Abstracs Neuroepidemiology 2021

01
SURVIVAL, FUNCTIONAL STATUS AND RECURRENCE THREE YEARS AFTER FIRST-EVER STROKE IN
SOUTHERN SWEDEN
Joseph Aked1; Hossein Delavaran1; Fredrik Wennerström2; Madeleine Jensen1; Arne Lindgren1
Lund university, Sweden; 2Skåne University Hospital, Lund. Sweden

1
Objectives: To assess mortality, functional status, and recurrence three years after stroke.
Methods: A population-based cohort of 400 individuals in Lund, Sweden, with first-ever stroke
between March 2015 and February 2016 was followed up three-four years after stroke onset. Survival
status was assessed via the Swedish Population Register. Follow-ups were performed by physical visit
or telephone to assess functional outcome and independence in activities in daily living (ADL) using
modified Rankin Scale (mRS) and Barthel Index (BI), respectively. Medical records were surveyed for
cases of recurrent stroke. Index and recurrent ischemic strokes were classified regarding pathological
mechanism using the Causative Classification System for Ischemic Stroke (CCS). Severity of stroke
symptoms at index, recurrence and follow-up was assessed using the National Institutes of Health
Stroke Scale (NIHSS). Comorbidities were assessed with Charlson Comorbidity Index (CCI).
Results: Among 400 first-ever stroke patients (335 ischemic stroke; 60 intracerebral hemorrhage; 5
undetermined stroke), 265 (66%) were alive three years post-stroke. Age (HR: 1.08; p<0.001), CCI at
baseline (HR 1.36; p<0.001) and NIHSS at baseline (HR: 1.11; p<0,001) were major predictors of three-
year mortality. Fifty-four surviving individuals were not possible to reach at the three-year follow-up.
At follow-up, 146 of 346 (42%) assessable individuals had a favourable outcome (mRS 0-2). The total
three-year stroke recurrence rate was 9% (35/400), and 9% (29/335) among those with ischemic
stroke at baseline. Ischemic stroke with undetermined pathogenetic mechanism had the highest
three-year recurrence rate (12%), followed by cardio-aortic embolism (8%).
Conclusions: In our Swedish population-based cohort, two thirds were alive at 3 years after first-ever
stroke, and four of ten had no-slight disability. Risk of death after stroke remains an important
consideration after stroke in high-income countries. Further analysis of this cohort is planned to
determine predictors for unfavourable outcome and other long-term consequences.
Neuroepidemiology 2021;55(suppl 1):1-106

02
POST-STROKE COGNITIVE IMPAIRMENT AND DEMENTIA
Rufus Akinyemi
University of Ibadan, Nigeria
More than half of stroke survivors experience post-stroke cognitive impairment and dementia (PSCID)
with cognitive impairment no dementia in two-thirds of cases and post-stroke dementia in one-third
of cases. Various tools are available to screen and assess cognition: for brief screening (e.g., Montreal
Cognitive Assessment) or diagnostic evaluation (e.g., NINDS VCI battery). Risk factors for PSCID are
multifactorial including older age, family history, genetic variants, low educational status, vascular
multi-morbidities, prior transient ischaemic attack, recurrent stroke and depressive illness.
Neuroimaging determinants of PSCID comprise silent brain infarcts, white matter changes, lacunar
infarcts, medial temporal lobe atrophy and global brain atrophy. Quantitative imaging of cerebral
blood flow and metabolism by positron emission tomography can differentiate between vascular
dementia and degenerative dementia and show the interaction between vascular and metabolic
changes. Microvascular changes including white matter lesions (WMLs), microinfarcts, cerebral
microbleeds (CMBs), blood-brain barrier damage, focal neuronal atrophy and low burden of co-
existing neurodegenerative pathology are key pathological substrates of PSCID. Biomarkers in the
cerebrospinal fluid and in the serum including inflammatory mediators and peripheral microRNAs
have been implicated. Treatment strategies to inhibit the development and mitigate the course of
PSCID include lowering of blood pressure, statins, neuroprotective drugs, and anti-inflammatory
agents while lifestyle interventions, physical activity, and cognitive training have been also tested, but
large controlled trials are needed.

03
INCIDENCE OF STROKE IN ARGENTINA - INITIAL DATA FROM A POPULATION-BASED

EPIDEMIOLOGICAL STUDY (EstePA)
Matias Alet1; Virginia Pujol-Lereis1; Daiana Dossi1; Guillermo Povedano1; Julieta Rosales1; Federico
Rodríguez-Lucci1; María Soledad Rodríguez-Pérez1; Mario Melcon2; Sebastian Ameriso1
Fleni, Buenos Aires, Argentina; 2FINEP, Junín, Argentina

1
Objectives: Stroke is one of the leading causes of mortality and disability worldwide. Latin America is
a region with diverse social, cultural and economic backgrounds. Regional data is essential to assess
the local impact of the disease and to plan rational adjudication of public health resources. Stroke
epidemiological information in Latin America is scarce. We determined two-year incidence of stroke
in a sample representative of the Argentinean population.
Methods: EstEPA is a population–based study to assess prevalence, incidence, mortality, and burden
of disease for stroke in the Department of General Villegas, province of Buenos Aires, Argentina
(population 30,864). The incidence study is being performed according to the methodology of WHO
STEPS stroke surveillance manual and will detect all first-ever strokes during a 5-year period (2017-
2022). Several sources of information are used, and all subjects are examined by vascular neurologists.
First-ever strokes include ischemic stroke, non-traumatic intracranial hemorrhage, subarachnoid
hemorrhage and stroke of undetermined type.
Results: During the first two years of the study, we identified 74 first-ever strokes. The average
incidence rate (cases per 100,000 population per year) was 120.0, slightly higher for women (120.8)
than for men (118.9) and increased with age for both sexes. The age-standardized incidence rate
adjusted for WHO´s World population was 86.6/100,000. Stroke incidence rates age/sex standardized
to the Argentinean population was 105.4/100,000.
Conclusion: Over the last several decades, stroke epidemiology has changed. In Argentina, first-ever
stroke incidence appears to be lower than previously reported in other Latin-American countries, and
similar to recent reports in our country and in Western countries. These numbers are consistent with
substantial regional differences and indicate a progressive decline in the incidence of stroke over time.
A longer recruitment period will help to better define this important aspect of stroke epidemiology in
our region.

04
STROKE SUBTYPES IN CANCER PATIENTS
Farah Aleisa; Lama Alshaikh-Mubarak; Hanouf Samadani
KFSH-D, Dammam, Saudia Arabia
Background: In the literature, 30% of active cancer patients were diagnosed with a recurrent
thromboembolic event by 3 months, including 13% with recurrent ischemic stroke, which is nearly
threefold higher than typical recurrent stroke rates in non-cancer patients.
Objectives: Identifying ischemic stroke subtypes will help us to understand the underlying stroke
mechanism, cancer and its treatment increase stroke risks. However, several confounding vascular
risk factors contribute to stroke occurrence in cancer patients.
Methods: It is a single center retrospective study for patients who were admitted with ischemic stroke
at King Fahad Specialist Hospital at Dammam, Saudi Arabia, between January 2018 and April 2020.
Ischemic Stroke subtypes and risk factors in cancer patients were compared with non-cancer patients
who were admitted to the same hospital during the same time period.
Results: Compared with non-cancer ischemic stroke patients the incidence of the stroke risk factors
in cancer patients were statistically lower in Hypertension (P:0.012), Dyslipidemia (P:0.017), atrial
fibrillation (P:0.02), and the risk factors that were higher among cancer group: previous stroke (P:
0.012), and smoking (P: 0.02), Stroke etiology was based on TOAST classification and was classified to
small vessel disease, cardioembolic stroke, large vessel disease and embolic stroke of undetermined
source, the majority of cancer patients with stroke had embolic stroke of undetermined source (ESUS)
which constitute 50% of patients. In our study, the most predominant cancer type associated with
stroke was gastro-intestinal adenocarcinoma (30%).
Conclusion: Patients with cancer have a substantial risk of ischemic strokes, there are different
mechanisms for stroke associated with cancer, in addition to the contribution of vascular risk factors,
the majority of stroke in cancer has undetermined source of embolism, therefore the approach for
ischemic stroke management would be different to reduce the risk of thromboembolism.

05
PREDICTORS FOR STROKE RECOVERY
Margit Alt Murphy
Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
Early and accurate prediction of recovery is needed to assist treatment planning but also to inform
researcher in patient selection for clinical trials. A range of models to predict motor recovery have
been suggested, including short clinical assessments of muscle function to more complex models with
various neurophysiological and neuroimaging techniques.
This talk aims to provide a short overview of the recent advances made on prediction of upper limb
motor recovery. Potential challenges of different models to implementation in clinical research and
practice will be addressed.

06
STROKE AND DEMENTIA, LEADING CAUSES OF NEUROLOGICAL DISABILITY AND DEATH, POTENTIAL
FOR PREVENTION
Abolfazl Avan1; Vladimir Hachinski2
1
Department of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran; 2Department
of Clinical Neurological Sciences, Western University, London, ON, Canada
Objective: To realize the potentially preventable disability and deaths related to ischemic heart
disease, stroke and dementia, and their changes from 2010 to 2019.
Background: Stroke and dementia share a number of modifiable risk factors and are the leading cause
of disability and the second leading cause of death worldwide, after cardiovascular diseases.
Methods: We report the Global Burden of Disease study (GBD) 2019 estimations for disability-
adjusted life years (DALYs) and death numbers and rates per 100,000 population related to ischemic
heart diseases, stroke, and Alzheimer’s disease and other dementias in the world, as well as their risk
attributed DALYs and deaths and their changes between 2010 and 2019.
Results: In 2019, neurological disorders have remained globally the leading cause of DALYs (273.1
million) and second leading cause of deaths (9.4 million) after cardiovascular diseases (excluding
stroke). Stroke and dementia combined contributed to 87.2% (8.2 million) of neurological deaths and
61.7% (168.5 million) of neurological DALYs in 2019. From 2010 to 2019, the absolute number of
deaths and DALYs from ischemic heart disease, stroke, and dementias increased, while their age-
standardized rates decreased (ischemic heart disease: -9.7% and -9.8%, stroke: -14.7% and -13.7%,
and dementia: -1.2% and -0.3%, respectively). For stroke, 86.4% of DALYs and for dementias 32.8% of
DALYs are attributable to risk factors. Globally, hypertension (54.8%) and unhealthy diet (30.0%) pose
the greatest risk for stroke DALYs, and smoking (15.1%) and obesity (12.5%) for dementia DALYs.
Conclusions: Stroke and dementia are increasing in numbers but show decreasing age-standardized
mortality and disability rates. They account for 62% DALYs and 87% deaths due to neurological
diseases, pose risks for each other, offering the possibility of their joint delay, mitigation or prevention.
It will require global, population, and individual management to flatten the curve of stroke and
dementia.

07
DEMENTIA PREVENTION INITIATIVE: THE NEED FOR A MORE COMPREHENSIVE APPROACH
M. Reza Azarpazhooh; Vladimir Hachinski, on behalf of the Dementia Prevention/Brain Health Group
Department of Clinical Neurological Sciences, Western University, London, ON, Canada
Background: The rising curve of dementia prevalence worldwide is threatening the sustainability of
health care systems, even in the richest countries. We need not only to intensify, but to diversify our
prevention efforts. Although the numbers of dementia cases are rising, some might be preventable
since the age-adjusted incidence is falling in some high-income countries. Current clinical high-risk
individual level approaches need to be complemented by a population level approach, where small
changes make a big difference.
Methods: Using multiple national administrative, hospital based, population-based studies in Canada,
our group proposes to:
1. Produce a unique Canada heat map (using geographic information system) of cognitive impairment,
dementia and identify high and low areas of dementia, stroke and heart disease incidence and
determine what accounts for the differences and what lessons can be learned and applied.
2. Identify known risk and protective factors and discover new ones through a combination of
standard, contextual and artificial intelligence analyses.
3. Develop customized cost-effective models of dementia prevention depending on what the most
relevant factors are for a particular jurisdiction.
Conclusion/ recommendations: Canada, a big small country, might be in a unique position of doing
so by the availability of multiple sources of data, a uniform health care system and a long tradition of
collaboration among investigators. We are planning to start this national dementia initiative in 2021.
A strong rationale and the knowledge exist for preventing vascular disease and decreasing the rates
of heart disease and stroke. However, our approach will be broader including all potential
contributions to dementia risk and protective factors known and to be discovered by our
comprehensive, complementary approaches. They might yield actionable population level prevention
solutions based on hitherto unexplored possibilities.
Dementia Prevention/Brain Health Group

PI Vladimir Hachinski; Co-PI Reza Azarpazhooh
Jason Gilliland, Western U Mark Daley, Western U

Saverio Stranges, Western U Shehzad Ali, Western U
Patrice Lindsay, HSFC Piotr Wilk, Western U
Ruthe Anne Conyngham, LHSC Kem Rogers, Western U
Moira Kapral, U of Toronto Kenneth Rockwood, Dalhousie U
Eric Smith, U of Calgary Naghmeh Mokhber, Western U
Matthew Meyer, LHSC Valery Feigin, Auckland U of Technology
Kathryn Nicholson, Western U Charles Alessi, Public Health England
W David Colby, Chatham Kent Robert Anderson, Ivey School of Business
Health Unit Janet Martin, Western U
Sandy Steinwender, Western U Serge Gauthier, McGill U
Nadia Khan, Hypertension Canada

08
LOW VERSUS STANDARD DOSE OF INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE IN ISCHEMIC

STROKE PATIENTS OLDER THAN 80 YEARS OLD: AN OBSERVATIONAL STUDY
Laura Baptiste1; Stéphane Olindo2; Igor Sibon2; Yannick Béjot1
CHU Dijon Bourgogne, Dijon, France; 2CHU Bordeaux, Bordeaux, France

1
Objectives: This observational study aimed to evaluate functional outcome at three months in elderly
ischemic stroke patients ≥ 80 years old treated with either standard-dose (0.9 mg/Kg) or reduced-dose
(0.6 mg/Kg) of intravenous thrombolysis with rt-PA.
Methods: We performed a retrospective analysis of data from two hospital-based registries
conducted in the University Hospitals of Dijon and Bordeaux, France, between January 2016 and
December 2018. These registries included patients aged ≥ 80 years old who were hospitalized for
acute ischemic stroke and who received intravenous thrombolysis with rt-PA (alteplase). Functional
outcome at three months was assessed using the modified Rankin scale score and was compared
between two groups (standard versus low dose of rt-PA) using ordinal logistic regression analysis. Rate
of symptomatic hemorrhagic transformation was also compared between the two groups.
Results: Of the 266 patients included in this analysis, 163 patients received a standard dose of rt-PA
and 103 patients received a reduced dose. No association between dose of rt-PA and functional
outcome at three months was observed [adjusted OR=1.26; 95% CI: 0.44-3.63, p=0.66 for comparison
low versus standard dose). No significant difference was noted with regard to rates of symptomatic
hemorrhagic transformation (14.6% in low dose group versus 19.3% in standard dose group, p=0.59).
Conclusions: This study suggested no differences in functional outcome at three months in elderly
ischemic stroke patients who received either standard or reduced dose of intravenous rt-PA. Further
studies are needed to determine the best early recanalization strategies in these patients, especially
those with comorbidities and frailty.

09
IMPACT OF COVID-19 ON NEUROLOGICAL DISORDERS
Ettore Beghi
Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
COVID-19, an infectious disease caused by the coronavirus SARS-CoV-2, is characterized by a complex

phenotype that includes, among others, neurological manifestations occurring during the acute phase
of the disease. These findings might be the result of a direct action of the virus on the nervous tissue
or an indirect action through the activation of immune-mediated and vascular mechanisms. An
increasing number of case reports have been published on a variety of neurological symptoms, signs
and diagnoses that indicate the involvement of the central and peripheral nervous system. Stroke,
ataxia, seizures, delirium, and depressed level of consciousness tend to prevail in severely affected
individuals. People with these severe complications are most likely aged with medical comorbidities.
These clinical conditions and other neurological disorders have been reported after other viral
outbreaks (Zika, H1N1, Ebola) and might reflect common complications of the viral action and even of
vaccines (swine flu, A/H1N1). These and other manifestations (e.g., fatigue, sleep disturbances,
memory problems) might be, however, the result of a specific action of SARS-CoV-2. While the
association of COVID-19 with specific neurological diseases (e.g., stroke) is still controversial, patients
with neurological comorbidities, or manifestations with onset during the acute phase of the infection,
tend to present a more severe disease, as documented by higher in-hospital mortality and the
presence of sequelae at hospital discharge. However, the quality of published contributions is at best
modest. Future studies should be undertaken in well-defined populations or in incident cohorts from
different clinical settings. Cohort or, at least, case-control designs should be favored using appropriate
controls. Precise case definitions are required using standardized diagnostic criteria and easily
collectable variables to be used in low-income countries.

10
IMPACT OF THE AGEING POPULATION ON THE CONTEMPORARY PROFILE OF STROKE PATIENTS:

LESSONS FROM POPULATION-BASED REGISTRIES
Yannick Béjot
Dijon Stroke Registry, EA7460, Department of Neurology, University Hospital of Dijon, University of
Burgundy, France
The high peak birth rate in the aftermath of the Second World War has been translating into a dramatic
ageing population in western countries. These demographic changes have had major consequences
in the stroke field as pointed out by population-based studies. Indeed, despite stable or decreasing
incidence rates in high-income countries, the global burden of stroke is on the rise with a massive
increase in the absolute number of stroke patients over time. In addition, improved acute
management of patients led to a reduction of case-fatality, with an increase in the number of stroke
survivors as a consequence. Currently, according to several European stroke registries, approximately
60% of patients suffering a stroke are > 75 years old and half are > 80 years old. Clinicians are directly
experiencing this demographic evolution that has resulted in major changes in the profile of patients
admitted to Stroke Units, with a need for better evaluating best acute stroke management and
secondary prevention strategies for the elderly. The expected increase in the number of stroke cases
by 2050 raises the issue of the sustainability of the capacity of dedicated beds in Stroke Units, and
both health policy makers and neurologists should consider urgent measures to address the current
and future needs for elderly stroke patients’ management.

11
BASICS OF BIOSTATISTICS
Derrick Bennett
University of Oxford, Oxford, United Kingdom
Medical statistics involves problem solving by a) obtaining sufficient background information to

formulate the problem [research question] carefully; b) collecting the necessary data in a valid way;
c) carrying out a preliminary examination of the data.
This talk will give a brief overview of how to design your study appropriately and how to analyse your
data in order to obtain reliable results that can answer the research question of interest. In order to
achieve these goals issues such as bias and chance will be discussed and ways to minimize the impact
of these factors will be briefly discussed.
By the end of this session of this session the participants should be able to appreciate that knowledge
of medical statistics can make it easier to justify study sample size. In addition, all collected data
(measurement) can be thought of as:
Measurement = “The Truth” + Bias + Random Error
Finally, by the end of the session participants will also have gained an appreciation that the knowledge
of statistics can also help to distinguish “the truth” from bias and random bias.

12
GUIDELINES FOR REPORTING NEUROEPIDEMIOLOGICAL STUDIES
Derrick Bennett
University of Oxford, Oxford, United Kingdom
Incidence and prevalence studies of neurological disorders play an important role in assessing the
burden of disease and planning services. However, the assessment of disease estimates is hindered
by problems in reporting for such studies. There are many reporting guidelines that relate to analytical
studies (e.g., STROBE) rather than descriptive epidemiological studies. Descriptive epidemiological
studies are particularly useful for estimating prevalence, incidence, morbidity and mortality time
trends for studies where global health is of concern.
There was a lack of user-friendly tools available for authors, editors and peer-reviewers to facilitate
best practice in reporting of descriptive epidemiological studies for neurological disorders. This talk
will discuss how the Standards of Reporting of Neurological Disorders (STROND) guideline was
developed and the rationale for the final items included. STROND) used evidence-based methods
endorsed by the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network, an
international initiative that seeks to improve the reliability and value of published health research
literature by promoting transparent and accurate reporting and wider use of robust reporting
guidelines.

