research was published in the Journal of Neurophysiology.
“The brain is so much more than individual neurons,” said Ben Maoz, co-first author of the paper and postdoctoral fellow in the Disease Biophysics Group in the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS). “It’s about the different types of cells and the connectivity between different regions of the brain. When modeling the brain, you need to be able to recapitulate that connectivity because there are many different diseases that attack those connections.”
“Roughly twenty-six percent of the US healthcare budget is spent on neurological and psychiatric disorders,” said Kit Parker, the Tarr Family Professor of Bioengineering and Applied Physics Building at SEAS and Core Faculty Member of the Wyss Institute for Biologically Inspired Engineering at Harvard University. “Tools to support the development of therapeutics to alleviate the suffering of these patients is not only the human thing to do, it is the best means of reducing this cost."
Researchers from the Disease Biophysics Group at SEAS and the Wyss Institute modeled three regions of the brain most affected by schizophrenia  — the amygdala, hippocampus and prefrontal cortex.
They began by characterizing the cell composition, protein expression, metabolism, and electrical activity of neurons from each region in vitro.
“It’s no surprise that neurons in distinct regions of the brain are different but it is surprising just how different they are,” said Stephanie Dauth, co-first author of the paper and former postdoctoral fellow in the Disease Biophysics Group. “We found that the cell-type ratio, the metabolism, the protein expression and the electrical activity all differ between regions in vitro. This shows that it does make a difference which brain region’s neurons you’re working with.”
Next, the team looked at how these neurons change when they’re communicating with one another. To do that, they cultured cells from each region independently and then let the cells establish connections via guided pathways embedded in the chip.
The researchers then measured cell composition and electrical activity again and found that the cells dramatically changed when they were in contact with neurons from different regions.
“When the cells are communicating with other regions, the cellular composition of the culture changes, the electrophysiology changes, all these inherent properties of the neurons change,” said Maoz. “This shows how important it is to implement different brain regions into in vitro models, especially when studying how neurological diseases impact connected regions of the brain.”
To demonstrate the chip’s efficacy in modeling disease, the team doped different regions of the brain with the drug Phencyclidine hydrochloride — commonly known as PCP — which simulates schizophrenia. The brain-on-a-chip allowed the researchers for the first time to look at both the drug’s impact on the individual regions as well as its downstream effect on the interconnected regions in vitro.
The brain-on-a-chip could be useful for studying any number of neurological and psychiatric diseases, including drug addiction, post traumatic stress disorder, and traumatic brain injury.(maybe stroke?)
"To date, the Connectome project has not recognized all of the networks in the brain,” said Parker. “In our studies, we are showing that the extracellular matrix network is an important part of distinguishing different brain regions and that, subsequently, physiological and pathophysiological processes in these brain regions are unique. This advance will not only enable the development of therapeutics, but fundamental insights as to how we think, feel, and survive."
This research was coauthored by Sean P. Sheehy, Matthew A. Hemphill, Tara Murty, Mary Kate Macedonia, Angie M. Greer and Bogdan Budnik. It was supported by the Wyss Institute for Biologically Inspired Engineering at Harvard University and the Defense Advanced Research Projects Agency.

Attached files

  • New model mimics the connectivity of the brain by connecting three distinct brain regions on a chip (Image courtesy of the Disease Biophysics Group/Harvard University)

Associations between both lignan and yogurt consumption and cardiovascular risk parameters in an elderly population: Observations from a Cross-Sectional Approach in the PREDIMED Study

So ask your doctor if this is useful for stroke prevention AND recovery. Then ask specifically what those diets consist of. Not this general crap of high consumption. Types and how much, a diet protocol. Has your doctor done nothing with these 6 research articles on yogurt back to June 2013?
Journal of the Academy of Nutrition and Dietetics, 01/06/2017
Creus–Cuadros A, et al. – This research was done in order to assess a possible relationship between yogurt and lignans using biomarkers of cardiovascular disease risk in an elderly population. The results of this study showed that high lignan and yogurt consumption is correlated with a better cardiovascular risk parameters profile in an elderly Mediterranean population.


