Brynjar Fure - Academia.edu (original) (raw)

Papers by Brynjar Fure

Additional file 1 : Table 3. Clinical characteristics, imaging features and CSF Aβ-42 of patients... more Additional file 1 : Table 3. Clinical characteristics, imaging features and CSF Aβ-42 of patients with PET examination

Frontiers in Neurology, 2021

Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of va... more Introduction: Post-stroke cognitive impairment (PSCI) is common, but evidence on the impact of vascular risk factors is lacking. We explored the association between pre-stroke vascular risk factors and PSCI and studied the course of PSCI.Materials and Methods: Vascular risk factors were collected at baseline in stroke survivors (n = 635). Cognitive assessments of attention, executive function, memory, language, and the Montreal Cognitive Assessment (MoCA) were performed at 3 and/or 18 months post-stroke. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS). PSCI was measured with global z; MoCA z-score; and z-score of the four assessed cognitive domains. Mixed-effect linear regression was applied with global z, MoCA z-score, and z-scores of the cognitive domains as dependent variables. Independent variables were the vascular risk factors (hypertension, hypercholesterolemia, smoking, diabetes mellitus, atrial fibrillation, coronary heart disease, p...

A high prevalence of malnutrition has been reported both in nursing homes and in hospitals, and p... more A high prevalence of malnutrition has been reported both in nursing homes and in hospitals, and people living in long-term care facilities and suffering from chronic diseases are at risk of developing malnutrition. In Scandinavia, the self-reported knowledge regarding management of insufficient nutritional practice is low. The use of systematic nutritional screening in hospitals in Norway is only 16%, and malnutrition is both underdiagnosed and undertreated. In 2009, the Norwegian Directorate of Health presented guidelines for prevention and treatment of malnutrition. The conclusion is that assessment of nutritional status is a necessary part of the consultation and treatment of geriatric patients, and that all geriatric inpatients should be screened for nutritional risk on admission and then weekly. In nursing homes, risk should be evaluated at admission and then every month, and for persons living at home, just ''regularly''. New standards have improved the practic...

BMC Neurology, 2021

Background Stroke survivors are known to have poorer health-related quality of life (HRQoL) than ... more Background Stroke survivors are known to have poorer health-related quality of life (HRQoL) than the general population, but less is known about characteristics associated with HRQoL decreasing through time following a stroke. This study aims to examine how in-hospital frailty is related to HRQoL from 3 to 18 months post stroke. Method Six hundred twenty-five participants hospitalised with stroke were included and followed up at 3 and/or 18 months post stroke. Stroke severity was assessed the day after admission with the National Institutes of Health Stroke Scale (NIHSS). A modified Fried phenotype was used to assess in-hospital frailty; measures of exhaustion, physical activity, and weight loss were based on pre-stroke status, while gait speed and grip strength were measured during hospital stay. HRQoL at 3- and 18-months follow-up were assessed using the five-level version of the EuroQol five-dimensional descriptive system (EQ-5D-5L) and the EuroQol visual analogue scale (EQ-5D VA...

Journal of Stroke and Cerebrovascular Diseases, 2021

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

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2020

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

Background: Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after... more Background: Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol (18F-Flut) positron emission tomography (PET), is common in 7-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18F-Flut-PET uptake after seven years correlates with amyloid-β peptide (Aβ₄₂) levels in cerebrospinal fluid (CSF) at one year, and with measures of neurodegeneration and cognition at seven years post-stroke. Methods: 208 patients with first-ever stroke or TIA without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or none. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At seven years, patien...

Journal of neuroimaging : official journal of the American Society of Neuroimaging, Jan 22, 2016

Pulsatility index (PI) of the middle cerebral artery is postulated to reflect the vascular resist... more Pulsatility index (PI) of the middle cerebral artery is postulated to reflect the vascular resistance in the artery distal of the probe, and has been reported to increase in small vessel disease, diabetes mellitus, ageing, and dementia. Lacunar infarcts are considered to be related to cognitive impairment. We therefore conducted a study to assess the association between cognitive impairment and PI in patients with a lacunar infarct. Consecutive patients presenting with an acute lacunar syndrome who were admitted to the stroke unit were enrolled. The patients were examined with Doppler ultrasonography of the intracranial arteries, and the PI of the middle cerebral artery was recorded. Cognitive function was evaluated by mini-mental state examination (MMSE), clock drawing test, and trail making test (TMT) A and B. Among the 113 patients included, 85 patients had an acute lacunar infarct and 28 had one or more nonlacunar infarcts. The mean PI was 1.46 (SD = .33). PI was significantly (...

European Geriatric Medicine, 2015

most important, followed by the disease severity, and discussion with health care professionals. ... more most important, followed by the disease severity, and discussion with health care professionals. However, despite incurable diseases and terminal conditions, 12(40.0%) patients would follow the advice by doctors, 9(30%) wished to go home, and 5(16.7%) agreed hospice care. ADs would be considered if life expectancy is less than 3 months in 16(53.3%) patients, 4 to 12 months in 6(20%), but 7(23.3%) would never consider ADs. Patients who were married, high school educated, and their spouse as the main caregiver had higher awareness of ADs. Attitude was positive among patients with APACHE II scores ≥16 and spouse as the main caregiver. Conclusion: Discussion and advice of medical professionals played an important role in decision of ADs. Education to medical professionals and patients might be of help.