13
UPDATES ON POST-STROKE REHABILITATION
Julie Bernhardt
Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
In this invited talk, Dr Bernhardt will provide a brief update on a number of areas of collaborative
action by researchers and clinicians that are aiming to build knowledge and people capacity in stroke
recovery and rehabilitation with the ultimate goal of improving patient outcomes after stroke. The
talk will focus on both national and international collaborative initiatives that are gaining momentum
and helping to drive progress in the field.

14
ACUTE TRIAGE OF PEDIATRIC STROKE IN EASTERN DENMARK
Julie Brix Bindslev1; Klaus Hansen2; Christina Engel Hoei-Hansen1; Thomas Truelsen2
Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;

1
Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

2
Objectives: Fast diagnosis of pediatric stroke is critical for improving access to hyperacute therapies.
In order to reduce diagnostic delay, a pediatric stroke pathway was implemented in Eastern Denmark
since 2017. Triage was done by vascular neurologists with experience from adult stroke patients
(VascN-adult). We describe our experience with acute triage of children with suspected stroke.
Methods: Prospective, consecutive registration of all pediatric patients with suspected stroke
symptoms from Jan 2020 through Dec 2020, Eastern Denmark (census 2.6 million). Consultation
requests to the VascN-adult were made from paramedics and clinicians in pediatric emergency
departments (PEDs). Patients triaged by the VascN-adult, were retrospectively followed-up for clinical
presentations, results of paraclinical examinations, and final diagnosis.
Results: Eighty-one patients with suspected stroke were registered; 32 (40 %) underwent acute stroke
evaluation. Stroke was the final diagnosis in 8 patients (10 %); 2 had transient ischemic attack (TIA), 4
acute ischemic stroke (AIS) and 2 hemorrhagic stroke (HS) (subarachnoid hemorrhage (SAH) or
intraparenchymal hemorrhage (IPH)). Patients with AIS, TIA and IPH, presented with focal neurological
signs, referable to a distinct vascular territory. Presentations included central facial palsy, hemiparesis
and aphasia. The patient with SAH presented with headache and impaired consciousness. No children
with AIS met criteria for intravenous thrombolysis or acute endovascular recanalization treatment:
two were < 2 years at presentation, one had minor-stroke (pedNIHSS < 4) and one had hypoperfusion-
induced stroke.
The most common stroke mimics were migraine (26%), seizures (10%), conversion disorders (7%) and
Bell’s palsy (5%).
Conclusion: Acute triage of suspected acute stroke by VascN-adult was feasible and suggested a
marked need for fast evaluation of children with suspected stroke symptoms.

15
ENHANCED EFFICACY OF ACUTE INTRA-ARTERIAL RECANALIZATION THERAPIES IN FEMALE STROKE

PATIENTS
Anna K. Bonkhoff1,2; André Karch2; Ralph Weber3; Jürgen Wellmann2; Klaus Berger2
1
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School,
Boston, USA; 2Institute of Epidemiology and Social Medicine, University of Muenster, Germany;
3
Department of Neurology, Alfried Krupp Hospital Essen, and Ruhr University Bochum, Germany
Objective: Stroke represents a major burden of disease for both men and women, yet clinically
meaningful sex differences exist in the causes, symptom presentation and management of acute
ischemic stroke (AIS). Recently, we showed that female AIS patients are more likely to undergo intra-
arterial recanalization therapy. Secondary evaluations of thrombectomy trials suggest more favorable
outcomes in women compared to men. Aim of this study was to investigate sex-specific effects of
intra-arterial therapies on the outcome at discharge in a large registry.
Methods: Data from the Stroke Registry of Northwestern Germany from 2015 to 2017 were used. We
stratified the entire sample into those patients that received intra-arterial treatment vs. those that
did not. Within these strata, we modeled favorable outcome at discharge (mRS<3) via logistic
regression and investigated sex differences via odds ratios (OR). Age, sex, admission-stroke severity,
onset-to-admission time, pre-stroke status, comorbidities, etiology, intravenous thrombolysis and
admission-year were integrated as input variables.
Results: A total of 13,229 patients contributed to the treatment group (mean age (SD): 72.1(13.0),
48.8% male, median NIHSS(IQR): 14(10), 29.1% favorable outcome), while 176,935 patients were in
the non-treatment group (mean age (SD): 72.5(13.0), 53.5% male, median NIHSS(IQR): 3(5), 66%
favorable outcome). Women in the treatment group experienced a more favorable outcome than men
(OR (95%-confidence interval): 1.228 (1.126-1.338). A similar sex-specific effect was still significant in
the non-treatment group, but substantially attenuated (OR: 1.031 (1.004-1.058)).
Conclusions: In our routine care stroke population, women experienced substantially more favorable
outcomes at discharge after acute intra-arterial therapy than men, indicating female-specific
favorable treatment effects. Future work is needed to examine whether these sex differences can also
be ascertained in the chronic phase.
Table 1. Odds ratios and 95%-confidence intervals for input variables in logistic regression models of favorable outcome at discharge.
Variable Odds ratios and 95%-confidence Odds ratios and 95%-confidence
intervals treatment group intervals non-treatment group
Age 0.978 (0.974-0.981) 0.981 (0.980-0.982)
Sex (reference: male patients) 1.228 (1.126-1.339) 1.031 (1.004-1.058)
NIHSS Scale upon admission 0.884 (0.878-0.890) 0.748 (0.745-0.750)
Intravenous thrombolysis 0.956 (0.874-1.045) 1.344 (1.291-1.399)
Onset-to-admission > 3h 0.701 (0.637-0.772) 0.810 (0.787-0.836)
Comorbidity: Diabetes 0.775 (0.698-0.860) 0.812 (0.791-0.835)
Comorbidity: Hypertension 0.823 (0.733-0.925) 0.859 (0.825-0.896)
Comorbidity: Atrial fibrillation 0.924 (0.813-1.051) 0.892 (0.857-0.928)
Comorbidity: Myocardial infarction 0.903 (0.786-1.039) 0.991 (0.950-1.033)
Comorbidity: Previous stroke 0.810 (0.720-0.911) 0.833 (0.810-0.857)
Comorbidity: Hypercholesterinaemia 1.34 (1.231-1.466) 1.029 (1.003-1.056)
Pre-stroke: Care at home 0.443 (0.365-0.538) 0.393 (0.378-0.408)
Pre-stroke: Care in institution 0.395 (0.285-0.453) 0.331 (0.361-0.347)
Stroke etiology: Atherothrombotic 1.049 (0.918-1.198) 0.871 (0.846-0.908)
Stroke etiology: Cardioembolic 1.495 (1.279-1.748) 0.991 (0.994-1.040)
Stroke etiology: Microangiopathic 2.716 (2.016-3.660) 1.325 (1.269-1.383)
Stroke etiology: Other determined cause 1.102 (0.880-1.378) 0.758 (0.704-0.816)
Stroke etiology: Competing cause 1.114 (0.846-1.466) 0.796 (0.743-0.852)
Year of admission 0.979 (0.928-1.033) 0.954 (0.940-0.969)

16
COGNITIVE POST-STROKE DISTURBANCES
Michael Brainin
Department of Clinical Neurosciences and Preventive Medicine Danube University Krems, Austria
Disorders of cognition following stroke occur between 7% in population-based studies of first-ever

stroke patients and 41% in hospital-based studies which includes recurrent strokes. Milder forms of
cognitive deterioration following stroke were found between 22% and 84% depending on definition,
testing, and time of investigation. Incidence rates are 2-3% increasing annually at linear rates. Probably
all stroke patients are at risk of suffering from cognitive deterioration, but some risk factors are more
important than others such as location of stroke, initial stroke severity, previous strokes, level of pre-
stroke cognition and presence of vascular risk factors. Genetic and inflammatory biomarkers are under
investigation, but observational data suggest that high levels of interleukins and C-reactive protein
have predictive value. Whereas an overlap with Alzheimer’s pathology is frequent, cognitive and brain
reserve can protect against cognitive deterioration and depends on education, leisure activities and
social interactions. Moreover, diagnosis of post-stroke cognitive deterioration (mild neurocognitive
disorder) varies according to test instruments used. Variations also result from speech disturbances,
emotional disorders such as depression. CT and MRI confirm the diagnosis and provide additional
information on location and size of infarct, previous infarcts, white matter lesions, microbleeds, and
brain atrophy.
Treatment is focused on the arterial lesions and prevention of stroke, whereas management focuses
on treatment of cognitive impairment. A number of new treatment approaches are being tested.
There is solid evidence that treatment of hypertension especially when started in mid-life effectively
prevents post-stroke cognitive deficits. Also, some evidence points to cognitive training and
modification of other modifiable risk factors. Life-style modifications have been shown to be beneficial
in preventing cognitive decline in persons at risk of dementia. While a general treatment
recommendation of cognitive decline following stroke (especially small vessel disease) is still lacking,
some ongoing exploratory drug trials and case series have shown promising effects in stroke patients.

17
THE EFFECTS OF THE POLYPILL IN PRIMARY STROKE PREVENTION
Michael Brainin; Yvonne Teuschl
Department of Clinical Neurosciences and Preventive Medicine Danube University Krems, Austria
Demographic changes and the increasing prevalence of modifiable risk factors (such as elevated blood
pressure, dyslipidemia, diabetes, overweight and unhealthy lifestyle behaviours) for stroke,
cardiovascular diseases and dementia imply the need for a cost-effective population-wide primary
prevention strategy. Fixed-dose combination medications offered as a single pill (polypills) have been
established for some chronic disease but not for primary stroke prevention. Cardiovascular polypills
include a statin, antihypertensives, and for secondary prevention, aspirin.
A systematic review of published studies shows that cardiovascular polypills are effective in reducing
blood pressure and cholesterol, and improve adherence compared to usual care. Hard endpoints and
long follow-up times were rare, and no randomized controlled trial tested stroke as primary endpoint.
However, the recent large Polyiran study found significant a reduction of first and recurrent strokes in
the polypill group compared to minimal care. Especially in low- and middle-income countries with a
high prevalence of risk factors even among people at young ages and a low affordability of medication,
cardiovascular polypills might be a cost-effective primary prevention strategy for stroke. Polypills
should be supplemented by lifestyle intervention and the implementation and distribution facilitated
by the involvement of community health workers. This approach has been adopted by the World
Stroke Organisation and was included in the cut-stroke in half strategy.

18
TEN YEARS OF THE AUSTRALIAN STROKE CLINICAL REGISTRY: HOW THE DATA HAVE BEEN USED TO
INFORM POLICY AND PRACTICE
Dominique Cadilhac1,2 on behalf of the Australian Stroke Clinical Registry consortium
1
School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; 2Stroke
Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Objectives: To describe the establishment and progress with the Australian Stroke Clinical Registry
(AuSCR) since it was established in 2009 using the recommended technical and operational standards
for Australia. The main purpose of AuSCR is to provide a standardized approach to monitoring stroke
care and outcomes, and provide the evidence needed for improvements to the quality of care in
hospital for people with stroke or transient ischaemic attack (TIA). A secondary objective is to facilitate
research.
Methods: Consecutive patients are included in the registry with a confirmed stroke or TIA (admissions
only) from participating hospitals. To reduce bias, an opt-out consent process is used and a waiver of
consent for people who die in hospital. At 90-180 days post admission, eligible registrants not known
to have died are posted a survey to determine their patient-reported outcomes. These registrants are
also asked whether they would like to be contacted for further research.
Results: Currently, 62 acute care public hospitals contribute data from various regions of Australia
with over 118,000 episodes of care recorded. Follow-up surveys have been completed on over 56,000
registrants (annual response rate between 65% to 71%), with survival status updated each year via
linkage with national death records. Our data linkage program has enabled enrichment of the
minimum dataset to provide greater detail before, during and after stroke, including survival status,
use of medications and readmissions to hospital. Over 10 cohort studies or clinical trials have been
facilitated through having access to our register of patients willing to be contacted for research
studies.
Conclusions: It takes several years to establish a registry and it requires a committed partnership
between clinicians, quality improvement scientists, epidemiologists and policy makers/funders.
Provision of data and benchmarked reports directly back to hospitals is essential including patient-
reported outcomes.

19
INCIDENCE AND PREVALENCE OF MOTOR FLUCTUATIONS AND DEEP BRAIN STIMULATION IN

PARKINSON’S DISEASE: COMPARISON BETWEEN TWO POPULATION-BASED COHORTS IN SOUTH
EAST MINNESOTA
Emanuele Camerucci; Cole Stang; Pierpaolo Turcano; Phillip Tipton; James Bower; Bryan Klassen;
Rodolfo Savica
Mayo Clinic, Rochester, United States
Objective: To assess the incidence and prevalence of motor fluctuations and deep brain stimulation
(DBS) implantation in two parkinsonism cohorts from south-east Minnesota.
Background: No previous studies have calculated incidence of motor fluctuations and DBS implants in
a population-based cohort of parkinsonism.
Methods: We used the Rochester Epidemiology Project (REP) to investigate a population-based cohort
of parkinsonism between 1991-2005 in Olmsted County, MN, and extended our search to the 6
surrounding counties using the expanded REP (eREP) to detect all incident cases of early-onset
parkinsonism (defined as diagnosed before 55 years of age) between 2010-2015. A movement
disorder specialist reviewed all medical records to confirm the diagnosis of Parkinson’s Disease (PD)
Results: In the 1991-2005 cohort, there were 312 PD. Among these, we found 51 (16%) patients with
motor fluctuations (incidence 2.60 cases per 100,000 person-years); DBS was implanted into 15 (29%)
of these (incidence 0.76 cases per 100,000 person-years). In the 2010-2015 cohort (<55 years), there
were 28 early-onset PD (EOPD). Of these, 14 (50%) had motor fluctuations (incidence 1.02 cases per
100,000 person-years) and 5 (36%, incidence 0.37 cases per 100,000 person-years) underwent DBS
implantation. Among the remaining 9 non-DBS EOPD patients with motor fluctuations, DBS was
discussed or planned in 7 (78%) of them but was yet to be performed.
Conclusion: Although motor fluctuations had a lower prevalence in the 1991-2005 cohort (not age
restricted), compared to the 2010-2015 cohort (age restricted to those <55 years), there was a higher
incidence. DBS was implanted in 29% of PD with motor fluctuations in the 1991-2005 cohort and in
36% of EOPD with motor fluctuations in the 2010-2015 cohort, with an incidence of, respectively, 0.76
and 0.37 cases per 100,000 person-years. The vast majority of EOPD with motor fluctuations had DBS
either performed or planned to be performed in the near future.

20
EARLY-ONSET PARKINSONISM AND EARLY-ONSET PARKINSON’S DISEASE: A POPULATION-BASED

STUDY (2010-2015)
Emanuele Camerucci; Cole Stang; Pierpaolo Turcano; Aidan Mullan; Peter Martin; Owen A. Ross; James
F. Bower; Michelle M. Mielke; Rodolfo Savica
Objective: To examine incidence and survival of Parkinson’s Disease (PD) and other parkinsonisms
occurring before 50 or 55 years of age.
Methods: We used a newly identified incident cohort of parkinsonism (<50 and <55 years) defined by
the expanded Rochester Epidemiology Project (eREP) medical records-linkage system between 2010-
15 in seven counties in Minnesota. A movement disorder specialist reviewed all charts to confirm the
diagnoses.
Results: We identified 27 patients with a diagnosis of incident parkinsonism in 2010-15 prior to 50
years of age: 11 (41%) early-onset PD (EOPD), 13 (48%) drug-induced parkinsonism (DIP), and 3 (11%)
other parkinsonism. When expanding to include those with a diagnosis before 55 years of age, we
found 69 incident cases of parkinsonism: 28 (41%) of both EOPD and DIP, and 13 (19%) of other
parkinsonism. Incidence of parkinsonism (<50) was 1.98/100,000 person-years, in EOPD (<50) it was
0.81/100,000; whereas in parkinsonism (<55) it was 5.05/100,000, and in EOPD (<55) was
2.05/100,000.
Levodopa-induced dyskinesia (LID) was reported in 45% of both EOPD (<50) and (<55) and occurred
after a median of 6.17 and 5.18 years after EOPD diagnosis, respectively. Onset of cardinal motor
symptoms was proximate to EOPD diagnosis, with the exception of impaired postural reflexes, which
followed EOPD (<50) by 4.33 years, and EOPD (<55) by 1.32 years.
In parkinsonism (<55), 9 (13%) were deceased at data collection day; all of them were men (1 only
EOPD). Men had greater risk of mortality compared to women (p= 0.049).
Conclusions: Incidence of both parkinsonism and EOPD was higher in men than women, regardless of
the cut-off age chosen. LID was reported 5-6 years after EOPD diagnosis in about 45% of the EOPD.
Men had a higher mortality compared to women, in parkinsonism (<55).

21
SEX DIFFERENCES IN DEEP BRAIN STIMULATION IMPLANTS, MANAGEMENT AND LEVODOPA

ADJUSTMENTS IN TWO POPULATION-BASED PARKINSONISM COHORTS IN MINNESOTA
Emanuele Camerucci; Cole Stang; Pierpaolo Turcano; Philip W. Tipton; James H. Bower; Bryan T.
Klassen; Michelle M. Mielke; Rodolfo Savica
Objective: To assess sex differences in deep brain stimulation (DBS) voltage, number of voltage
adjustments, Levodopa doses, and survival in two population-based incident cohorts of Parkinsonism.
Methods: We used the Rochester Epidemiology Project (REP) to explore a population-based
parkinsonism cohort between 1991-2005 in Olmsted County, MN. We extended to the 6 surrounding
counties between 2010-2015 using the expanded REP (eREP) to identify all incident cases of early-
onset parkinsonism (diagnosis before 55 years of age). A movement disorder specialist reviewed all
medical records to confirm the diagnoses of Parkinson’s disease (PD).
Results: We found 20 (15 in the first cohort and 5 in the second) PD patients that underwent DBS
implantation (12 men and 8 women). Median age at DBS implantation was 58.3 years (IQR: 54.7-63.1)
in men and 68.8 (IQR: 60.2-76.2) in women (p= 0.11). Median electrodes voltage was 2.91 V (IQR: 2.08-
3.05) in men and 2.15 V (IQR: 2.04-2.31) in women (p= 0.32), with a median number of adjustments
of 5 (IQR: 3.75-7.00) in men and 4.5 (IQR: 2.75-6.5) in women (p= 0.67).
Median daily dose of Levodopa was higher in men (1200 mg, IQR: 1050-1600) compared to women
(500 mg, IQR: 450-700), (p= 0.004).
Six (30%) were deceased at data collection. These included one man, who died at 66.4 years of age
(7.9 years after DBS implantation) and 5 women (median age of death was 81 years (IQR: 75.6-82.5),
4.3 years after DBS implantation, IQR 3.3-6.0).
Conclusion: Among the 20 DBS-PD cases, men underwent DBS implantation 10 years earlier than
women. Men also required higher electrode voltages, more voltage adjustments and higher Levodopa
doses (p= 0.004). These findings suggest that men may have a greater disease severity at the time of
DBS implantation.