  • The researchers directed a cross-sectional analysis of the relationship between baseline dietary information and cardiovascular risk parameters using food frequency questionnaires.
  • They enlisted 7,169 Spanish participants of the PREDIMED (Prevención con Dieta Mediterránea) study (elderly men and women at high cardiovascular risk) from June 2003 to June 2009.
  • After that, cardiovascular risk parameters, including cholesterol, triglycerides, glucose, body mass index, weight, waist circumference, and blood pressure were measured.
  • Finally, general linear models were utilized to evaluate the relationship between categorical variables (yogurt, total dairy intake, lignans, and yogurt plus lignans) and cardiovascular risk parameters.


  • The results of this study showed that the consumption of either yogurt or lignans appears to beneficially effects on human health, but the consumption of both demonstrated greater improvement in some cardiovascular health parameters.
  • It was observed in the findings that participants with a higher consumption of both yogurt and lignans indicated lower total cholesterol (estimated β-coefficients=-6.18; P=0.001) and low-density lipoprotein cholesterol levels (β=-4.92; P=0.005).
  • Findings also revealed that participants with lower yogurt and lignan consumption had a higher body mass index (β=0.28; P=0.007) and weight (β=1.20; P=0.008).
Go to PubMed Go to Abstract Print Article Summary Cat 2 CME Report

Comparison between Mediterranean and Vegetarian diets for cardiovascular prevention: The cardiveg study

So ask your doctor which one is better for stroke prevention AND recovery. Then ask specifically what those diets consist of. Not this general crap of vegetables and olive oil. Types and how much, a diet protocol.

Nutrition, Metabolism & Cardiovascular Diseases, 01/09/2017
Pagliai G, et al. – The present study sought to compare the impacts of Mediterranean and Vegetarian diets on several anthropometric and circulating cardiovascular biomarkers. Results of this study suggested that both Mediterranean and Vegetarian dietary patterns appear to be equally effective in diminishing anthropometric parameters among clinically healthy subjects, but Vegetarian diet determined a significant reduction of total cholesterol, LDL cholesterol and insulin levels, while Mediterranean diet determined a significant reduction of triglycerides.


  • For the purpose of this study, 88 clinically healthy subjects (68 F; 20 M; mean age: 50.7 ± 12.9) were randomly allocated to Mediterranean (Med) or Vegetarian (Veg) isocaloric diets lasting 3 months each, and then crossed over.
  • After that, adherence to the specific dietary intervention was established through questionnaires and 24–h dietary recall.
  • Finally, anthropometric measurements, body composition and blood sampling were obtained from each member toward the start and toward the finish of each intervention phase.


  • At the end of the 3–months intervention phase, Med and Veg both determined a significant (p<0.05) decrease of total body weight, fat mass and BMI, without any significant difference between the 2 diets [body weight: –2.0 kg (–2.5%) vs. –2.4 kg (–3.0%)], [fat mass: –1.8 kg (–6.1%) vs. –1.6 kg (–5.6%)] [BMI: –0.7 kg/m2 (–2.4%) vs. –0.8 kg/m2 (–2.8%)], for Med and Veg, respectively.
  • With regard to circulating biomarkers, Veg determined a significant (p<0.05) diminish for total cholesterol [–6.0 mg/dL (–2.9%)], LDL cholesterol [–6.5 mg/dl (–5.1%)] and insulin levels [–0.7 mU/L (–6.9%)], while Med determined a significant decrease of triglycerides [–11 mg/dL (–8.9%)].
Go to Abstract Print Article Summary Cat 2 CME Report