Dementia and geriatric cognitive disorders extra, 2012

Post-stroke cognitive impairment and dementia may be caused by pure vascular, pure degenerative o... more Post-stroke cognitive impairment and dementia may be caused by pure vascular, pure degenerative or mixed disease. The relation between post-stroke cognitive impairment and the combination of vascular pathology and degenerative changes is less evaluated. We aimed to evaluate the associations between white matter lesions (WMLs) and patient performance 1 year after stroke on tests of executive functioning, memory and visuospatial function, adjusted for the effects of lifestyle and disease-related factors, including medial temporal lobe atrophy (MTLA).

Tidsskrift for Den norske legeforening, 2011

International Journal of Technology Assessment in Health Care

INTRODUCTION:Multiple Sclerosis (MS) is an inflammatory neurological disease. The standard treatm... more INTRODUCTION:Multiple Sclerosis (MS) is an inflammatory neurological disease. The standard treatment is disease modifying drugs which may alleviate symptoms and slow the progress of disability, but not lead to remission. Autologous Hematopoetic Stem Cell Transplantation (AHSCT) is a new technology for treatment of MS in Norway. Disease remission in some patients treated with AHSCT has been postulated, in particular in patients in the early course of disease with high disease activity classified as having Relapsing-remitting multiple sclerosis (RRMS), but severe complications have also been reported.METHODS:We conducted a systematic literature search. No restrictions were set in terms of study design, although case series should include at least ten patients with a majority having RRMS. We performed a cost analysis from a healthcare perspective with a time frame of one year.RESULTS:One randomized controlled trial (RCT) (n = 21, RRMS = 7), one registry study (n = 345), and seven case ...

Journal of Stroke and Cerebrovascular Diseases

Topics in Stroke Rehabilitation

Background Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after ... more Background Cognitive impairment (CI) with mixed vascular and neurodegenerative pathologies after stroke is common. The role of amyloid pathology in post-stroke CI is unclear. We hypothesize that amyloid deposition, measured with Flutemetamol ( 18 F-Flut) positron emission tomography (PET), is common in 7-year stroke survivors diagnosed with CI and, further, that quantitatively assessed 18 F-Flut-PET uptake after seven years correlates with amyloid-β peptide (Aβ 42 ) levels in cerebrospinal fluid (CSF) at one year, and with measures of neurodegeneration and cognition at seven years post-stroke. Methods 208 patients with first-ever stroke or TIA without pre-existing CI were included during 2007 and 2008. At one- and seven-years post-stroke, cognitive status was assessed, and categorized into dementia, mild cognitive impairment or none. Etiologic sub-classification was based on magnetic resonance imaging (MRI) findings, CSF biomarkers and clinical cognitive profile. At seven years, pat...

Physical Therapy

Background Two-thirds of patients with stroke experience only mild impairments in the acute phase... more Background Two-thirds of patients with stroke experience only mild impairments in the acute phase, and the proportion of patients < 70 years is increasing. Knowledge about balance and gait and predictive factors are scarce for this group. Objective The objective of this study was to explore balance and gait in the acute phase and after 3 and 12 months in patients ≤70 years with minor ischemic stroke (National Institute of Health Stroke Scale (NIHSS) score ≤3). This study also explored factors predicting impaired balance after 12 months. Design This study was designed as an explorative longitudinal cohort study. Methods Patients were recruited consecutively from two stroke units. Balance and gait were assessed with the Mini-BESTest, Timed Up and Go (TUG), and preferred gait speed. Predictors for impaired balance were explored using logistic regression. Results This study included 101 patients. Mean (SD) age was 55.5 (11.4) years, 20% were female and mean (SD) NIHSS score was 0.6 (...

Dementia and Geriatric Cognitive Disorders

Tidsskrift for Den norske legeforening

Brynjar Fure er ph.d. og spesialist i geriatri, i nevrologi og i indremedisin. Han arbeider som o... more Brynjar Fure er ph.d. og spesialist i geriatri, i nevrologi og i indremedisin. Han arbeider som overlege i geriatri og nevrologi ved Centralsjukhuset i Karlstad. Forfatter har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.

Vascular Health and Risk Management

Background: Stroke and coronary heart disease share the same risk factors, and a multifactorial i... more Background: Stroke and coronary heart disease share the same risk factors, and a multifactorial intervention after stroke may potentially result in the same reduction in cardiovascular mortality as seen after coronary events. We aimed to evaluate the effect on survival 7 years after a 1-year multifactorial risk factor intervention, and identify clinical predictors for long-term survival in a hospital-based cohort of patients with first-ever stroke or transient ischemic attack (TIA). Materials and methods: We performed a secondary analysis of a randomized controlled trial including patients between February 2007 and July 2008 comparing an intensive risk factor intervention vs usual care the first year poststroke to prevent cognitive impairment. From February 2014 to July 2016, all patients were invited to a follow-up. For patients dying throughout the follow-up period, date of death was obtained from the medical record. Examination at baseline and 1-year follow-up included extensive assessment of vascular risk factors and cognitive assessments. Results: A total of 195 patients were randomized. Mean (SD) age was 71.6 (12.5) years, 53.3% were male, mean (SD) body mass index (BMI) was 25.6 (4.1) kg/m². During follow-up, 35 patients in the intervention group and 41 in the control group died. Kaplan-Meier survival estimates show no significant difference in intention-to-treat (ITT) population or complete case (CC) population (log-rank P=0.29 vs log-rank P=0.07). In multivariable Cox proportional hazards regression analyses, lower age and higher BMI was independently associated with longterm survival, adjusted HR (95% CI) 1.08 (1.05-1.11) per year and 0.91 (0.85-0.97) per kg/m². Conclusion: In this post hoc analysis, we found no significant effect on survival after 7 years of a multifactorial risk factor program given during the first year after first-ever stroke or TIA. Higher BMI was an independent predictor for long-term survival in this cohort.