22
DIET QUALITY OVER MIDDLE ADULTHOOD AND LATE-LIFE SUBJECTIVE COGNITIVE FUNCTION
AMONG U.S. WOMEN
Yaying Cao1; Changzheng Yuan1; Alberto Ascherio2; Olivia Okereke3; Geng Zong4; Francine Grodstein3;
Albert Hofman5; Walter Willett2
1
Department of Big Data in Health Science, School of Public Health, School of Medicine, Zhejiang
University, Hangzhou, China; 2Department of Nutrition, Harvard T.H. Chan School of Public Health,
Boston, United States; 3Channing Division of Network Medicine, Brigham and Women’s Hospital and
Harvard Medical School, Boston, United States; 4CAS Key Laboratory of Nutrition, Metabolism and
Food Safety, Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai,
China; 5Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, United States
** Yaying Cao & Changzheng Yuan have equal contribution to this article and serve as co-first authors.
Objectives: To examine the prospective associations of long-term adherence to three diet patterns as
Alternate Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and
Alternate Healthy Eating Index 2010 (AHEI-2010), with late-life subjective cognitive function (SCF) as
a validated indicator for early-stage cognitive dysfunction.
Methods: Among 49,493 female nurses averaged 48 years at baseline, we calculated the average diet
scores from seven repeated food frequency questionnaires collected in 1984, 1986, and every four
years afterward until 2006. Self-reported SCF was assessed in 2012 and 2014 by a 7-item questionnaire
on recent change in memory and cognition and was classified as “good” (0 points, 40.8%), “moderate”
(0.5-2.5 points, 46.9%), and “poor” (3-7 points, 12.3%).
Results: Comparing the extreme quintiles of AMED, DASH, and AHEI-2010 scores, the multivariate-
adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for moderate SCF were 0.81 (0.75, 0.87),
0.76 (0.71, 0.82), and 0.93 (0.87, 0.99), respectively. The corresponding ORs (95% CIs) for poor SCF
were 0.57 (0.51, 0.64), 0.61 (0.55, 0.68), and 0.81 (0.73, 0.90), respectively, which were equivalent to
approximately 5, 4, and 2 years younger in age, respectively. These associations were also seen for
diet indices evaluated 28 years before SCF assessment. Compared to participants with a low (in tertile)
diet quality in both remote and recent years, the best SCF was observed among those maintaining a
high diet quality over time, with a 40%, 32%, and 20% lower odds of poor SCF observed for AMED,
DASH, and AHEI-2010, respectively. Moreover, for each standard deviation higher in the change of
diet quality from remote to recent years, the reduced odds of poor SCF were 11% for AMED, 5% for
DASH, and 3% for AHEI-2010, respectively.
Conclusions: Our findings support the beneficial roles of long-term adherence to healthy diets in
maintaining cognitive function in women.

23
BARRIERS TO NEUROLOGICAL CARE: ADDRESSING THE NEEDS
William M Carroll
President, World Federation of Neurology; University of Western Australia, Perth, Australia
It is simplistic but true that the principal barrier to equality of access to neurological care is financial.
While there are a number of other important barriers, financial constraints figure significantly in the
magnitude of their effect. These include suboptimal resources to develop and maintain high level
public health, education and training at all levels of healthcare professionals, the quantity and quality
of these practitioners and their resourcing, which all can be summarised by the “Atlas gap” and the
WFN Needs Registry Survey. Access to medications is constrained by a number of mechanisms but it
is the prohibitively high cost of medications which is primarily responsible. There are also bureaucratic
barriers to what seems such a straightforward matter. As a consequence, a frustrating inertia seems
to permeate all levels of these issues.
It is hoped that the landmark WHA73.10 Resolution to develop a ten-year intersectoral Global Action
Plan for Epilepsy and Neurological Disorders will serve to focus the attention of a sufficiently
motivating force to overcome these barriers. If this can be achieved in one or more member state
jurisdictions and provide a successful template for others to engage these barriers, then there is
reason for optimism. Not that the crushing problem of inadequate finances faced by low
sociodemographic index countries can be reversed, but a shift in the approach and attitude towards
the redistribution of scarce resources may catalyse the process. This will likely require both a bottom
up and top-down strategy.

24
TRENDS IN CLINICAL FEATURES AND RISK FACTORS OF AMYOTROPHIC LATERAL SCLEROSIS: A 14-
YEAR COHORT STUDY IN CHINA
Lu Chen1; Lu Xu2; Shengfeng Wang2; Siyan Zhan2; Dongsheng Fan1
1
Department of Neurology, Peking University Third Hospital, Beijing, China; 2Department of
Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
Objectives: To determine the transition pattern of clinical presentation, risk factors and comorbidities
for ALS patients over the past 14 years by analyzing a large clinical-based cohort in mainland China.
Methods: Sporadic ALS patients were recruited at Peking University Third Hospital from January 2003
to December 2018. The 14 years were grouped into three periods to analyze changes in baseline
characteristics of participants for every half decade.
Results: 3 410 patients with sporadic ALS were recruited in this study, with 2 181 males and 1 229
females. There were 2 481 patients with spinal-onset ALS, 599 with bulbar-onset ALS, 240 with FAS,
66 with PMA and 24 with PLS. The proportion of bulbar-onset ALS increased from 13.0% in 2005-2009
to 19.5% in 2015-2018 (P<0.001). The mean (SD) age at onset increased from 49.5 (11.4) years in 2005-
2009 to 53.0 (11.0) years in 2015-2018 (P <0.001). ALS patients with diabetes or hypertension showed
a delay in ALS onset, and the delay was even more obvious when the patients had both two
comorbidities. The proportion of riluzole users climbed by approximately 2.5 times from 2005-2009
to 2015-2018 (P <0.001).
Conclusions: In recognition of the lack of clinical data on ALS in mainland China, our study represents
a large cohort of patients diagnosed over a 14-year period. The age at onset and the percentage of
patients who used riluzole were both observed to be increasing. Besides, our study confirmed that
several comorbidities, such as diabetes and hypertension, may result in a delayed age at onset of ALS.

25
PLASMA FOLATE LEVELS IN RELATION TO COGNITIVE FUNCTION: A COMMUNITY-BASED COHORT OF

OLDER ADULTS IN CHINA
Xiao Chen1; Jiaxi Yang2; Shiyu Yan1; Yuhui Huang1; Yaying Cao3; Geng Zong3; Yan Zheng4; Xiaofeng
Wang4; Changzheng Yuan1
1
Department of Big Data and Health Science, Zhejiang University School of Public Health, Hangzhou,
Zhejiang, China; 2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA,
USA; 3CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition
and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai,
China; 4Human Phenome Institute, National Clinical Research Center for Aging and Medicine, Huashan
Hospital, Fudan University, Shanghai, China
Background: The association between plasma folate concentration and age-related cognitive function
was inconsistent across studies. Limited studies have examined this relationship among Chinese older
adults.
Objective: To explore the prospective association of plasma folate level in 2017 with the risk of
developing cognitive impairment in 2019 in Rugao, China.
Methods: This study included 615 participants without baseline cognitive impairment (mean age: 79
years) from the Rugao Longevity and Ageing Study (RuLAS). We used logistic regression to examine
the prospective association between baseline plasma folate and development of cognitive dysfunction
in two years. Fasting blood samples and laboratory tests including plasma folate and homocysteine
(Hcy) were collected at baseline, and folate concentration was categorized into quintiles. Cognitive
impairment was defined using the Hasegawa Dementia Scale (HDS) ≤21.5 points.
Results: During 2-year follow-up, 20.7% of the participants was identified as cognitive impairment.
After controlling for age, gender, and plasma Hcy, highest plasma folate level was associated with
substantially lower odds of cognitive impairments (highest vs. lowest quintile of plasma folate
concentration: OR=0.41 [95 % CI: 0.19-0.89]). The association remained similar after further adjusting
for other demographic and lifestyle factors (OR = 0.42 [95% CI: 0.18-0.98]). A stronger association was
observed particularly among males (OR=0.11 [95% CI: 0.03-0.52]).
Conclusion: Our findings supported a potential beneficial association between plasma folate level and
cognitive function in older Chinese populations, particularly among males. More longitudinal studies
with larger sample size and longer follow-up are required for further confirmation.

26
NEUROPSYCHOLOGICAL REHABILITATION AFTER TRAUMATIC BRAIN INJURY IN LOW-RESOURCE

SETTINGS – A SINGLE BLIND RANDOMIZED STUDY
Sakshi Chopra
All India Institute of Medical Sciences (AIIMS), New Delhi, India
Objective: Traumatic Brain Injury (TBI) incapacitates nearly 3.5 million in India annually & can result
in a host of issues including physical, cognitive, social, & emotional. Despite its utility,
neuropsychological rehabilitation is not able to reach most of the affected, which could be because of
lack of awareness, trained manpower & cost of treatment. An economical, home-based intervention
may assist in faster recovery.
Method: The study followed a single-blind randomized controlled trial in a tertiary care center. It was
initiated after obtaining ethical approval & the Clinical Trials Registry of India clearance. A 6-week
indigenized literacy-free cognitive intervention RETRACE© - Rehabilitation of Eclectic Cognitive
Functioning post-Traumatic Brain Injury to Retrain & Restore Attention, Concentration, Memory &
Executive Functions was developed. 49 patients aged between 18-45 years, both genders, within 1
month post Mild or Moderate TBI were randomly assigned to the control group (CG) or intervention
group (IG). While the IG was given the 6-week intervention, the CG was given treatment-as-usual.
Results: RETRACE© was useful in improving the episodic memory, working memory, executive
functioning, response speed, mental status, & aided in reducing the post-concussive symptoms,
anxiety symptoms and quality of life both immediately & six months after intervention. The fMRI
findings revealed focused & specific activations in the right anterior cerebellum, bilateral medial
frontal gyrus, left declive and right middle temporal gyrus for IG, while the controls exhibited
hyperactivation which signifies cognitive overload.
Conclusion: A holistic neuropsychological intervention helps in improving the cognitive &
psychological issues after brain injury. Neuropsychological interventions not only help in improving
the subjective & objective deficits, but also have a significant role to play in the neurobiological activity
& enhancement after injury, validating clinical utility.

27
MIGRAINE: A CROSS-SECTIONAL STUDY AMONG PHYSICIANS AND MEDICAL STUDENTS REGARDING

MIGRAINE PREVALENCE, AWARENESS AND KNOWLEDGE OF DIAGNOSIS AND MANAGEMENT
Hassan Choudry1; Fateen Ata2; Mahammed Khan Suheb3; Naveed Alam1
1
Department of Neurology, Punjab Medical College, Faisalabad Medical University, Faisalabad,
Pakistan; 2Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar;
3
AdventHealth, Orlando, Florida, United States
Objectives: Despite its high prevalence, migraine remains underdiagnosed worldwide, a primary
reason of which is a knowledge gap in physicians regarding diagnostic criteria, and clinical features,
and other aspects of migraine. The primary objectives of this study were to measure that knowledge
deficit in doctors and medical students and assess prevalence of migraine in the same population.
Method: A web-based questionnaire was distributed among doctors and medical students of Punjab
Medical College, Faisalabad Pakistan. Inclusion criteria were doctors and medical students who
experienced headaches. Subjects were asked questions about diagnostic criteria, features, triggers,
and prophylaxis of migraine. They were presented with diagnostic criteria of migraine embedded in
the questionnaire and asked to self-diagnose if they think they had migraine. Data was handled in
Excel 2016 & analyzed in SPSS 26.
Result: We had 213 respondents and 190 fulfilled inclusion criteria, with 99 (52%), 58 (30%), 12 (6.3%)
belonging to Specialties of Medicine, Surgery and Others respectively. 52 (27%) of our total
respondents (213) were diagnosed with migraine, with 26 (50%) being aware of it. Majority (62%) of
subjects never consulted any doctor for their headache. Half (48%) had never heard of or didn’t
remember the ICHD diagnostic criteria. 38% falsely believe that having any type of aura is essential for
diagnosis of migraine. Migraine Awareness was associated with likelihood of having consulted a
physician. There was no statistical difference in knowledge of different aspects of migraine between
medical students vs doctors, medicine specialty vs other specialty doctors, or consult seekers vs non-
consult seekers.
Conclusion: Knowledge gaps exist related to migraine among medical students and doctors in Pakistan
particularly related to diagnosis but to management as well and which may lead to underdiagnoses
and mismanagement of migraine in clinics.

28
AN AUTOIMMUNE ENCEPHALITIS WITH ANTI-TITIN ANTIBODY POSITIVE: A CASE REPORT
Xiaoqi Chu*; Jiaqi Lin*; Ning Mao; Shuang Chen; Liting Fan; Yongzhong Lin; Yusong Ge
Department of Neurology, The Second Hospital of Dalian Medical University, Shahekou District, Dalian
City, Liaoning Province, 116023, China
*Contributed equally
Background: Autoimmune encephalitis (AE) is an autoimmune disease of central nervous system

which can cause cognitive damage, behavior disorder, paralysis, mental symptom and seizure.
Recently, more and more novel antibodies related to AE have been discovered, which are helpful for
clinicians to make early diagnosis and give corresponding treatment.
Case presentation: We report a case of a 66-year-old male man whose initial complaint were dizziness,
memory loss, bradykinesia and change of character. It was after two detailed hospital visits that he
was clearly diagnosed with anti-titin positive autoimmune encephalitis. After the first discharge, the
patient decided to stop taking the drug by himself during the hormone reduction treatment, causing
symptoms to recur and worsen than before. The results of the antibody tests in cerebrospinal fluid
and serum were all negative at the first admission, but the tests showed positive anti-titin antibodies
at the second admission. Both cerebrospinal fluid tests showed elevated protein levels. Both brain
MRIs had no obvious abnormal signal on T2 and T2-weighted fluid-attenuated inversion recovery
imaging, but compared with the first brain MRI image, encephalatrophy was found in frontal lobes,
parietal lobes and temporal lobes. After regular treatment, follow-up of the patient one month after
the second discharge found that all his symptoms were dramatically relieved.
Conclusion: This article highlights a rare case of anti-titin antibody positive autoimmune encephalitis,
which is difficult to diagnose and manage. When the antibody test results are negative and the
possibility of autoimmune diseases cannot be ruled out, the antibody spectrum needs to be detected
again if necessary. Moreover, the time of treatment is related to the outcome of patients and they are
supposed to take medicine under the guidance of a doctor.

29
INCIDENCE AND PREVALENCE OF STROKE AND ITS RISK FACTORS IN THE PHILIPPINES: A SYSTEMATIC
REVIEW
Maria Epifania Collantes1; Yves Miel Zuniga2; Dienzel Uezono2
1
Department of Neurosciences, University of the Philippines-Philippine General Hospital, Manila, The
Philippines; 2University of the Philippines, Manila, The Philippines
Background and Purpose: Various epidemiologic studies reported different stroke incidence and
prevalence rates in the Philippines. Thus, there is a need to synthesize existing information on these
indicators to depict more accurate evidence on the burden on stroke in the country. The objective of
this systematic review is to provide evidence on the incidence and prevalence of stroke in the
Philippines as well as its associated risk factors.
Methods: PubMed and HERDIN were searched for accessible full-text Philippine epidemiologic studies
on stroke incidence and prevalence, whether population or hospital based, and its associated risk
factors. We used three tools for risk of bias assessment namely, the Newcastle Ottawa Scale for cohort
studies, the Quality assessment checklist of Hoy, et al for cross-sectional prevalence studies, and the
AXIS tool for general cross-sectional studies.
Results: A total of 14 studies were included in this review. Based on these studies, the national stroke
incidence rate ranged from 3.95%-5.61% while national stroke prevalence rate ranged from 0.486%
to 6.0%. Hypertension remains as the commonly reported risk factor of stroke alongside diabetes,
smoking, and high cholesterol level.
Conclusions: Despite limitations, we were able to perform complete assessment of risk of bias in
included studies which provide information on the studies with reliable information. Based on this
systematic review, there is variability on data and limited studies on the national epidemiology of
stroke in the Philippines. It is recommended that the national government consider establishing a
system such as a national registry for better data collection and analysis.

30
THROMBECTOMY: THE CHALLENGES
Stephen Davis
Melbourne Brain Centre, Royal Melbourne Hospital and University of Melbourne, Australia
Endovascular thrombectomy (EVT) for large vessel occlusion is the most powerful therapy for acute
ischemic stroke. In patients treated within 6 hours of onset and in selected patients with evidence of
a small core and substantial ischemic penumbra up to 24 hours, the number of patients required to
treat to obtain excellent outcome in only 2-3. This makes EVT one of the most effective treatments in
modern medicine. Probably around 10% of all ischemic stroke patients require this therapy. For
patients able to rapidly access the catheter laboratory, emerging trial evidence suggests that bridging
therapy with intravenous thrombolysis may not add to the benefits of rapid thrombectomy. There
remain other areas of controversy, such as the need for advanced perfusion imaging versus simple
non-contrast CT with use of the ASPECTS score to measure early ischemic damage. The safety and
efficacy of reperfusion of large ischemic cores is another area of uncertainty. Current clinical trials are
addressing these questions.
The greatest barrier on a global scale is the restriction of EVT to predominantly first world countries
and limited private facilities in developing regions. Even some first world countries have scant
resources, while rural and remote regions are generally underserviced. There is a shortage of skilled
neuro-interventionists and facilities. Looking to the future, one exciting technical advance in its infancy
is the prospect of telerobotic thrombectomy. The basic model is that a radiologist could perform the
basic catheter angiogram and work remotely with an expert neuro-interventionist (who could be in a
distant location), connected by digital telemedicine and robotics, who would perform the
thrombectomy.

31
WHITE MATTER NETWORK STRUCTURE AS A SUBSTRATE OF COGNITIVE BRAIN RESERVE IN

CEREBRAL SMALL VESSEL DISEASE: THE MAASTRICHT STUDY
Nathan de Jong1 2 3; Jacobus Jansen1,2; Walter Backes1,2; Sebastian Köhler 1 3,4 for the Maastricht Study
1
School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands;
2
Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands;
3
Alzheimer Centrum Limburg, Maastricht University Medical Center, Maastricht, the Netherlands;
4
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands
Objective: Visible abnormalities of cerebral Small Vessel Disease (cSVD) are associated with cognitive
decline and increased dementia risk. However, there is heterogeneity in observed effect of cSVD
burden on cognitive outcomes, which might be explained by interindividual differences in brain
reserve (BR). We sought to test the BR hypothesis in a large population-based dataset by studying
whether connectivity measures modify the association between MRI-derived cSVD burden and
cognition scores.
Methods: The Maastricht Study is a population-based cohort study with extensive phenotyping,
enriched for type-2 diabetes. Cognitive test scores, structural connectivity data, and 3T MRI were
available for n=4798 participants (mean age(±SD) =59.2(±8.7), 50.0% male). Images were assessed by
Fazekas score ((≤1 or ≥2), presence of microbleeds and lacunar infarcts in terms of dichotomous
measures, and combined into a cSVD score (range 0-3). Node degree (ND), a measure of the mean
interconnectedness of nodes in the structural connectome, was used as connectivity score. A
composite cognition score (CS) was taken as the mean score across three cognitive domains (Memory,
Information Processing Speed and Executive Function). Multivariable linear regression analyses were
used to investigate the interaction effect between ND and cSVD score on CS, adjusted for age, sex,
education, and diabetes status.
Results: Higher cSVD score was associated with lower CS. ND modified the association between cSVD
score and CS in the adjusted model (p for interaction p<0.004). While there were clear cognitive
differences across cSVD levels if ND was low, the association between cSVD and cognition was
attenuated in a dose-response fashion with increasing ND (Figure 1).
Conclusions: Structural ND provides evidence of an individual’s CR based on white matter organization
in the presence of damage from cSVD. Even in participants with the highest cSVD burden, sufficiently
high ND score was associated with normal CS.
Figure 1

32
THE BURDEN OF NEUROLOGIC DISEASES IN EUROPE
Günther Deuschl1; Ettore Beghi2; Claudio Bassetti3
Department of Neurology, Christian-Albrechts University, Kierl, Germany; 2Department of

1
Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy; 3Department of
Neurology, University of Bern, Bern, Switzerland
Compared to the global burden many of the trends are similar for Europe. But as a region with mostly
higher income countries there are differences to the overall trend. Also, within Europe the three
different WHO subregions are different with respect to predominant neurologic diseases causing the
burden.
While the prevalence of neurologic diseases equals 50% of the amount of the world population the
prevalence in Europe is 60% of the population. When comparing the 21 WHO disease groups,
neurologic disease is no 3 after cardiovascular disease and cancer in terms of DALYs and deaths. The
three commonest causes of DALYs in Europe are stroke, dementia and headache. Differences are
clearly seen among the three different subregions of Europe. Overall neurologic diseases are
increasing during the past 25 years. Neurodegenerative disease is fastest growing. While the rates of
stroke and infections are decreasing, the prevalence of stroke is increasing.
The data demonstrate the need for fighting overarching challenges in Europe, but there are also
regional differences which need careful attention. The data provide a framework for deeper planning
of healthcare in Europe. At the same time the health trends may reflect developments of aging in the
different regions as well as attempts for prevention and treatment.