If you want to live longer, take good care of your telomeres

For all the things that your doctor isn't  doing to get you to 100% recovery I bet you are getting nothing on how to age better and longer. On your own again.
A couple paragraphs from there;
Pay attention to this story as if your life depended on it.
That’s because thinking about things other than the task at hand can seriously up your anxiety level. Not to stress you out or anything, but that might make you age faster, get sick and die, according to “The Telomere Effect: A Revolutionary Approach to Living Younger, Healthier, Longer,” a book from molecular biologist Elizabeth Blackburn and health psychologist Elissa Epel.
Blackburn (and two colleagues) won the Nobel Prize in 2009 for the discovery of telomerase, the enzyme that replenishes the bits of DNA on either end of your chromosomes. Those bits are called telomeres, and they’re often compared to the plastic caps on shoelaces.
It’s a strategy based on the book’s promising premise: Even if you’re a total stress case, it’s possible to reverse the negative effects by transforming how you respond to situations.
The key, the authors explain, is to develop a “challenge” response. Basically, instead of crumbling under the pressure of responsibilities or events, you should have a “bring it on!” mentality. It also helps to banish negativity, practice self-compassion and not be an idiot about your health. (I.e., get enough sleep and physical activity, cut out processed foods and smoking.)

I looked at stroke recovery as a challenge not as 'woe is me'.

The neuroprotective compound P7C3-A20 promotes neurogenesis and improves cognitive function after ischemic stroke

How many decades will it take before followup studies are done in humans? I'm guessing never because we have fucking failures of stroke associations and NO stroke strategy or stroke leadership. Or you just could hire your own researchers to test this out.
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The neuroprotective compound P7C3-A20 was proposed as a therapeutic for stroke.
P7C3-A20 reduced sensorimotor and cognitive deficits that occur after stroke.
P7C3-A20 significantly increased neurogenesis in both neurogenic niches.
P7C3-A20 significantly reduced both hippocampal and cortical atrophy which was strongly correlated to tissue sparing.
P7C3-A20 treatment enhanced flux of nicotinamide adenine dinucleotide.


Ischemic stroke is a devastating condition with few therapeutic interventions available. The neuroprotective compound P7C3-A20 inhibits mature neuronal cell death while also increasing the net magnitude of postnatal neurogenesis in models of neurodegeneration and acute injury. P7C3 compounds enhance flux of nicotinamide adenine dinucleotide (NAD) in mammalian cells, a proposed therapeutic approach to treating cerebral ischemia. The effectiveness of P7C3-A20 treatment on chronic histopathological and behavioral outcomes and neurogenesis after ischemic stroke has not previously been established. Here, a transient middle cerebral artery occlusion in rats was followed by twice daily injection of P7C3-A20 or vehicle for 7 days. P7C3-A20-treated rats performed significantly better than vehicle-treated controls in sensorimotor cylinder and grid-walk tasks, and in a chronic test of spatial learning and memory. These behavioral improvements with P7C3-A20 treatment were correlated with significantly decreased cortical and hippocampal atrophy, and associated with increased neurogenesis in the subventricular zone and hippocampal dentate gyrus subgranular zone. Furthermore, cerebral ischemia significantly reduced NAD in the cortex but P7C3-A20 treatment restored NAD to sham levels. Thus, P7C3-A20 treatment mitigates neurodegeneration and augments repair in the brain after focal ischemia, which translates into chronic behavioral improvement. This suggests a new therapeutic approach of using P7C3 compounds to safely augment NAD and thereby promote two independent processes critical to protecting the brain from ischemic stroke: mature neuron survival and postnatal hippocampal neurogenesis throughout the post-ischemic brain.


  • Aminopropyl carbazole;
  • Ischemic stroke;
  • Neuroprotection;
  • Neurogenesis;
  • P7C3-A20;
  • NAD

Correspondence to: Andrew A. Pieper, Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Ave, PBDB 1318, Iowa City, IA 52242, United States.

Correspondence to: W. Dalton Dietrich, Department of Neurological Surgery, University of Miami Leonard M. Miller School of Medicine, 1095 NW 14th Terrace, Suite 2-30, Miami, FL 33136-1060, United States.