33
UPDATE ON STROKE GENETICS
Martin Dichgans
Institute for Stroke and Dementia Research, Ludwig-Maximilians-University (LMU), Munich, Germany;
President of the European Stroke Organisation (ESO)
Stroke has a substantial heritable component. Recent gene discovery efforts have expanded the
number of monogenic conditions associated with stroke while also linking common variants at
multiple (N=>35) genetic loci to stroke risk. These discoveries have highlighted novel mechanisms and
pathways implicated in stroke as a whole and to specific stroke subtypes such as stroke related to
large artery atherosclerosis, cardioembolism, and small vessel disease. Recent discoveries further
defined shared genetic influences with related vascular traits. Mendelian Randomization and other
approaches have established causal relationships with risk factors and hold great promise for
prioritizing targets for exploration in clinical trials. Genome-wide polygenic scores for stroke and
related vascular phenotypes enable the identification of high-risk individuals many years before the
emergence of vascular risk factors. Among the major challenges ahead are the development of a
better understanding of rare variants and ancestral differences for integration of genetics into
precision medicine, integration with other omics data (proteomics, metabolomics, lipidomics etc.),
uncovering the genetic factors that govern stroke recurrence and stroke outcome and, ultimately, the
conversion of genetic findings to novel therapies.

34
POPULATION-BASED STROKE REGISTRY IN VARNA, BULGARIA: FEASIBILITY AND PILOT DATA
Klara Dokova1; Virginia Atanasova1; Mihael Tsalta-Mladenov2; Dimitrinka Rosenova2; Gabriela

Antonova3; Vilian Gabrovski3; Silva Andonova4
1
Faculty of Public Health, Medical University, Varna, Bulgaria; 2Faculty of Medicine, Medical University,
Varna, Bulgaria; 3MBAL St. Anna, Varna, Bulgaria; 4University hospital St Marina, Medical University,
Varna, Bulgaria
Objectives: Bulgaria has the highest burden of stroke among EU countries. A pilot study was
undertaken to prepare the establishment of a population-based stroke registry in Varna city, Bulgaria,
in the period 1st October - 31st December 2020. The “Varna Stroke Registry” aims to provide
prospective, systematic data on stroke epidemiology twenty years after the last community stroke
registry functioned in the region. We aim to describe methods of establishment and initial results.
Methods: A network of stroke notification centers was established, following the WHO STEPs-STROKE
methodology. It includes all three hospitals (one university and two big public hospitals) providing
stroke care for the population of the city. Data for fatal cases was provided by the municipal
directorate of population registration. The Emergency center for medical care provided information
on all emergency calls presenting symptoms of potential stroke. Data on all definite and potential
stroke cases was collected for the specified period by the study registrar. Suspected incident non-
hospitalized strokes were assessed by study neurologists.
Results: A total of 993 notifications of potential stroke cases were documented for the three pilot
months, after excluding duplicates, patients from outside the city and other time period. Data from
324 patients (34.7% of all notifications) was recorded as first in а lifetime stroke (median age 74 years,
52% women). More than two thirds, 255 patients (78.7% of cases) were hospitalized and confirmed
by CT scans. Ischemic stroke accounts for 84.6% of the cases, intracerebral hemorrhage - 9.6% of the
cases, and 5.8% undetermined.
Conclusion: Population-based stroke registry is feasible for the Bulgarian population. The main
feasibility issue is the involvement of general practitioners and outpatient neurologist to collaborate
in the process of data notification which will be at the center of our efforts in the main phase.

35
CAN ENGAGEMENT IN SOCIALLY AND COGNITIVELY STIMULATING LEISURE ACTIVITIES

COMPENSATE FOR OTHER DEMENTIA RISK FACTORS? A PROSPECTIVE COHORT STUDY
Lukas Duffner1; Kay Deckers1; Dorina Cadar2; Andrew Steptoe2,3; Marjolein De Vugt1; Sebastian Köhler1
1
Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University,
Maastricht, The Netherlands; 2Department of Behavioural Science and Health, University College
London, London, United Kingdom; 3Department of Epidemiology and Public Health, University College
London, London, United Kingdom
Objectives: With the projected surge in global dementia cases, research is increasingly focusing on
lifestyle factors as preventive measure. Social and cognitive leisure activities are promising targets but
have thus far received relatively little attention. This study investigates whether cognitive and social
activities contribute to dementia risk, and whether engagement in these activities moderates the
association between other known risk factors (education, wealth & lifestyle factors).
Methods: We used data of the English Longitudinal Study of Ageing (ELSA) on engagement in social
and cognitive activities in 6346 participants, followed up from 2008/2009 until 2014/2015. Dementia
prevalence was assessed until up to 7 years after baseline. Self-reported cognitive (e.g., “reading the
newspaper”) and social (e.g., being a member of a social club) activities and social participation (e.g.,
“going to the cinema”) were clustered into high and low based on a median split. We then assessed
their individual contribution to dementia-risk as well as their interaction with the other risk factors,
using Cox regression models, controlling for age, sex, education, wealth and lifestyle risk factors.
Results: We found that higher engagement in cognitive (HR=0.476; 95% CI=0.27-0.84) and social
activities (HR=0.60; 95% CI=0.42-0.87) as well as social participation (HR=0.59; 95% CI=0.38-0.90) were
associated with lower dementia risk, independently of the other risk-factors in the model. We also
found an interaction between the level of engagement in social activities and level of education with
regard to dementia risk, but not with other risk factors.
Conclusions: Cognitive and social leisure activities and social participation may be beneficial for overall
dementia risk. The benefits of social activities may be larger for people with low education. Both
should be taken into account when designing dementia prevention measures.

36
POPULATION-BASED VALIDATION OF PREHOSPITAL STROKE SCALES FOR THE DETECTION OF LARGE

VESSEL OCCLUSION: DIJON STROKE REGISTRY
Gauthier Duloquin; Mathilde Graber; Lucie Garnier; Valentin Crespy; Maurice Giroud; Yannick Béjot
Dijon Stroke Registry, Department of Neurology, University Hospital of Dijon
Objectives: Mechanical thrombectomy dramatically changed the management of patients with acute
ischemic stroke (IS) due to large vessel occlusion (LVO). So as to improve the identification of these
patients, who would require a direct transfer to centers including neurointerventional facilities,
several prehospital scales were developed. However, their diagnostic accuracy was only evaluated on
predefined patients recruited in stroke units. Therefore, this study aimed to assess the diagnostic
accuracy of these scales in routine practice using data from a population-based registry.
Methods: All patients with IS were prospectively identified among residents of Dijon, France, using a
population-based registry (2013-2017). Sixteen scales were applied to included patients using
recorded clinical data. The presence of LVO was assessed after arterial imaging reviewing by
investigators. The diagnostic accuracy of the scales to detect LVO was evaluated by calculating
sensibility, specificity, positive predictive values (PPV) and negative predictive values (NPV).
Results: 1060 cases of IS were recorded, for which in 971 cases arterial imaging was available. 284
patients had a visible arterial occlusion, irrespective of its location. For the detection of terminal
internal carotid artery, M1 portion of middle cerebral artery (MCA) and basilar occlusion, the
evaluated scales had a high heterogeneity in sensibility (69.8% to 98.2%) and specificity (32.8% to
85.5%). The PPV ranging from 16.6% to 40.9% and the NPV ranging from 95.3% to 99.3%. Considering
in addition the M2 portion of the MCA, the sensitivity and the NPV decrease, ranging respectively from
58.9% to 93.3%, and from 91.2% to 96.0%.
Conclusions: Our study demonstrated that currently available prehospital scales failed to combine
both a good sensitivity and specificity to detect LVO in routine clinical practice. Further studies are
needed to address the issue of the best strategy for prehospital triage of IS patients.

37
APPLICATION OF MOTOR LEARNING PRINCIPLES IN UPPER LIMB TASK-ORIENTED TRAINING IN

STROKE CLINICAL TRIALS – A SCOPING REVIEW
Subramanian Durairaj1; Sanjukta Sardesai1; John Solomon1; Mindy F Levin2
1
Manipal College of Health Professions (MCHP), Manipal Academy of Health Education (MAHE),
Manipal, India; 2School of Physical and Occupational Therapy, McGill University, Montreal, Quebec
Canada
Background: Stroke is the second leading cause of death and disability-adjusted life years (DALYs)
globally. Evidence suggests that task-oriented training (TOT) helps to improve upper limb function
after stroke. TOT is a core element applied in various approaches such as the Motor relearning
programme (MRP), bilateral arm training (BAT) and constraint induced movement therapy (CIMT). The
primary objective of this scoping review is to investigate whether motor learning principles such as
practice structure and augmented feedback were reported in stroke clinical trials involving upper limb
TOT. The secondary objective of this review is to investigate whether principles of practice were
reported in stroke clinical trials involving upper limb TOT and also to investigate the practice intensity
of TOT reported in stroke clinical trials involving upper limb TOT.
Methods: A systematic search was performed in PubMed, CINAHL, Web of Science, Scopus, and
Cochrane databases using MESH terms and keywords. Two reviewers independently did the title,
abstract, and full text screening based on the inclusion and exclusion criteria and any conflicts
between the two reviewers were resolved by a third reviewer. Finally, two reviewers independently
did data extraction from the included studies in a charting form and data charting was done.
Results: A total of 16,923 studies were retrieved and 143 studies were retained with 61 studies on
TOT and 82 studies on CIMT.
Conclusion: The results of this scoping review showed that motor learning principles in TOT were
inconsistently reported. This review suggests that detailed reporting of motor learning principles in
upper limb TOT stroke clinical trials is necessary to rely on the effects of the intervention and to
replicate or build on the research findings in future.

38
PARAMEDIC IDENTIFICATION OF STROKE AND ASSOCIATED ACCESS TO REPERFUSION THERAPY:

PRELIMINARY ANALYSIS OF STATE LINKAGE STUDY
Amminadab Eliakundu1; Karen Smith2; Joosup Kim1,3; Monique Kilkenny1,3; Kathleen Bagot1,3; Emily
Andrew2; Shelley Cox2; Christopher Bladin2,3; Dominique Cadilhac1,3
1
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health,
Monash University, Melbourne, Australia; 2Ambulance Victoria, Melbourne, Australia; 3Stroke
Division, Florey Institute of Neurosciences & Mental Health, Melbourne, Australia
Objective: Failure to recognise people with stroke in the pre-hospital setting may have important
implications for access to time-critical treatment. We investigated the provision of reperfusion
(thrombolysis - tPA or thrombectomy - ECR) and timeliness of treatment and if these were affected by
paramedic identification of stroke.
Methods: Patient-level data from the Australian Stroke Clinical Registry (AuSCR) were linked with
Ambulance Victoria (AV) data collected between January 2015 – October 2017. Data were matched
using probabilistic iterative methods on personal identifiers. Descriptive statistics were used to
compare access to time-dependent evidence-based treatment and paramedic identification of stroke.
Results: Amongst 7,343 AuSCR registrants, 4,758 cases were matched to emergency ambulance
transport records from AV (42% female, median age at stroke: 72 years, stroke diagnosis; intracerebral
haemorrhage (ICH) 13%, Ischaemic 66%, transient ischaemic attack (TIA) 19%, Undetermined stroke
2%). Suspected diagnosis by paramedics were: stroke 56% (n= 2,647), TIA 11% (n= 505), other
conditions 33% (n= 1,593) and subarachnoid haemorrhage <1% (n= 13). Paramedics used the
Melbourne Ambulance Stroke Screen tool in 78% of patients suspected of stroke/TIA compared to
14% of those not suspected of stroke/TIA. Hospital pre-notification was recorded in 56% of patients
suspected of stroke/TIA compared to 16% of those not suspected of stroke/TIA by paramedics. Of
those suspected of stroke who arrived within 4.5hrs, 31% (n= 491) received reperfusion if they had an
ischaemic stroke compared to 15% (n= 79) who were not suspected of having stroke (x2= 52, p<0.001).
There was no evidence for a difference in time to groin puncture based on the paramedic suspicion of
stroke.
Conclusion: In this novel Australian data linkage study, we found that correctly identified patients with
stroke by paramedics led to more pre-notification of hospitals and greater access to treatment for
ischaemic stroke.

39
A PRACTICAL SOLUTION FOR MOTIVATIONAL MASS STROKE PREVENTION
Valery L. Feigin1; Rita Krishnamurthi1; Alexander Merkin1; Priya Parmar2; Michael A. Kravchenko 3; Luke
Skinner4; Yogini Ratnasabapathy4; Sheila Martins5
1
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New
Zealand; 2Department of Biostatistics, Auckland University of Technology, New Zealand; 3Department
of Translational Neuroscience, Research Center of Neurology, Moscow, Russia; 4Waitemata District
Health Board, Auckland, New Zealand; 5Hospital de Clínicas de Porto Alegre, Universidade Federal do
Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network, Brazil
Background: Stroke remains the second leading cause of death and the third leading cause of disability
in the world and its burden is increasing fast. With almost half of the world population using
smartphones, mobile technologies (apps) offer far-reaching tools for improving the health of billions
of people.
Methods: In 2014, Auckland University of Technology together with other national and international
experts developed a free to use Stroke Riskometer app that, based on 20 of the most important
lifestyle and medical risk factors, calculates not only absolute but also relative risk of stroke, thus
motivating the user to know why their risk of stroke is increased. It also provides evidence-based
recommendations for managing risk
factors identified in the user, allows
goal setting, monitoring of progress,
provides warning signs of stroke, and
offers participation in research. Voted
the number 1 app by senior American
physicians in 2015 and properly
validated (including a recent
successful proof-of-concept
randomised clinical trial) the app
remains the only comprehensive
evidence-based mobile tool for
primary stroke prevention endorsed
by all major international stroke and CVD organisations and recommended for global use by the World
Stroke Organization. Rationale, evidence for and logistics and practical solutions of integrating the app
into mass individual, primary and secondary health care system will be presented at the conference
as outlined in the figure. This integrative system is currently under development in NZ, Brazil and
Russia.
Conclusions: According to the World Stroke Organization estimates, the wide use of the Stroke
Riskometer app together with population-wide primary CVD prevention strategies, a polypill (one of
two low-dose off-patent blood pressure and lipid lowering medications) and task-shifting in health
service delivery to tackle health worker shortage for primary prevention in the individual level as
described above, it would be possible to reduce stroke incidence by 50% and dementia incidence by
40%.

40
NEUROEPIDEMIOLOGY: HINTS FOR PUBLICATION
Valery L. Feigin
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland,
New Zealand
Background: Getting your research published in a good medical journal is a challenging task as the
rejection rate for many international journals is very high. Knowing how to write a good scientific
article from an editor’s perspective is useful.
Methods: Professor Valery Feigin, Editor-in-Chief of
Neuroepidemiology, provides some hints on how to write a
good scientific article from an editor’s perspective. The
correct study design, appropriate format of the article and
presentation of the study results, writing a proper cover
letter to the Editor, choosing the right title for the article
and the target journal, are all important aspects that
increase the chances of publication.
Conclusions: Writing a good article requires special skills
and knowledge. The cornerstone of a good article is the
methodologically sound research the article is based on.
However, even good research may not get published in a
good, relevant journal if the article is not properly written.
Valery Feigin’s presentation provides important hints to
authors to increase the chances of publication of their
research.

41
INCIDENCE OF STROKE IN THE URBAN AREA OF WESTERN UKRAINE: TEMPORAL TRENDS AND
FEATURES OF STATISTICAL ACCOUNTING
Olena Filipets; Valeriy Pashkovskyy
Bukovinian State Medical University, Chernivtsi, Ukraine
Objectives: Ukraine is a low-income eastern European country with consistently high burden of stroke.
The main underlying factors are decline and ageing of population, poor control of modifiable risk
factors, and insufficient access to quality medical services. The purpose of our research is to assess
temporal trend in stroke incidence among the population of the western region of the country, and
to identify current needs for improvement of stroke accounting.
Methods: We retrospectively analyzed stroke morbidity from 2009 to 2018 in the city of Chernivtsi, a
medium-density urban area with population nearly 240 thousand people. The study used multiple
data sources from municipal hospitals and outpatient departments, as well as the official state and
sectorial reports of Ministry of Health of Ukraine.
Results: In total 4060 people in selected subpopulation experienced first-ever or recurrent strokes
over a 10-year period. The incidence of total stroke decreased by 11.7% from 197.2 per 100 000 in
2009 to 174.1 per 100 000 in 2018, showing non-significant downward linear trend (r2=0.16). There
were fluctuations of incidence within the study interval with the maximal 214.8 per 100 000 persons
in 2014 and further 18.9% decline to the minimal rate in 2018. Annual stroke incidence in Chernivtsi
was 1.5-1.7 times lower than the official rates in total population of Ukraine. This discrepancy has
diminished since 2014, which is possibly related to the loss of statistical data from the temporarily
occupied territories in eastern Ukraine where higher stroke occurrence rates have always been
registered.
Conclusions: Despite relatively stable stroke incidence over a 10-year period, there is a need for
extended stroke surveillance in the studied population due to negative socioeconomic, demographic
changes and serious health care challenges. Registration of first-ever stroke cases should be included
in routine statistical monitoring for efficient assessment of stroke epidemiology.

42
IMPACT OF THE COVID-19 PANDEMIC AND NATIONAL LOCKDOWN ON HOSPITALIZATION FOR

STROKE AND RELATED 30-DAY MORTALITY IN FRANCE: A NATIONWIDE OBSERVATIONAL STUDY
Amélie Gabet1; Clémence Grave1; Philippe Tuppin2; Yannick Béjot3; Valérie Olié1
Santé Publique France, Saint Maurice, France; 2Caisse Nationale d'Assurance Maladie, Paris, France;
1
CHU Dijon Bourgogne, Dijon, France

3
Introduction: This nationwide study aimed to assess the impact of COVID-19 pandemic and the
national lockdown implemented in France (17th March/ 10th May 2020) on hospitalization rates for
stroke, characteristics of patients, and related 30-day case-fatality rates.
Methods: All hospitalizations for stroke in France during the 24 first weeks (January to June) of each
year from 2017 to 2020 were selected in the national hospital discharge database (Programme de
médicalisation des systèmes d’information – PMSI). Weekly incidence rates ratios (IRR) were
computed to analyze time-trends in rates of patients hospitalized for stroke between the year 2020
and years 2017-2019, as well as in-hospital case-fatality rates, and 30-day case-fatality rates. Weekly
odds ratios (OR) of stroke comorbidities, disabilities and acute care management characteristics were
also calculated.
Results: IRR of patients hospitalized for stroke decreased up to 30% during the lockdown, compared
to years 2017-2019. Stroke patients hospitalized during the lockdown had significant higher in-hospital
case-fatality rates were noted for the second and third weeks of the lockdown compared to years
2017-2019, as well as higher proportion of patients with severe stroke symptoms. The increase in in-
hospital case-fatality rates reached almost 60% in stroke patients aged under 65 years old. Out-of-
hospital 30-day case-fatality rates increased between week 11 and week 15 among patients who
returned to home following their hospitalization for stroke. Important changes in care management
were found including lower rates of stroke patients admitted to resuscitation units, higher rates of
mechanical thrombectomy, and lower mean length of stay.
Conclusions: A dramatic decrease in rates of patients hospitalized for stroke was found during the
lockdown in France, associated with greater in-hospital and 30-day out-of-hospital case-fatality rates.
These findings highlight the need to reinforce key messages with regard to stroke awareness and the
need of medical consultation in any case in the general population during the COVID-19.

43
CHARACTERISTICS, MANAGEMENT AND IN-HOSPITAL MORTALITY OF PATIENTS HOSPITALIZED FOR

STROKE WITH A CONCOMITANT DIAGNOSTIC OF COVID-19 IN FRANCE
Amélie Gabet1; Clémence Grave1; Philippe Tuppin2; Yannick Béjot3; Valérie Olié1
Santé Publique France, Saint Maurice, France; 2Caisse Nationale d'Assurance Maladie, Paris, France;
1
CHU Dijon Bourgogne, Dijon, France

3
Introduction: The aims of this study were to compare the characteristics and the management of
patients hospitalized for stroke with a diagnostic of COVID-19 to those without a COVID-19 diagnostic
in France, and to assess the association between the COVID-19 diagnostic and stroke outcomes.
Methods: All patients hospitalized for stroke between 1st January and 14th June 2020 in France were
selected from the French national hospital discharge databases (Programme de médicalisation des
système d’information - PMSI). A diagnostic of COVID-19 was researched during the index
hospitalization for stroke or in a prior hospitalization that had occurred after the 1st of January 2020.
Results: Among the 55,309 patients hospitalized for stroke, 520 (0.9%) had a concomitant COVID-19
diagnostic or such diagnostic prior to the index hospitalization for stroke. Patients with COVID-19 had
more comorbidities, higher prevalence of heart failure, arrhythmias, and venous thrombo-embolism
as compared to patients hospitalized for stroke without a COVID-19 diagnostic. Higher probabilities to
be admitted to a resuscitation unit (2.13 [1.57-2.88]) and in-hospital mortality (OR=2.59 [2.08-3.24])
were found in patients with COVID-19 than in those without COVID-19 after adjustment for
comorbidities. Patients with a COVID-19 diagnostic recorded as a primary discharge diagnosis of the
index hospitalization for stroke were more likely to die in-hospital than patients with a COVID-19
diagnostic registered as an associated diagnostic or during a prior hospitalization (OR=1.68[1.08-
2.62]).
Conclusions: Although this study could not state on the temporality between COVID-19 and stroke,
we observed increased probability of stroke severity and death in patients hospitalized for stroke with
a COVID-19 diagnostic compared to patients hospitalized for stroke without a COVID-19 diagnostic.
These results also highlighted the difficulties to manage patients with both acute COVID-19 and stroke.

44
JOB STRESS AND RISK OF STROKE IN POPULATION 25-64 YEARS IN RUSSIA/SIBERIA: GENDER ISSUES.
MONICA-PSYCHOSOCIAL EPIDEMIOLOGICAL STUDY
Valery Gafarov1,2; Elena Gromova1,2; Dmitriy Panov1,2; Almira Gafarova1,2; Igor Gagulin1,2
1
Institute of Internal and Preventive Medicine – branch of Institute of Cytology and Genetics SB RAS,
Novosibirsk, Russia; 2 Collaborative Laboratory of Cardiovascular Disease Epidemiology, Novosibirsk,
Russia
Purpose: To determine gender differences in the impact of stress at work on the risk of stroke over
16-years of follow-up in an open population of 25-64 years in Russia/Siberia.
Methods: Under the third screening of the WHO MONICA-psychosocial program (MOPSY) random
representative sample including both genders aged 25–64 years was surveyed in Novosibirsk in 1994
(n=1346, 48.8% males; mean age 44.9 ± 0.4 years; response rate was 77.3%). Stress at work was
assessed by means Karazek scale. New-onset cases of stroke were identified from 1994 to 2010. This
longitudinal survey performed in frame budgetary issue # АААА-А17-117112850280-2.
Results: A high level of stress at work was in 29.5% of men and in 31.6% of women. The middle level
was in 48.9% of men and in 50.7% of women (χ2=2.574 υ=2 p=0.276). The risk of MI over 16-years
period in persons experiencing stressful situations at work was as follow: in men HR=2.603 (95%CI,
1.06-4.153) and in women HR was 1.956 (95%CI 1.008-3.795). In multivariate analysis risk of stroke in
men was HR=3.8 (95%CI 1.6-8.8) and in women it was HR=1.95 (95%CI 0.984-3.887). The risk of stroke
was higher in those who are living alone, divorced and widowed men HR=4.2 (95% CI 1.5-13.2) and in
women with high school or primary education degree HR=3 (95%CI 0.852-11.039).
Conclusions: It was established that a high level of stress at work is not gender specific. The risk of
stroke incidence over a 16-years period is higher in men than in women and it is affected by the social
gradient in both genders.

45
SYNERGIES TO PREVENT STROKE – STOPSTROKE – AN INTERDISCIPLINARY RESEARCH PROGRAM ON

STROKE PREVENTION
Seana Gall1; Amanda Thrift2; Judith Katzenellenbogen3; Mark Nelson1; Tim Kleinig4; Valery Feigin5;
Dominique Cadilhac2; Lee Nedkoff3; Joosup Kim2; Monique Kilkenny2
1
University of Tasmania, Hobart Australia; 2Monash University, Melbourne, Australia; 3University of
Western Australia, Perth, Australia; 4Central Adelaide Local Area Health Network, Adelaide, Australia;
5
Auckland University of Technology, Auckland, New Zealand
Background: In 2021, approximately 13 million people will have their first stroke. At least 10 million
of these strokes are preventable, because they are caused by theoretically controllable risk factors,
such as high blood pressure and smoking. While much research effort has been directed towards acute
stroke care and recovery, less has addressed stroke prevention.
Methods: Our Australia and New Zealand collaboration obtained $5 million over 5 years (2020-2024)
from the Australian National Health and Medical Research Council for a research program on stroke
prevention. Our diverse (gender, location, cultural backgrounds), interdisciplinary team includes both
consumers and epidemiologists, clinicians (neurologists, general practitioners, nursing and allied
health), health services researchers at different career stages. Our program has three themes; Theme
1 - Identifying those at risk of stroke: Theme 2 - Improved management of those at risk of stroke and
Theme 3 - Real-world modelling and effectiveness of stroke prevention, including cost-effectiveness.
Results: In our first 12 months we established governance procedures, including an independent
advisory committee; recruited program staff including the program manager; and developed a
protocol for a priority setting activity with the community and stakeholders to be conducted in 2021.
Using diverse data sources, preliminary results are available for projects in theme 1 and 3, with
recruitment for intervention studies in theme 2 beginning in 2021.
Outcomes: There is a need for a concerted effort to enhance the prevention of stroke. Our research
program will provide contemporary information on who, what and when we should target, and how,
to improve the prevention of stroke.

46
EVALUATING THE EFFECT OF PERSONALISED KNOWLEDGE TO REDUCE THE RISK OF STROKE (PERKS-
INTERNATIONAL) – STUDY DESIGN PROTOCOL
Seana Gall1; Rita Krishnamurthi2; Valery Feigin2; Amanda Thrift3; Tim Kleinig4; Mark Nelson1;
Dominique Cadilhac3; Derrick Bennett5; Tara Purvis3; Shabnam Jalili-Moghaddam2; Gemma Kitsos1
1
University of Tasmania, Hobart, Australia; 2Auckland University of Technology, Auckland, New
Zealand; 3Monash University, Melbourne, Australia; 4Central Adelaide Local Area Health Network,
Adelaide, Australia; 5University of Oxford, Oxford, United Kingdom
Background: The Stroke Riskometer mobile phone app uses individual demographic, health, and
lifestyle data to provide personalised information on risk of stroke and advice on how to modify risk.
We hypothesise that the App, compared to usual care, will reduce the risk of stroke.
Methods: The trial, funded by the Australian National Health and Medical Research Council, is a Phase
III, prospective, pragmatic, open-label, single blinded endpoint 2-arm randomised controlled trial.
Online screening and booking systems will be used to recruit 790 participants across Australia and
New Zealand with the following criteria: aged >35 and ≤75 years, 2+ modifiable risk factors, no history
of stroke/CVD/dementia and ownership of a smartphone. Participants will be randomised using a
stratified block approach (strata: age, baseline number of risk factors, location, sex). The intervention
group will be provided with the Stroke Riskometer App, and instruction on how to use it, while those
in the usual care group will be provided with a written risk factor summary, but will not be informed
about the App. Blinded assessments will be conducted face-to-face at baseline and 6 months and
online at 3 and 12 months. The primary outcome is a combined cardiovascular behaviour and
biomedical risk score (range 0 [no healthy risk factors] to 7 [all healthy risk factors]) at 6 months post-
randomisation. Secondary outcomes include individual risk factors, quality of life and knowledge
about stroke. An economic analysis will be undertaken, with a process evaluation carried out in
parallel to the main trial.
Results: The trial will begin recruitment in early 2021 with results expected in 2025.
Conclusion: Stroke is largely preventable. This study will be the first to provide evidence of the
effectiveness of a mobile app to reduce the risk of stroke.

47
STROKE REHABILITATION IN LMICS: AN EDUCATION AGENDA
Dorcas Gandhi
Christian Medical College and Hospital, Ludhiana, India
Objectives: Developing and delivering cost-effective, equitable-access rehabilitation services of stroke

rehabilitation is a challenge especially in low-income and middle-income countries (LMICs) where the
unmet need for rehabilitation and recovery treatments is high. We aim to discuss the WHO
Rehabilitation 2030 agenda and focus on development and implementation of effective stroke
rehabilitation services in LMICs.
Methods: Following a database search we found 16 LMIC stroke guidelines out of which a guideline
that covered similar recommendations to those of the Australian (HIC) stroke rehabilitation guideline
was selected, from each of the 6 WHO regions. 3 reviews and 25 trials on Stroke rehabilitation were
included. Unmet needs and priorities of stroke rehabilitation were extracted from WHO:
Rehabilitation 2030 website, Sub-Saharan regional workforce information and a taskforce
recommendation.
Results: We have enumerated the specific barriers to development and implementation of effective
stroke rehabilitation services in LMICs. Using stroke rehabilitation clinical practice guidelines from
both high-income countries and LMICs we highlight opportunities for rapid uptake of evidence-based
practice. We have developed a ‘Call-for-action’ for stakeholders to build high-impact, standardised,
and accessible education to train the stroke rehabilitation and recovery workforce. We finally discuss
local examples of stroke rehabilitation education & awareness programmes.
Conclusions: (1) Provision of education and building capacity in global stroke recovery and
rehabilitation community, (2) work in partnership for greater effect and accelerated progress, and (3)
Translation and roll-out of evidence-based protocols and implementation tools, easy accessibility of
the same through controlled repositories were identified as essential goals.

48
EPIDEMIOLOGY, DIAGNOSIS AND MANAGEMENT OF PROLACTINOMA PATIENTS IN A SINGLE

MEDICAL CENTER IN MOROCCO
Fortuné Gankpe1; Mohammed Benzagmout2
CHUZ, Abomey Calavi, Benin; 2 CHU HASSAN II, Fez, Morocco

1
Objective: The diagnosis of prolactinoma is made earlier in women than in men who are diagnosed in
an advanced stage of the pathology. The aim of this study was to describe the epidemiological, clinical
and therapeutic patterns of prolactinomas in a single medical center in Morocco.
Methods: We collected the retrospective data of 75 patients from 2007 to 2019 in the Hassan II
University Hospital of Fez in Morocco.
Results: Prolactinoma represented 48.1% of overall patients with pituitary adenoma including 69.3%
women. The mean age was 33 years in female and 38 in male. There were 28 cases of
microprolactinoma including 27 women, 30 cases of macroprolactinoma and 17 cases of invasive
prolactinoma. Hyperprolactinemia was correlated to the size of prolactinoma whereas giant
prolactinomas seemed to produce a serum prolactin higher than 1000 ng/ml. Medical treatment was
the management of choice in our sample and only 17.3% patients underwent a surgery procedure
through endoscopic, endonasal, transsphenoidal approach. So, dopamine agonist allowed to
normalize the prolactinemia, reduce the tumoral volume and restore the symptoms in the majority of
our patients.
Conclusion: This study identified the epidemiological profile of patients with prolactinoma in Hassan
II University Hospital of Fez in Morocco. Furthermore, it was a 33-year-old woman who presented an
amenorrhea – galactorrhea syndrome’s with hyperprolactinemia higher than 200 ng/mL. And the MRI
reveals frequently a microprolactinoma. Our study is a contribution for the setting of a nationwide
study to identify the Moroccan profile of prolactinoma.

49
ASSOCIATION BETWEEN DEPRESSION, ANXIETY AND DEMENTIA AMONG OLDER PEOPLE IN

CENTRAL AFRICA: EPIDEMCA POPULATION-BASED STUDY
Antoine Gbessemehlan1,2,3,4; Maëlenn Guerchet1,2,3*; Dismand Houinato1,2,3,4; Jean-Pierre Clément1,2,3,5;

Pascal Mbelesso6; Bébène Ndamba-Bandzouzi7; Jean-François Dartigues8; Pierre-Marie Preux1,2,3; for
the EPIDEMCA group
1
INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; 2University of Limoges, U1094,
Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges,
France; 3IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France; 4Faculty of Health
Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, LEMACEN, University of
Abomey-Calavi, Cotonou, Benin; 5Memory Research Center, Limoges, France; 6Department of
Neurology, Brazzaville University Hospital, Brazzaville, Republic of Congo; 7Department of Neurology,
Amitié Hospital, Bangui, Central African Republic; 8University of Bordeaux, INSERM, Bordeaux
Population Health Research Center, UMR 1219, Bordeaux, France
Objectives: Older people are vulnerable to mental and cognitive health issues. Studies reported that
depressive or anxious older people are more likely to present or to develop dementia over time. The
relations between these psychiatric disorders and dementia are poorly explored in sub-Saharan Africa.
Therefore, we investigated the association between depression, anxiety and dementia among older
people living in two Central Africa countries.
Methods: A multicenter cross-sectional study was carried out between 2011 and 2012 in Republic of
Congo (ROC) and in Central African Republic among people aged ≥65 years. An annual follow-up was
performed only in ROC until 2015. Data were collected using a standardized questionnaire and
participants underwent a short physical examination. Depression and anxiety symptoms were
collected at baseline and were ascertained using a community version of the Geriatric Mental State
(GMS-B3). Probable cases were defined as having a GMS-AGECAT score ≥3. Dementia diagnosis was
performed by a neurologist according to DSM-IV criteria. Cross-sectional and longitudinal associations
between depression, anxiety and dementia were investigated using logistic and competing-risk
regression models respectively.
Results: Sample for cross-sectional analyses was 1773 participants (median age: 72 [interquartile
range: 67-77] years) and 1053 (59.4%) were female. In total, 650 (36.7%), 133 (7.5%) participants
presented respectively depression and anxiety symptoms, and 135 (7.6%) participants were diagnosed
with dementia. After accounting for several covariates, depression significantly increased the odds of
dementia (adjusted Odds Ratio= 1.62; 95%CI: 1.05-2.50), while anxiety was not associated with
dementia (aOR= 0.81; 95%CI: 0.40-1.65). The effects of both psychiatric disorders on dementia
incidence within the Congolese participants will be presented in detail.
Conclusions: Many Central African older people experience depression more than anxiety and are
more likely to present dementia. Promoting and strengthening social support around depressive older
people could help to delay or manage dementia in this population.

50
RECURRENT STROKE IN PATIENTS WITH ATRIAL FIBRILLATION: FREQUENCY AND HETEROGENEITY
Lyudmila Geraskina1; Andrey Fonyakin1; Madina Burzhunova2; Muslimat Alieva2; Naida Garabova2;
Riya Mary Jose2
Research Center of Neurology, Stroke Unit, Russian Federation; 2RUDN University, Neurology and
1
Neurosurgery department, Russian Federation
Background and Aims: Atrial fibrillation (AF) has been associated with cardioembolic stroke (CES), but
in the presence of other risk-factors competing with AF, stroke is interpreted as non-cardioembolic
(nCES). At present to all patients with AF, for prevention of recurrent stroke (RS), lifelong
administration of oral anticoagulants (OACs) is recommended.
Aims: Evaluate frequency and competing causes of RS in AF patients.
Methods: We analysed 200 patients with non-valve AF and stroke in 2014-18. Among them, RS was
registered in 55 patients. Presence of hypertension (AH), carotid/intracranial atherosclerosis, Diabetes
Mellitus (DM), heart-valves disorders, coronary artery disease (CAD), left ventricular thrombosis,
cardiomyopathy, PFO, antiphospholipid syndrome, dissection, vasculitis were evaluated.
Results: RS developed within 1 month in 13 (24%) patients, within 1 year in 9 (16%), relapse at later
date occurred in 33 (60%) of patients. AH was in 51 (93%) patients, stable CAD in 17 (31%), DM-in 14
(25%), carotid stenosis (>70%) in 13 (24%) patients. In 22 (40%) patients revealed other potential
sources of CES (heart valves/chambers disorders). Frequency of CES increased from 20 (36%) to 40
(73%) patients (p<0,001). Frequency of lacunar stroke (LS) decreased from 18 (33%) to 4 (7%) patients,
frequency of atherothrombotic stroke (ATS) remained the same – 11 (20%) patients. 6 (11%) of
patients with previous stroke were treated as cryptogenic, and AF for the 1st-time was registered with
RS, so we defined it as CES.
Conclusions: RS occurred due to multiple risk-factors, potential sources of CES, and due to low
adherence to ACs treatment. Stroke in patients with AF is characterized by pathogenic heterogeneity,
we detected increase of CES among all RS cases. Transformation of the pathogenic RS subtype from
nCES to CES occurs in early and long-term, and due to lack of ACs therapy. Therefore, in patients with
AF for prevention of RS, OAKs should be prescribed regardless of subtype of 1st-stroke.

51
COMORBIDITIES IN PATIENTS WITH EPILEPSY AND LONG-TERM FOLLOW-UP: OUTCOME AND

ASSOCIATION
Giorgia Giussani1; Elisa Bianchi1; Simone Beretta2; Jacopo Di Francesco2; Andrea Stabile2; Davide
Carone2; Clara Zanchi2; Lorenzo Tinti2; Marta Pirovano2; Claudia Trentini2; Giada Padovano2; Diletta
Cereda2; Sofia Scanziani2; Sara Gasparini3; Graziella Bogliun2; Carlo Ferrarese2; Ettore Beghi1 for the
PRO-LONG Study Group
1
Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy; 2Epilepsy Center, Department of
Neurology, San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy; 3Medical
and Surgical Sciences Department, School of Medicine, Magna Græcia University of Catanzaro,
Catanzaro, Italy; Regional Epilepsy Centre, Great Metropolitan Hospital, Reggio Calabria, Italy
Objectives: The aim of this study was to assess frequency and types of comorbidities in people with
epilepsy and verify their association with the disease and its outcome.
Methods: This was an Italian retrospective cohort study performed in 13 epilepsy centers. Eligible
patients were children (excluding neonates) and adults diagnosed before December 31, 2005 and
followed for a minimum of 10 years. Comorbidities were classified according to organ and relationship
with epilepsy (causal mechanism, shared risk factors, bidirectional effect, consequence, chance
association). Two pairs of raters independently reviewed patients’ records and classified each
comorbidity. In case of disagreement, a third reviewer took the final decision. Comorbidity types and
association with epilepsy were described in the entire sample and in different prognostic patterns
(sustained remission, relapsing-remitting course, no remission). Differences were evaluated with the
chi-square test.
Results: Of 1006 included patients, 266 (26.4%) had at least one comorbidity. 172 (17.1%) had 1
comorbidity, 61 (6%) 2 comorbidities, and 33 (3.3%) 3+ comorbidities. The most common were
developmental/perinatal (7.5%), psychiatric (6.2%), cardiovascular (5.3%) and endocrine/metabolic
(3.8%). Comorbidities were classified, in decreasing order, as chance association (11.1%), shared risk
factors (10.1%), causal (9.4%), bidirectional (1.3%) and consequence (0.1%). Psychiatric diseases were
present in 13.3% in patients with no remission, 5.9% in patients with relapsing-remitting course, and
4.8% in patients with sustained remission (p=0.016). The corresponding numbers for
endocrine/metabolic diseases were 9.6%, 3,4% and 2.9% (p=0.013), for respiratory diseases were
3.6%, 0.3% and 0.3% (p=0.001), and for urogenital diseases were 3.6%, 0.7% and 1.6% (p=0.048).
Conclusions: The most common comorbidities in patients with epilepsy are developmental/perinatal,
psychiatric, cardiovascular and endocrine/metabolic. Chance, causal association and shared risk
factors are the prevailing underlying mechanisms. Patients without any remission period report more
frequently endocrine/metabolic, psychiatric, respiratory comorbidities and urogenital diseases.

52
DISORDERS OF CONSCIOUSNESS (DOC): IMPLICATIONS FOR NURSING ALONG THE CONTINUUM
Theresa Green
University of Queensland, Herston, Australia
Due to disruption of normal brain function from trauma or disease, neurological function is often
compromised resulting in reduction or alterations of consciousness, typically called disorders of
consciousness (DOCs), and patients require specialised interprofessional care. Types of DOCs will be
discussed, and the critical importance of nursing management explored. This includes understanding
the mechanism, etiology, and pathophysiology of the injury. As well, knowledge of the types of
injuries, complex clinical assessments, nursing diagnosis, and awareness of diagnostic evaluations are
essential for proper assessment and management. Given the complexity of care and recovery, it is
important to also consider the needs of family, and the influence of cultural diversity on care provision.
Nursing interventions and potential complications for patients with DOC will be discussed with a focus
on patient-and-family centred care.

53
VALIDATION OF THE LEBANESE ARABIC VERSION OF THE BACS SCALE (THE BRIEF ASSESSMENT OF
COGNITION IN SCHIZOPHRENIA) AMONG SCHIZOPHRENIC INPATIENTS
Chadia Haddad1,2,8; Pascale Salameh3,4,5; Souheil Hallit3,6; Sahar Obeid2,3,7; Georges Haddad2,6; Jean-
Pierre Clément1,8,9*; Benjamin Calvet1,8,9 *
1
INSERM, Univ. Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and
Tropical Neurology, GEIST, Limoges, France; 2Research department, Psychiatric Hospital of the Cross,
Jal Eddib, Lebanon; 3INSPECT-LB: Institut National de Sante Publique, Epidémiologie Clinique et
Toxicologie, Beirut, Lebanon; 4Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; 5School of
Medicine, University of Nicosia, Cyprus; 6Faculty of Medicine and Medical Sciences, Holy Spirit
University of Kaslik (USEK), Jounieh, Lebanon; 7Faculty of Arts and Sciences, Holy Spirit University of
Kaslik (USEK), Jounieh, Lebanon; 8Pôle Universitaire de Psychiatrie de l’Adulte, de l’Agée et
d’Addictologie, centre hospitalier Esquirol, Limoges, France; 9Centre mémoire de ressources et de
recherche du Limousin, centre hospitalier Esquirol, Limoges, France
*Last co-author
Introduction: Assessment of cognitive disorders in schizophrenia is becoming a part of clinical and

research practice by using batteries that differ widely in their content. The Brief Assessment of
Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia.
The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a
standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls.
Methods: A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls
received the Arabic version of the BACS in a first session, and a standard battery in a second session.
Results: Mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia.
All tests demonstrated significant differences between controls and patients (p < .01). Principal
components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the
variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly
correlated with the standard battery composite scores in patients (r = .78, p < .001) and healthy
controls (r = .77, p < .001). Also, correlation analysis between the BACS sub-scores and the standard
battery sub-scores showed significant results (p < .05). The Arabic-BACS demonstrated high ability to
discriminate patients with schizophrenia from healthy controls.
Conclusion: Results showed that the Arabic version of the BACS is a useful tool for assessing cognition
in patients with schizophrenia and could be used in clinical practice in Lebanon.

54
CEREBRAL INFARCTION IN YOUNG ADULTS. ANALYSIS OF 104 CASES
Otto Jesus Hernandez Fustes1; Carlos Arteaga Rodriguez2; Mabel Kawasaki3
Federal University of Paraná-UFPR, Curitiba, Brazil; 2Universidade Positivo, Curitiba, Brazil; 3Clinica
1
Neurológica, Francisco Beltrão, Brazil
Introduction: Ischemic cerebral infarction (ICI) in young adults continues to be a complex and
heterogeneous pathology, associated with diagnostic errors in the identification of its initial clinical
manifestations. Epidemiological studies indicate an increase in the incidence of ICI in young people,
with a significant socio-economic and psychosocial impact.
Material and Methods: A retrospective and descriptive study was carried out of 104 patients with a
diagnosis of ICI aged between 19-45 years, admitted to the Neurology Service of a University Hospital
in Curitiba, Brazil, during a period of four years. We analyzed the data from the ICI protocol with
demographic and clinical data.
Results: Young adults with ICI represented 11.2% of the total number of patients treated with this
pathology in our hospital in the same period. We studied 53 men with an average age of 39.3 years
and 51 women with an average age of 36.9 years. Motor impairment (hemiplegia or hemiparesis) was
the most frequent clinical manifestation on admission, followed by aphasia and altered consciousness.
All patients were admitted between 2 hours to 24 hours from the beginning of their clinical
manifestations. The anterior circulation was the most compromised (85.8%).
Conclusion: Hypertension, use of illicit drugs, use of oral contraceptives and increased levels of
fibrinogen isolated foram fatores important for the development of cerebral infarction.

55
NEUROCOACH - A VIRTUAL THERAPIST FOR POST-STROKE RECOVERY
Michael Hittle; Maarten Lansberg
Stanford University School of Medicine, Department of Neurology, Stanford, United States
Stroke is the leading cause of disability in the United States. Hemiparesis (arm and/or leg weakness),
affecting up to 66% of stroke survivors, is a major cause of post-stroke disability. Recovery from
hemiparesis is often limited by our current rehabilitation model. These limitations include:
1) Lack of resources to offer long-term daily intensive therapy.
2) Diminishing motivation over time to continue rehabilitation therapy as both patients and medical
providers have no easy way to objectively track progress.
3) Significant time cost for outpatient services (2-4 hours per 1-hour therapy session), and a lack of
options to transport stroke patients to outpatient rehabilitation centers or to offer rehabilitation in
the patient’s home environment.
The current model for stroke recovery is broken and precludes many patients from achieving their
potential in recovery. The NeuroCoach Platform promises to address the limitations of the current
model, increase at-home rehabilitation in stroke patients, and enhance our understanding of a
patient’s recovery and rehabilitation - resulting in better care and better outcomes.
The NeuroCoach Platform is a mobile application coupled with a web-based provider dashboard that
delivers personalized rehabilitation protocols and interventions to patients in the comfort of their
home, while measuring compliance and movement quality using the watch-based sensors and
collected video. NeuroCoach empowers providers to monitor and treat large patient populations in a
fraction of time, while reducing costs and illuminating a patient's activities and recovery outside the
clinic.
We are currently running a clinical trial trial to explore the feasibility and efficacy of the NeuroCoach
Platform and provide the groundwork for subsequent studies and implementations.

56
TOWARDS A CLINICALLY USEFUL RISK PREDICTION TOOL FOR DEMENTIA
Arfan Ikram
Erasmus University Medical Center, Rotterdam, The Netherlands
Objectives: Dementia, including Alzheimer’s disease (AD), is a multifactorial disease with multiple
interacting pathways leading to the ultimate clinical syndrome. As such, any diagnostic and predictive
panel should be reflective of these various pathways and it is therefore unlikely that a single biomarker
will provide sufficient diagnostic or predictive accuracy.
Methods and Results: In the Rotterdam Study, we have set-up a research line on prediction of
dementia that focuses on this multifactorial origin of the disease. We have first established a ‘basic’
model for non-laboratory-based prediction of dementia that can be used in primary care. Predictors
at this stage include age, history of stroke, subjective memory complaints, and instrumental activities
of daily living. We have then expanded this model by incorporating laboratory-based predictors from
various modalities: APOE reflecting the genetic component, memory scores reflecting cognitive
functioning, and brain volume, hippocampus volume and white matter lesions providing imaging-
based biomarkers. This extended model meaningfully improves on the basic model. We are now in
the process of further expanding this model by including advanced imaging markers (e.g., diffusion-
tensor, amyloid-PET, resting state fMRI), emerging -omics markers (rare variants, metabolomics,
miRNA) and blood-based biomarkers (amyloid-beta40 and 42, NFL, tau).
Conclusions: A clinically useful risk prediction model for dementia should involve biomarkers
reflecting the various underlying risk factors and pathologies. This talk will showcase the performance
of the basic and extended models; will highlight ongoing work on expanding the set of ‘advanced’
markers; and pinpoint some avenues for research in coming years.

57
EVALUATING THE POTENTIAL OF MOBILE PHONE-BASED APPLICATIONS IN IMPROVING STROKE

AWARENESS AMONG WITH AUCKLAND POPULATION
Navneet Kaur
Auckland University of Technology, Auckland, New Zealand
Objective: Stroke, a cerebrovascular disorder, has been recognized as the third leading cause of
disabilities worldwide. Recent studies have reported that the lack of awareness regarding symptoms
and risk factors of stroke in the general population could potentially be contributing to the increased
health burden. Hence, the objective of the current study was to explore whether the avenue of
smartphone-based applications, such as Stroke Riskometer, can be utilized to improve stroke
awareness.
Method: A mixed-methods approach was utilized to assist in evaluating the potential of Stroke
Riskometer in improving stroke awareness. Repeated measures experimental design was utilized to
measure the participants’ stroke awareness at two varying times (baseline and following
intervention). Adapted questionnaires with overlapping ten questions were employed to assess the
stroke awareness. Stroke awareness was computed by assigning points for every correct response.
Additionally, two focus groups were also employed to gain insight into the participants' experience
with the Riskometer.
Results: Thirty participants (23 for the quantitative segment, and seven for the qualitative segment)
were included in the final analysis. A statistically significant difference in the stroke awareness
following an interaction with the Stroke Riskometer was detected via repeated measures ANOVA (F(1,
23) = 27.60, p<0.05). The narratives from participants implicated the role of Stroke Riskometer as an
avenue for acquiring new and potentially life-saving information. Additionally, the personalization of
information was also reported as empowering and helpful.
Conclusion: The study provides preliminary evidence regarding the potential of smartphone-based
applications such as Stroke Riskometer in improving stroke awareness. The devoted sections in the
application aiming to disseminate personalized information regarding risk factors and symptoms of
stroke was recognized as empowering and reassuring by the participants. Hence, primary awareness
interventions facilitated through applications such as Stroke Riskometer can potentially assist in
improving the stroke awareness of the population.

58
“THEY’VE GOT A BIT BETTER AND THEY’RE GOOD ENOUGH TO GO BACK…” PERSPECTIVES ON
STROKE REHABILITATION FOR ABORIGINAL SURVIVORS
Janet Kelly1; Anna Dowling1; Susan Hillier2; Alex Brown1; Tim Kleinig3; Kendall Goldsmith4; Katharine
McBride2; Jeyaraj Pandian5; Sally Castle4; Amanda Thrift6
1
South Australian Health & Medical Research Institute, Adelaide, Australia; 2University of South
Australia, Adelaide, Australia; 3University of Adelaide, Adelaide, Australia; 4SA Health, Adelaide,
Australia; 5Christian Medical College, Ludhiana, India; 6Monash university, Victoria, Australia
Background: Stroke incidence is greater among Aboriginal and Torres Strait Islander (hereinafter
respectfully termed Aboriginal) peoples than non-Aboriginal people in Australia, with stroke occurring
at younger ages. Little is known about the preferences of Aboriginal people for rehabilitation following
a stroke. We aimed to identify the needs of Aboriginal people who have a stroke, from the
perspectives of Aboriginal survivors and health care providers, specifically focussing on rehabilitation
services and longer-term support.
Methods: We interviewed Aboriginal people who had experienced stroke in the prior 3 years. We also
conducted focus group discussions or individual interviews among health professionals who provided
care in each of six designated hospitals and community health centres. Data from all interviews were
analysed separately for Aboriginal survivors and health professionals, compared using NVivo, and
organised into themes and subthemes.
Results: Six Aboriginal survivors and five health care professionals were interviewed individually, while
73 health care providers participated in 11 focus groups. Four main themes emerged: the importance
of family in sharing health information and providing support at home; variable access to services,
including reduced services in rural and remote regions; the impact of stroke on Aboriginal people’s
lives including access to appropriate accommodation options and financial implications; and making
positive lifestyle choices. Issues were compounded by co-morbidities, conflicting priorities, and
inadequate or inflexible services and transport. Both patients and healthcare providers highlighted
the importance of communication and involvement of family as essential for a shared understanding,
particularly when making decisions about participating in short and long-term rehabilitation. Stories
of resilience were also shared.
Conclusions: Aboriginal people report making positive lifestyle changes, but experience significant
unmet rehabilitation needs. Addressing issues of communication, advocacy and flexible delivery
should improve some of the shortfalls in service provision, particularly in regional and remote areas.

59
COSTS OF DEMENTIA IN LOW-AND-MIDDLE INCOME COUNTRIES: A SYSTEMATIC REVIEW
Angeladine Kenne Malaha; Clémence Thébaut; Dayna Achille; Pierre-Marie Preux; Maëlenn Guerchet
INSERM U1094 Tropical Neuroepidemiology, Limoges, France
Objective: To review studies conducted on the costs of dementia in low- and middle-income countries
(LMICs), describe their methodology and summarize costs
estimates.
Methods: We conducted a systematic review, searching in bibliographic databases in health,
economics and social sciences, and main grey literature resources. Publications were evaluated by two
independent investigators, conflict discussed, and the final decision taken by a third investigator. We
included all studies presenting costs of any aspect of dementia care.
Results: Overall, 6,843 title and abstract, then 74 full texts articles evaluated. Finally, 15 single studies
were included. Those were from only 9 out of the 156 LMICs: China (6); Brazil (2); and one from
Argentina, Colombia, Iran, Peru, Romania, Thailand and Turkey. No study was from Africa. Studies
focused mainly on Alzheimer’s disease. Studies investigated all three categories of cost-of-illness i.e.,
medical, social and informal care costs, but items, data collection and definitions in each category
were highly variable. Dementia costs tend to increase with the severity of the disease with greater
medical costs in the mild stage and higher social and informal care costs in the moderate and severe
stages. Costs estimates varied widely: from $327.4 to $1,266.3 for annual medical costs, from $112.4
to $5,575.0 for social costs; and costs from $324.0 to $10,031.1 for informal care. Overall, dementia
care cost up to $19,101 per year for a single patient, usually at the charge of families.
Conclusion: Limited studies have been conducted on dementia costs in LMICs, with none so far in
Africa. It appears urgent to provide accurate evidence of the disease burden in the region to guide
public health policies.

60
NEUROEPIDEMIOLOGY IN LATIN AMERICA
Carlos N. Ketzoian
Sección Neuroepidemiología, Institute of Neurology, Montevideo, Uruguay
The development of Neuroepidemiology studies in Latin America has a history of over 40 years,
through which several researchers from different countries have recorded and documented their
findings.
A highly relevant role was played by Professor Bruce Schoenberg from the Institute National of Health,
U.S.A., and Professor Michel Dumas from the Institut d'Épidemiologie et Neurologie Tropicale,
Limoges, France.
The First Pan American Congress of Neuroepidemiology was held in Bogotá, Colombia in 1985. After
this first congress, two Pan American Neuroepidemiology Congresses were held: the second one in
Santiago de Chile in 1986, and the third and last one in 2010 in Punta del Este, Uruguay.
There have been many symposia and meetings on this topic, particularly as satellite activities of the
Pan American Congresses of Neurology, such as the Meetings of Puerto Rico in 1987, Montevideo,
Uruguay in 1991, Guatemala in 1995, Buenos Aires, Argentina, in 1997, Cartagena de Indias, Colombia
in 1999, Santiago, Chile in 2003, San Diego, USA in 2006, Santo Domingo, Dominican Republic in 2007,
Punta del Este, Uruguay in 2010, and La Paz, Bolivia in 2012.
There are more than 60 research teams in Neuroepidemiology in 17 Latin American countries working
on one (26 - 43%) or more (35 - 57%) neurological disorders.
The diseases most frequently studied by neuroepidemiologic researchers in Latin America are
epilepsy, multiple sclerosis and dementia. There are also specific neurologic diseases studied
regarding regional problems (neurological disorders by altitude - Bolivia-Peru, neurocysticercosis,
among others).
Moreover, Latin America has strengths to conduct neuroepidemiological surveys, which should be
exploited to achieve their development. Data about those will be provided.
Aspects of training in Neuroepidemiology in different countries of the region will be presented, with
special emphasis on training in neurological research methodology.

61
EPIDEMIOLOGY OF PARKINSON DISEASE IN ODESSA (2017-2019)
Iryna Khubetova1; Yurii Vorokhta2
Odessa Regional Hospital, Odessa, Ukraine; 2Odessa International Medical University, Odessa,
1
Ukraine
The aim of the study is to estimate the prevalence of Parkinson's disease in the city of Odessa for 2017-
2019.
Material and methods: An analysis of the reporting documentation for 2017-2019 was carried out,
the general level of prevalence of Parkinson's disease (G20) and the frequency of new cases were
determined. A comparison of epidemiological indicators with global and national indicators has been
carried out.
Results: Today, Parkinson's disease is perhaps the highest rate of spread among neurological diseases.
According to experts, there are 4 million patients in the world, and by 2040 their number will reach
14.2 million, as humanity is rapidly aging. According to statistics from the Ministry of Health, over
23,000 people with Parkinson's disease are registered in Ukraine, or 61.4 per 100,000 population.
Every year 2,500 Ukrainians get be informed about this diagnosis from doctors.
According to our previous studies, the incidence of Parkinson's disease in urban areas is higher than
in rural areas, apparently due to better detection. Thus, according to monitoring data in the city of
Odessa, there is a constant increase in the incidence of PD. If in 2017 308 patients or 47.3 cases per
100,000 population were detected, then in 2018 - 435 (52.2 per 100,000 population), and in 2019 -
481 (57.8 per 100,000 population). The detection rate of new cases of Parkinson's disease ranged from
2.0 to 3.7 cases per 100,000 population. Thus, the prevalence of BP in the city of Odessa for the
analyzed period corresponds to the national values.
Conclusions: In recent years, there has been a tendency towards an increase in the prevalence of
Parkinson's disease among the population of Odessa.

62
AUSTRALIAN STROKE DATA LINKAGE PROGRAM: USING DATA TO IMPROVE OUTCOMES
Monique Kilkenny1,2, on behalf of the National Stroke Data Linkage Interest Group
1
School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; 2Stroke
Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Objectives: To describe the successful linkages between the Australian Stroke Clinical Registry (AuSCR)
and state-based and national administrative datasets. To identify projects and individual case studies
used to generate evidence to understand variations in the continuum of stroke care and outcomes.
Methods: Our data linkage program has been funded with grants (over the last ten years) from the
Australian National Health and Medical Research Council (3 Projects: Stroke123, CRE Stroke
Rehabilitation and PRECISE) and the Stroke Foundation (3 Projects: GPStroke, Ambulance and POLAR).
Data from >80 hospitals in the AuSCR (~120,000 registrants) are now linked to one or more of the
following datasets (~23 million records): ambulance records, emergency presentations, inpatient
admissions, physician visits, medication dispensing, rehabilitation admissions, aged care, mortality
and primary care practitioner consultations.
Results: These datasets have been used to generate evidence to understand stroke care and
outcomes. Several important and novel questions have been answered using the data. These include:
the impact of acute care on readmissions and survival (Stroke123); adherence to secondary
prevention medications and frequency of primary care consultations after stroke (GPStroke); the
influence of ambulance transport (Ambulance); and outcomes after rehabilitation (CRE Stroke
Rehabilitation). With further interrogation of these datasets, we can identify sub-optimal care and
assess the effectiveness of primary care models (PRECISE).
Conclusions: Stroke is the third leading cause of global disease burden. The program has been
visionary and remains highly contemporary in the field of linked data and its use in reforming health
policy. There is active participation of clinicians and policymakers to ensure the results generated from
specific research questions have direct benefits accelerating change in practice and translating into
policy.

63
CAN ALZHEIMER'S DISEASE EVER BE PREVENTED
Amos D Korczyn
Department of Neurology, Tel Aviv University, Tel Aviv, Israel; CONy president
Dementia is an important public health problem of increasing magnitude. At present, available

therapies provide only minor and temporary relief, and attempts to find a cure have so far failed. The
suggestion to abolish amyloid or tau have largely been disproven. Epidemiological studies have
identified risk factors for dementia, particularly Alzheimer's disease and vascular dementia. In
principle, these findings provide an opportunity to intervene and prevent the dementia epidemic.
Attention to nongenetic risk factors such as hypertension, hyperlipidemia, smoking, and obesity may
thus not only prevent cardiovascular disease but also dementia, although it is difficult to prove the
efficacy of these measures for dementia prevention. In fact, it is more appropriate to speak about
delaying the onset of dementia than preventing it altogether.

64
FEASIBILITY OF DEMENTIA ASSESSMENTS IN THE NEW ZEALAND (NZ) INDIAN COMMUNITY
Rita Krishnamurthi1; Adrian Martinez-Ruiz2; Susan Yates2; Ekta Singh Dahiya1; Sanjalin Naiker2; Reshmi
Bala2; Sarah Cullum2 on behalf of the Lived Experiences of Dementia in Aotearoa (LiDiA) Group
1
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology,
Auckland, New Zealand; 2Department of Psychological Medicine, The University of Auckland,
Auckland, New Zealand
Objectives: The number of people living with dementia in NZ is over 60,000 but these figures are
estimates, based on extrapolated data. There has never been a community-based prevalence study in
NZ, and little is known about the impact of dementia in the NZ Indian community. We aimed to
determine if a full-scale dementia prevalence study is feasible and to test the acceptability of
procedures and measures. A multi-ethnic study is currently underway, we present the preliminary
findings from Indian and Fijian-Indian community here.
Methods: We utilised the Statistics NZ meshblock (pre-specified geographic units) to recruit a
representative sample of the population meeting inclusion criteria. All study materials including
consent forms and questionnaires were translated into Hindi, and Fijian Hindi (a dialect spoken in Fiji).
Interviewers were fully trained in all the procedures, including on culturally appropriate processes.
Subsequently, the 10/66 (Prince M, BMC Public Health. 2007) dementia assessment protocol (global
gold standard language and culture-fair assessment tool for dementia diagnoses) was administered.
The assessment includes three main sections: 1) Participant, 2) Informant, and 3) Household.
Results: A total of 1,607 households were approached, of which 377 people were over 65 years old.
Of these 60% agreed to be contacted, and a total of 65 were of Indian or Fijian Indian ethnicity. To
date, 19 interviews have been completed. A diagnosis of dementia was determined in 15% of this
sample.
Conclusions: Preliminary findings have showed that a community-based prevalence study in the
Indian community in NZ is feasible. Informal feedback from both interviewers and participants
(including caregivers) showed that the initial approach, and interview procedures are acceptable.
Learnings from this study will be utilised to design a full-scale dementia prevalence study in the
community. This data is crucial to plan for ethnic specific dementia care services.

65
HEALTH AND WELLNESS COACHING TO IMPROVE LIFESTYLE RISK FOR STROKE PREVENTION
Rita Krishnamurthi1; Susan Mahon1; Suzanne Barker-Collo2; Priya Parmar1; Takayoshi Ikeda1; Alain C
Vandal3; Valery L Feigin1
1
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology,
Auckland, New Zealand; 2Department of Psychology, The University of Auckland, Auckland, New
Zealand; 3Department of Statistics, The University of Auckland, Auckland, New Zealand
Objectives: Health and Wellness Coaching (HWC) is a psychological intervention that can motivate
people to improve lifestyle behaviors. Hence HWC has the potential to reduce the risk of stroke and
cardiovascular disease (CVD). We aimed to determine the effectiveness of HWC in the 5-year risk of
CVD and stroke (primary outcome) as well as improving lifestyle behaviour using the Life’s Simple 7
(LS7) scale for cardiovascular health. Here we present the findings for the effect of HWC on LS7.
Methods: We conducted a Phase III, prospective, pragmatic, open-label, single blinded endpoint 2-
arm randomised controlled trial. Participants with a 5-year CVD risk of ≥10% were recruited from
primary care practices in New Zealand and randomized into HWC or Usual Care (UC). HWC participants
received 15 individualized sessions over nine months, by trained coaches. LS7 (range 0 [no healthy risk
factors] to 7 [all healthy risk factors]) was assessed at baseline and 9-months post-randomisation. The
difference of means between the arms was assessed for all outcomes at baseline and at 9 months
using linear or logistic regression as relevant.
Results: A total 1116 participants were screened, of which 320 eligible participants (mean age 60
years, 62% male) were randomised (HWC n=161, UC n=159). At 9-months, 77% of HWC and 90% of
UC completed the LS7 assessment. There was a significant improvement in the total LS7 score of 0.485
(95% CI [0.0738, 0.896], p= 0.0214), and blood pressure score (odds ratio 1.83, 95%CI [1.13,2.97],
p=0.0143), in the HWC group compared to UC. There was no significant difference in the overall 5-
year CVD or other LS7 components between the groups.
Conclusions: HWC has the potential to improve lifestyle risk factors in those at increased risk of CVD.
As high blood pressure is the most significant modifiable risk factor for stroke, implementing HWC in
primary healthcare has the potential to reduce stroke incidence.

66
MACROPHAGES ACTIVITIES DISORDERS IN THE ACUTE PERIOD OF VARYING SEVERITY

EXPERIMENTAL HEMORRHAGIC STROKE
Andrey Kulchikov
Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
Background: In the acute period of stroke, the development of immunosuppression can lead to
infectious and inflammatory complications.
Aim. Study of the functional activity of macrophages in the acute period of varying severity
experimental stroke.
Materials and methods: In an experimental study on 45 Wistar Rats (210-230g), phagocytic activity,
spontaneous metabolic activity of spleen and abdominal macrophages, induced metabolic activity of
peritoneal macrophages, as well as spontaneous and induced adhesive activity and additionally
inhibition of modified adhesive activity of peritoneal macrophages were assessed at experimental
stroke (ES) (in the area of the left capsula interna) of mild, moderate and severe. These parameters
assessed in 72 hours after modeling experimental stroke of varying severity.
Results: Modeling experimental stroke of varying severity after 72 hours led to a decrease in
phagocytic (Mild ES: 5.00 [4.00; 5.25]%, Moderate ES: 5.00 [4.00; 5.25]%, Severe ES: 3.00 [2.75;
3.25]%) and spontaneous metabolic (Mild ES: 28.00 [26.75; 30.50] c.u., Moderate ES: 24.50 [23.75;
27.00] c.u., Severe ES: 22.00 [20.50; 23.25] c.u.) of spleen macrophage activity with significant
differences compared to control group (p<0.001). At the same time, there was a decrease in
phagocytic, spontaneous and induced metabolic activity of peritoneal macrophages with significant
differences compared to control group (p<0.001). An increase in the adhesive activity of peritoneal
macrophages was also found (Mild ES: 1299.50 [1283.50; 1328.50] c.u., p<0.001; Moderate ES:
[1393.50; 1442.75] c.u., p<0.001; Severe ES: 1495.00 [1464.00; 1550.50] c.u., p<0.001) with significant
differences compared to the control group. These disorders increase in animals with more severe
stroke patterns.
Conclusion: In the acute period of stroke, there is a decrease in the functional activity of macrophages
with an increase in their adhesive activity, which increase in more severe models of stroke.

67
DISORDERS OF THE DISTRIBUTION OF SPLEEN LYMPHOCYTES BY THE PHASES OF THE CELL CYCLE
WITH EXPERIMENTAL STROKE OF VARYING SEVERITY GRADES
Andrey Kulchikov
Institute of General Pathology and Pathophysiology, Moscow, Russian Federation
Background: The impairment of the immune system during stroke plays an important pathogenic role
during the course of this disease and generally develops at a systemic level from depression of a non-
specific and cellular immunity, activation of humoral immunity and imbalance in the cytokine system.
The aim: to study the proliferative activity and distribution of lymphocytes in the phases of the cell
cycle in stroke varying severity grades.
Materials and methods: in an experimental study (Animals were Wistar rats weighing 200-220 g,
N=55), the proliferative activity and distribution of spleen T- and B lymphocytes in the mitotic cycle
were studied in an experimental stroke in the left hemisphere (capsula interna) mild, moderate and
severe stroke model.
Results: in the modeling of the Stroke, there were changes in the distribution of B-lymphocytes by the
phases of the cell cycle in the form of a decrease in proliferative activity, as indicated by a decrease in
the pool of cells in the Stroke groups in S-phase (Mild Stroke: 55.72±4.23%; Moderate Stroke: 53.16 ±
4.13%; Severe Stroke: 47.69±4.92%), in the G2/M-phases (Mild Stroke: 1.06±0.27%; Moderate Stroke:
0.86±0.26%; Severe Stroke: 0.55±0.15%), and an increase in cells in the G0/G1-phases (Mild Stroke:
43.22±4.15%; Moderate Stroke: 45.98±4.06%; Severe Stroke: 51.76±4.99%) with significant
differences. A similar tendency was noted in relation to T-lymphocytes in the Stroke groups as a
decrease in the percentage of cells in the S-phase and an increase in the pool of cells in the G0/G1-
phases, but an increase in the number of lymphocytes in the G2/M-phases with significant differences.
These changes increase with the severity of the stroke grade model.
Conclusion: acute cerebrovascular pathology leads to disruption of the distribution of T- and B-
lymphocytes of the spleen across the phases of the cell cycle and a decrease in their proliferative
activity, increasing with the severity of the stroke grade model.

68
EXCESS MORTALITY IN STROKE PATIENTS AGED 80+ YEARS RECEIVING ACUTE ENDOVASCULAR
RECANALIZATION THERAPY, EASTERN DENMARK 2017-2019
Nicolaj Grønbæk Laugesen1; Klaus Hansen1; Trine Stavngaard2; Joan Højgaard1; Thomas Truelsen1
1
Neurological Dept., Rigshospitalet, Copenhaen, Denmark; 2
Radiology Dept., Rigshospitalet,
Copenhagen, Denmark
Objectives: To assess the outcome and predictors of good outcome in patients aged 80+ years with
acute ischemic stroke with large vessel occlusion (AIS-LVO) who receive acute endovascular
recanalization treatment (aERT) based on real-life-data (RLD).
Methods: Prospective observational cohort study of all patients with arterial puncture for aERT in
Eastern Denmark (2018 census 2.6 million). Patients were enrolled from January 1st, 2017 to
December 31st, 2019. Outcome was assessed using the modified Rankin Scale (mRS) at 3 months.
Predictors of an unfavorable outcome (mRS 3-6) in patients aged 80+ years were analyzed with
multivariate logistic regression analyses confined to patients with pre-stroke mRS 0-2 adjusting for
baseline NIHSS, ASPECT score and collateral status, age, sex, treatment with thrombolysis, and co-
morbidity status (diabetes, atrial fibrillation, ischemic heart disease, hypertension, previous stroke,
peripheral arterial disease).
Results: A total of 714 AIS-LVO patients were treated with aERT of which 176 (24.7%) were aged 80+
years. At 3 months mRS 0-2 was observed in 269 (50%) <80 years and in 61 (34.7%) in patients aged
80+ years, P=0.001, whereas mortality was 17.8 % in patients aged <80 years and 36.4 % in patients
aged 80+ years, P<0.001. In multivariate analyses a significantly increased risk of unfavorable outcome
was observed with decreasing ASPECT score, Odds Ratio (OR) =1.74 (95%CI: 1.4-2.64), increasing
NIHSS, OR=1.09 (95%CI: 1.01-1.18), and increasing age, OR=1.14 (95%CI: 1.02-1.29). All patients aged
80+ years with ASPECT <6 had unfavorable mRS at 3-months.
Conclusions: In this large study based on RLD mortality at 3-months was significantly higher in patients
with AIS-LVO treated with aERT who were 80+ years compared with patients <80 years. In multivariate
analyses ASPECT score, NIHSS, and increasing age were significant predictors of unfavorable outcome
but not sex, collateral score, comorbidity, or treatment with thrombolysis.

69
REDUCTION IN ACUTE STROKE ADMISSIONS DURING THE COVID-19 PANDEMIC – DATA FROM THE
ISRAELI NATIONAL STROKE REGISTRY
Carmit Libruder1; Amit Ram1; Yael Hershkovitz1; David Tanne2; Natan Bornstein3; Ronen Leker4; Anat
Horev5; Hen Hallevi6; Shlomi Peretz7; David Orion8; Inbar Zucker1
1
Ministry of Health, Ramat Gan, Israel; 2Rambam Health Care Campus, Technion Faculty of Medicine,
Haifa, Israel; 3Shaare Zedek Medical Center, Jerusalem, Israel; 4Hadassah-Hebrew University Medical
Center, Jerusalem, Israel; 5Soroka University Medical Center, Beer-Sheva, Israel; 6Tel Aviv Sourasky
Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 7Rabin Medical
Center, Petach Tikva, Israel; 8Chaim Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
Background: The COVID-19 pandemic overwhelmed healthcare systems worldwide. We aimed to

investigate the impact of the COVID-19 outbreak on admission rates and in-hospital care for acute
stroke and transient ischemic attack (TIA) in Israel.
Methods: We conducted a retrospective observational study, based on data reported to the Israeli
National Stroke Registry from seven tertiary hospitals. Included were all admissions for acute stroke
or TIA that occurred between January 1 and April 30, 2020. Data were stratified into two periods
according to the timing of COVID-19 restrictions: 1) "Pre-pandemic": January 1 to March 7, 2020. 2)
"Pandemic": March 8 to April 30, 2020. We compared the average number of weekly hospital
admissions between the two periods. We further investigated changes in demographic characteristics
and in some key parameters of stroke-care, including: percentage of reperfusion therapies performed;
time from hospital arrival to brain imaging and to thrombolysis; length of hospital stay and in-hospital
mortality.
Results: Included were 2,260 cases: 1,469 in the pre-COVID-19 period and 791 in the COVID-19 period.
The average number of weekly hospital admissions significantly declined between the two periods, by
47.6% for TIA and by 29.3% for stroke. No significant changes were detected in demographic
characteristics and in most parameters of stroke management. Higher in-hospital mortality was
noticed only for hemorrhagic stroke.
Conclusions: The observed decrease in admissions for acute stroke and TIA is of great concern. Public
awareness campaigns are needed, as patients reluctant to seek urgent stroke-care are deprived of
lifesaving procedures and secondary prevention treatments.

70
COMPREHENSIVE AND STRUCTURED 3-MONTH STROKE FOLLOW-UP USING THE POST-STROKE

CHECKLIST (THE STRUCT-FU STUDY): A FEASIBILITY AND EXPLORATIVE STUDY
Kristina Månsson; Teresa Ullberg; Ida Berhin; Helene Pessah-Rasmussen
Department of Neurology, Skåne University Hospital, Lund University, Lund, Sweden
Background: The Struct-FU study aims to assess the feasibility of a comprehensive stroke follow-up
model and to map stroke-related problems and subsequent multidisciplinary interventions using a
modified Post-stroke Checklist (PSC).
Methods: We consecutively screened all acute stroke patients at Skåne University Hospital, Sweden
in 2018–2019. Patients discharged to own home were eligible for inclusion. We defined a stroke-
related health problem as a health- or social issue corresponding to one of the 14 items in the modified
PSC. Three-months post-stroke, a semi-structured interview using a 14-item modified PSC was
completed to map the prevalence of stroke-related health problems, as well as any subsequent
multidisciplinary stroke team interventions.
Results: The number of included patients was 200, of whom 165 (82.9%) completed three-month
follow-up. The majority (92.7%) reported stroke-related problems identified using the PSC, with the
median number being three per patient, and half having four or more problems. Patients <=65 years
(n=44) presented with more stroke-related problems than patients >65 years (n=121) (5 vs. 3,
p=0.003). The median number of interventions was two per patient. Doctor’s interventions (changes
in medication, referrals or further work-up) were done in 53% of patients, 77% needed a nurse’s or
other stroke team professional’s intervention. Only 3.6% of patients reported other stroke-related
challenges (PSC item 14) than those specified in item 1–13.
Conclusion: We report a high burden of stroke-related health problems in community dwelling stroke
patients with mild to moderate stroke. Multidisciplinary interventions were prompted in the vast
majority (85%). Only 3.6% of patients reported challenges not captured with the Post-stroke Checklist,
reflecting that the comprehensive approach captures the majority of stroke-related health problems,
and gives a good estimate of the total stroke-related health burden for each individual.

71
VIRTUAL REALITY IN APHASIA REHABILITATION: APPLICATIONS OF EVA PARK
Jane Marshall1; Stephanie Wilson2; Niamh Devane1; Richard Talbot1; Madeline Cruice1
1
Division of Language and Communication Science, City University of London, London, United
Kingdom; 2Centre for Human Computer Interaction Design, City, University of London, London, United
Kingdom
Objectives: Two studies explored whether aphasia intervention can be delivered online via a virtual
reality platform called EVA Park. Intervention in Study 1 targeted individual communication skills.
Group intervention in Study 2 targeted wellbeing. Feasibility findings and indicative outcomes were
explored.
Methods: EVA Park is a virtual island designed with and for people with aphasia. It contains a range of
simulated settings, such as a café, houses, and hair salon. Intervention is delivered in real time by
therapists, support workers or volunteers. All users are represented by avatars. In Study 1 (N = 20)
participants received 25 hours of communication stimulation in EVA Park over 5 weeks. Activities
targeted individual communication goals, such as holding conversations. In Study 2 (N = 34)
participants received 21 hours of group social support in EVA Park over 6 months. The studies
employed randomised, waitlist-controlled designs. Outcomes were assessed on a range of measures,
and all participants with aphasia were interviewed post therapy.
Results: Feasibility findings in both studies were good. Compliance with treatment was high and
interviews demonstrated positive responses to receiving intervention in EVA Park. In Study 1 there
were significant gains on a measure of functional communication post therapy, although secondary
measures of word production, narrative, communication confidence and social isolation showed no
change. In Study 2 the primary measure of wellbeing showed no change post intervention. Secondary
measures of communication, social connectedness and quality of life were similarly unaffected.
Conclusions: The studies showed that it was feasible to deliver two, contrastive aphasia interventions
via EVA Park, a virtual reality platform. Therapy recipients were positive about using EVA Park and
found the platform accessible. Studies were not powered to evaluate therapy efficacy, although
indicative changes were reported in one.

72
A CLUSTER-RANDOMISED CONTROLLED TRIAL EVALUATING THE EFFECTIVENESS OF STROKE

RISKOMETER IN IMPROVING STROKE RISK AWARENESS IN ADULTS: A PRELIMINARY STUDY
Mohammed Zarudin Mat Said1; Kamarul Imran Musa1; Tengku Alina Tengku Ismail1; Anees Abdul
Hamid2; Ramesh Sahathevan3; Zariah Abdul Aziz4; Valery Feigin5
1
Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kelantan,
Malaysia; 2Primary Care Unit, Kelantan State Health Department, Jalan Bayam, Kelantan, Malaysia;
3
Department of Medicine and Neurology, Ballarat Health Services, Ballarat Victoria, Australia;
4
Department of Medicine, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia; 5National Institute
for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
Background: Stroke is a global public health problem with significant burden, especially to the low-
and middle-income countries. The Stroke Riskometer application (app) represents a new stroke
prevention strategy that is distinctly different from the conventional high-cardiovascular disease
(CVD) risk approach.
Objectives: This proposed study aims to evaluate the effectiveness of the Stroke Riskometer app in
improving stroke awareness and stroke risk probability amongst the adult population.
Methods: The study was designed as a parallel-group non-blinded cluster-randomised controlled trial
(RCT). It was conducted in Kelantan, Malaysia, with 6-months follow-up. A total of 116 participants
were randomised to either the interventional group (n = 58, who received free Stroke Riskometer app
and stroke informational leaflets) or the control group (n = 58, receive standard management).
Results: The mean age of participants was 31.97 (SD 9.89). There were no significant differences in the
baseline characteristics except for the household income (p-value = 0.023) and the body mass index
(BMI) (p-value = 0.038). The interventional group showed significant improvement in the stroke risk
awareness level within 3-weeks of study duration (64.4% vs 72.5%; 95% CI, 4.45 to 13.05). Over the 6-
weeks study period, the mean stroke risk probability of the interventional group has been significantly
lower than that of the control group (1.62% vs 1.95%; 95% CI, 0.119 to 0.888).
Conclusion: The preliminary study suggests that the Stroke Riskometer app resulted in more
favourable impact on both the stroke risk awareness level as well as the stroke risk probability. If
implemented on a larger scale - as a primary preventive modality - in Malaysia, the proposed
intervention can potentially benefit the control and prevention of stroke and other similar non-
communicable diseases.

73
DATA SCIENCE ADVANCES IN THE GLOBAL PREVENTION AND TREATMENT OF STROKE
George A. Mensah1; David C. Goff, Jr2; Walter L. Koroshetz3
1
Center for Translation Research and Implementation Science, National Heart, Lung, and Blood
Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Maryland, USA; 2Division of
Cardiovascular Sciences, NHLBI, NIH, Bethesda, Maryland, USA; 3Office of the Director, National
Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
Background: Remarkable computational and technological advances over the past decade now
provide data to guide global stroke prevention. These data provide potent metrics to inform public
health policy for reducing stroke burden. Objectives: Describe recent global health metrics for stroke.
Methods: Narrative review of published data using examples from GBD 2019 Study1 showing their
relevance for global stroke
prevention and treatment.2
Results: From 1990 to 2019, global
stroke burden rose steadily,
reaching 143 million DALYs, 6.55
million deaths, and 101 million
prevalent cases. However, age-
standardized rates (ASR) for deaths
and DALYs from stroke declined
globally over that period
suggesting importance of
population growth and ageing and
crucial role of prevention. ASR for
prevalence of stroke survivors
increased in several locations including in China, Indonesia, and parts of USA. ASR for deaths also
increased in locations in Indonesia and the Philippines. No sex differences were seen in patterns of
ischemic or hemorrhagic stroke. Regional disparities were substantial. ASR for deaths and DALYs were
highest in Oceania, Central Asia, East Asia, Southeast Asia, Eastern Europe, and sub-Saharan Africa,
while prevalence of stroke survivors was highest in Oceania, Southeast Asia, East Asia, and the Middle
East/North Africa regions. Conclusions: These findings suggest that data science advances can inform
global stroke prevention and regional stroke disparities reduction. They can be particularly invaluable
when coupled with geocoded data on access to stroke care and distribution of stroke care resources
at the local level.3
References
1. Roth GA, Mensah GA, Johnson CO, et al. Global Burden of Cardiovascular Diseases and Risk Factors,
1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76:2982-3021.
2. Mensah GA, et al. From Data to Action: Neuroepidemiology Informs Implementation Research for
Global Stroke Prevention and Treatment. Neuroepidemiology. 2015;45:221-229.
3. CDC. Chronic Disease GIS Exchange Map Gallery. https://go.usa.gov/xs4P7. Accessed 2/15/2021.

74
AVAILABILITY AND COST OF ANTIEPILEPTIC AND PSYCHOTROPIC DRUGS AFTER COMMUNITY-BASED

INTERVENTIONS IN MADAGASCAR
Sedera Aurélien Mioramalala1; Arsène Ratsimbasoa2; Roger Marie Ranomezantsoa3; Pierre-Emile

Bruand4; Pierre-Marie Preux1; Farid Boumédiène1
1
INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Neuroépidémiologie Tropicale, Institut
d’Epidémiologie et de Neurologie Tropicale, GEIST, Limoges, France; 2Département Santé Publique,
Faculté de Médecine de Fianarantsoa, Madagascar; 3Ecole Doctorale de Géochimie et Chimie
Médicinale (Medicinal Chemistry) - (GEOCHIMED), Université de Fianarantsoa, Madagascar; 4Global
Health Programs, Sanofi, Gentilly, France
Background: In Madagascar, prevalence of epilepsy is 27.3/1000 and the lifetime prevalence of mental
disorders 34.0. From 2013 to 2018, interventions were carried out by the MoH to train GPs on these
diseases and raise awareness among the population.
Objectives: The objective was to compare the availability and cost of drugs between intervention and
control areas in 8 regions of Madagascar.
Methods: Data were collected from all types of points of sale (POS) for medicines (public and private).
All psychotropic and antiepileptic drugs were included. The study received ethical approval from the
Madagascar MoH.
Results: 218 POS (82.5%) agreed to be investigated. Regarding the overall availability of AEDs, there
was no significant difference between intervention and control areas (95.9% vs 94.4% of POS stocking
at least one AED). There were however differences for carbamazepine (79.7% vs 53.4%) and sodium
valproate (27.0% vs 11.8%) with these being available in a greater number of POS in the intervention
areas (p <0.05). Phenobarbital was the most commonly stocked AED in both areas (90.5% and 88.9%
p=0.7). Phenytoin was not available in any supply chain. Among psychotropic drugs, anxiolytics
(89.0%) were the most frequently available overall, followed by neuroleptics (21.6%) and tricyclic
antidepressants (15.6%). There were significantly more outlets in the intervention areas having
tricyclic antidepressants (27.0%) and mood stabilizers (4.1%). The price of AEDs and psychotropic
drugs were lower in the intervention areas, except for injectable neuroleptics.
Conclusions: These results suggest greater availability and lower prices for antiepileptic and
psychotropic drugs in the intervention areas. As both availability and cost of drugs can affect access
to treatment, this provides a relevant focus for the national epilepsy and mental health strategic plan
after intervention.

75
STROKE INCIDENCE IN SARS-COVID EPIDEMICS: THE EXPERIENCE OF ODESSA
Tetiana Muratova1; Denis Khramtsov1; Alexander Stoyanov1; Sergiy Zbrozhek2; Ruslana Voronina3; I.
Khubetova4; Yurii Vorokhta4; Marina Vikarenko1; Galina Kozlova1; Iryna Dobush1; Eugene
Andryuschenko1
1
Odessa National Medical University, University Clinic, Odessa, Ukraine; 2 Hospital “Into-Sana”,
Odessa, Ukraine; 3 Hospital “Odrex”, Odessa, Ukraine; 4Odessa Regional Hospital, Odessa, Ukraine;
5
Odessa International Medical University, Odessa, Ukraine
The aim of the study was to assess the stroke incidence in Odessa in the context of the COVID
epidemic.
Material and methods: The analysis of reports on hospitalization of patients with stroke for 2019-
2020 was carried out. We studied the incidence of strokes in patients under 50 years of age, as well
as the incidence of stroke detection in patients with manifestations of acute COVID infection, as well
as convalescents after COVID.
Results: According to the Odessa Regional Laboratory Center of the Ministry of Health of Ukraine, as
of January 15, 2021, 77,753 cases of COVID-19 were registered in the Odessa region. Of these, 34,839
people are residents of Odessa. It was found that, compared to 2019, the number of hospitalizations
has changed slightly - from 933 to 976 hospitalizations per year ( = + 4.4%), which corresponds to
93.3 and 97.6 cases per 100,000 population. The number of stroke patients under the age of 50 did
not exceed 10% of the total number of hospitalizations. In 2020, 58 (5.9%) cases of stroke were
registered in patients with manifestations of acute COVID infection and 112 (11.5%) cases of stroke in
convalescents after COVID.
These data are consistent with previously published results by Mao et al. (2020), who determined that
5.7% of patients with a severe course of coronavirus infection may develop stroke. In a study by Li Y
et al. (2020) showed that the incidence of stroke in COVID-19 patients is about 5% with an average
age of 71.6 years.
Conclusions: The frequency of stroke in patients with manifestations of acute COVID infection in
Odessa was 5.9%, and in convalescents after COVID - 11.5%.

76
INNOVATIVE METHODS USING DIGITAL DEVICES IN CLINICAL AND EPIDEMIOLOGICAL RESEARCH ON

NEUROLOGIC DISORDERS
Lorene M Nelson
Stanford University School of Medicine, Stanford, United States
In recent years, the advent of digital mobile health devices has been a boon to the study of neurologic
disorders, largely because of the promise of obtaining remote objective measurement of neurologic
functions such as gait, dexterity, autonomic function, sleep, speech, cognition and other neurologic
parameters. These tools are relevant for prospective studies of patients, whether they be randomized
trials or observational cohort studies. Digital mobile devices offer the ability to obtain rich data on
neurologic function in real-world settings, capturing more nuanced assessment of phenotypic features
and functional consequences of neurologic disorders than when measures are taken less frequently
and restricted to clinical settings. During this brief keynote, Dr. Nelson will (1) illustrate the promise
of digital devices by providing examples of the most successful uses of digital devices in neurologic
research, (2) describe the challenges that researchers face when using digital technology, and (3)
discuss opportunities to expand this promising methodology in the study of neurologic disorders in
the coming decade. She will draw from her own research where she applied smartphone and Apple
Watch technology to conduct a prospective study for the purpose of identifying triggering factors
among patients with episodic migraine.

77
A QUALITATIVE STUDY OF FACTORS AFFECTING TIME TO TREATMENT OF ANEURYSMAL

SUBARACHNOID HAEMORRHAGE – THE REDDISH STUDY
Thuy Phuong Nguyen1; Christine Stirling1; Gemma Kitsos1; Linda Nichols1; Ronil V Chandra2; Sabah
Rehman1; Karen Smith3; Ian Mosley4; Leon Lai2; Hamed Asadi2; Jens Froelich5; Nova Thani5; Amanda
Thrift6; Seana Gall1
1
University of Tasmania, Hobart, Tasmania, Australia; 2Monash Health, Clayton, Victoria, Australia;
3
Ambulance Victoria, Doncaster, Victoria, Australia; 4Alfred Health, Melbourne, Victoria, Australia;
5
Royal Hobart Hospital, Hobart, Tasmania, Australia; 6Monash University, Clayton, Victoria, Australia
Objectives: Delays in treatment of aSAH appear to be common but the causes are not well
understood. We conducted a qualitative study to explore facilitators and barriers to timely treatment
of aSAH.
Methods: We used a multiple case study approach across two tertiary referral centres in Australia.
Cases of aSAH surviving >1 day were identified prospectively. We conducted semi-structured, face-to-
face/telephone interviews with the patient, their next-of-kin and health professionals focused on
events from symptom onset to treatment to secure the aneurysm. Interviews were recorded and
transcribed. Within-case analysis identified barriers and facilitators in 4 phases (pre-hospital,
presentation, transfer, in-hospital) followed by thematic analysis across cases using a case-study
matrix.
Results: Twenty-seven cases with 89 interviewees were included. Five themes were identified (see
word clouds, Figure 1). ‘Early recognition’ of aSAH/severe condition led to urgent response by all
stakeholders, facilitating shorter time to treatment. Conversely, not recognizing possible aSAH led to
slower responses. ‘Accessibility to health care’ could be a facilitator or barrier to timely treatment
depending on patient’s location, distance to facilities, transport, and environmental conditions.
‘Coordination’ between and within health services had both positive and negative impact on time to
treatment, however, good coordination as a facilitator was more dominant. ‘Complexity’ of patient’s
condition affected time to treatment in multiple time periods, depending on the level of complexity.
‘Availability of resources’ such as imaging staff or theatre availability were facilitators while
unavailability of resources was a barrier to timely treatment. This health system-related theme was
identified most frequently during diagnosis and treatment phases.
Conclusions: The identified themes may be modifiable at the patient/health professional level and
health system level and may improve timely treatment of aSAH.

78
USING STROKE STATISTICS FOR POLICY PURPOSES – CHALLENGES AND OPPORTUNITIES
Bo Norrving
Department of Clinical Sciences/Neurology Medical Faculty, Lund University, Lund, Sweden
Objectives: Epidemiological data on stroke are often included in advocacy and policy activities to
increase the awareness of stroke in the population, to improve prevention of stroke, and to improve
stroke services. However, the way such data are presented and aligned with other facts or arguments
differ.
Methods: This plenary talk will present a model how statistical stroke data can be combined with
other arguments, based on the author’s experience from activities within the civil society (scientific
stroke societies and stroke support organizations) and governmental organizations.
Results: To ensure a common data source and language for the presentation of stroke statistics, the
World Stroke Organization published the Global Stroke Fact Sheet 2019, extracted from the Global
Burden of Disease. The Fact Sheet includes approved statements/language on each data item.
However, just presenting statistical data on the size of a disease is insufficient, as such data competes
of attention and resources with other diseases. Demonstration of gaps and inequalities in the
occurrence of stroke and in stroke services add important information. For stroke, there is a strong
knowledge base that substantial improvements can be achieved by adhering to evidence-based
principles. Furthermore, such actions are extremely cost effective for the society. Reference to an
official stroke action plan is very helpful. Adding the patient perspective provides another dimension
to the advocacy.
Conclusions: Stroke statistics should not be used alone for advocating for stroke policy purposes. Data
need to be set in context that substantial improvements can be made, with an excellent cost
effectiveness. The chain of arguments for prioritizing actions on stroke are very strong and apply to all
regions.

79
UTILIZING DISEASE REGISTRIES TO SCALE UP NEUROLOGY RESEARCH IN AFRICA: EXPERIENCE FROM

THE NIGERIA PARKINSON DISEASE REGISTRY
Njideka Okubadejo1; Oluwadamilola Ojo1; Mie Rizig2
1
College of Medicine, University of Lagos, Lagos, Nigeria; 2University College London, London, United
Kingdom
Background/Objective: The representation of Africa in neurology research is low. Specifically for

Parkinson’s disease (PD), the frequency of publications relative to other continents (e.g. for
epidemiological, genetics, clinical trials and cohort studies) ranges from 2.6 – 5.7%. The studies have
typically included small cohorts. Exploring PD heterogeneity in Africans offers unique opportunities to
unravel disease mechanisms, reduce health disparities, and provide evidence for implementing
emerging interventions. This report aims to illustrate the advantage of a national registry to upscale
PD research in Africa.
Methods: The Nigeria Parkinson Disease Registry was established as an institutional pilot in November
2016, subsequently expanded to include neurologists nationwide. An anonymized minimal dataset
form captures consenting participants. An extensive linked database collects other clinical and
biological data. Uniform diagnostic criteria and assessments for phenotypic characterization are
applied network-wide.
Results: The NPDR enrolled 1077 PD from November 2016 and January 2021 through 47 participating
neurologists from 6 regions of Nigeria. All majority Nigerian ethnic groups (Yoruba – 38.1%; Igbo
19.4%; Hausa 11.9%; Tiv 3.6%; Ibibio 2.7%; Idoma 2.0%; Ishan/Esan 1.6%; Fulani 1.5%; Urhobo 1.5%;
Bini 1.1%) and 15 ethnic minorities (all<1% each) have been included.
Conclusions: Disease registries provide a platform to scale up participant accrual in neurology research
through networks of researchers at multiple sites. The registry has enabled a more robust sample size
for research, ethnic diversity, and a platform/opportunities for multi-pronged international
collaborative engagements that include genomics studies, capacity building through educational
programs, and future directions that will enhance the research output and create opportunities for
training and mentorship for early career researchers in Nigeria and Africa.

80
DISPARITIES BY DIABETES STATUS IN THE QUALITY OF CARE AND LONG-TERM OUTCOMES

FOLLOWING ACUTE STROKE OR TRANSIENT ISCHAEMIC ATTACK
Muideen Olaiya1; Dominique Cadilhac1; Joosup Kim1; Amanda Thrift1; Barbora de Courten1; Nadine
Andrew1; Rohan Grimley1; Craig Anderson2; Vijaya Sundararajan3; Natasha Lannin1; Christopher Levi4;
Helen Dewey1; Monique Kilkenny1
1
Monash University, Victoria, Australia; 2University of Sydney, Sydney, Australia; 3La Trobe University,
Bundoora, Australia; 4University of Newcastle, Newcastle, Australia
Objectives: To determine whether there are disparities in acute care and long-term outcomes for
patients with acute stroke (ischaemic [IS] or intracerebral haemorrhage [ICH]) or transient ischaemic
attack [TIA], according to diabetes status.
Methods: An observational study (2009-2013) using linked data from the Australian Stroke Clinical
Registry, National Death Index, hospital admissions, and emergency presentations. History of diabetes
and readmissions were ascertained from health records. Outcomes included mortality and hospital
readmissions for all-causes, cardiovascular disease, and stroke at one year following stroke/TIA.
Multilevel (level=hospital) regression models were used to determine associations between diabetes
and outcomes.
Results: Overall, 14,132 patients were included (median age 76 years, 46% female, 22% with diabetes).
Compared to patients without diabetes, those with diabetes were more often discharged on
antihypertensives (79% vs. 68%) or with a care plan (50% vs. 47%). Proportions of patients treated in
a stroke unit were comparable by diabetes status. Associations between diabetes and outcomes
differed by stroke type (p <0.05). In patients with IS/ICH, diabetes was associated with all-cause
mortality (hazard ratio [HR] 1.13 95% CI 1.04-1.23), but not cause-specific mortality. By contrast, for
those with TIA, diabetes was associated with all-cause mortality (HR 1.79, CI 1.35-2.43) and mortality
due to cardiovascular disease (HR 1.75, CI 1.06-2.91). Diabetes was associated with greater rates of
all-cause readmission in both patients with IS/ICH (incidence rate ratio 1.18, 95% CI 1.08-1.30) and TIA
(rate ratio 1.19, 95% CI 1.02-1.37).
Conclusion: In the context of variable adherence to best-practice recommendations for managing
acute stroke/TIA, comorbid diabetes was associated with poorer outcomes after stroke/TIA. Better
optimisation of secondary prevention in patients with stroke/TIA and diabetes is warranted,
particularly for those with TIA.

81
QUALITY OF LIFE AFTER STROKE IN A CLUSTER RANDOMIZED TRIAL. FINDINGS FROM STANDFIRM
Zhomart Orman1; Amanda Thrift1; David Ung1; Muideen Olaiya1; Dominique Cadilhac1; Thanh Phan1;
Mark Nelson2; Velandai Srikanth1; Christopher Bladin3; Richard Gerraty4; Sharyn Fitzgerald1; Judith
Frayne5; Joosup Kim1
Monash University, Victoria, Australia; 2Menzies Institute for Medical Research, Hobart, Australia;
1
Box Hill Hospital, Box Hill, Australia; 4Epworth Healthcare, Melbourne, Australia; 5Alfred Hospital,
3
Melbourne, Australia
Objectives: To define whether an individualized management program affects health-related quality

of life (QoL) in patients with stroke or transient ischemic attack (TIA), and to determine factors
associated with better QoL.
Methods: Patients aged at least 18 years with stroke or TIA were recruited from four urban hospitals
in Victoria (Australia) for a multicentre, cluster‐randomized controlled trial with blinded assessment
of outcomes and an intention‐to‐treat analysis. Participants in the control group received usual care.
Those in the intervention group were provided with a nurse-led stroke-specific education and an
individualized chronic disease management plan with input from a stroke physician on top of usual
care. We used the Assessment of Quality of Life instrument to measure QoL and an established
algorithm to convert responses to utility scores, ranging from -0.04 (worse than death) to 0.00 (equal
to death) to 1.00 (good health). The Mann-Whitney U test was applied to compare QoL between the
two study groups. Quantile regression models were used to identify factors associated with QoL at 3,
12 and 24 months.
Results: Overall, we recruited 563 participants with a mean age of 68 years, and 36% being female. At
24 months after baseline, the response rate was 89%. No difference was detected between the
intervention and usual care groups at any time point. Factors independently and consistently (at all
time points) associated with poorer QoL included older age and presence of handicap and anxiety.
Females, single marital status, lower educational attainment, living in an institution, and depression
were independently associated with poorer QoL at specific, but not all, time points.
Conclusions: The intervention did not affect QoL over two years after stroke. Managing handicap,
anxiety and depression could improve the QoL of patients with stroke or TIA.

82
THE RELATIONSHIP BETWEEN ROUGH MOTOR FUNCTION LEVEL AND FAMILY BECK DEPRESSION IN
CEREBRAL PALSY PATIENTS
Yasemin Özkan
Adnan Menderes University, Aydın, Turkey
Cerebral palsy (CP) is the most common cause of physical disability in the pediatric age group.
It is a disorder of movement and posture that occurs as a result of non-progressive damage to the
brain that has not yet completed its development. Cognitive, sensory, communication, perception,
behavior, seizure disorders may also accompany motor impairment.
It was found that parents who have a disabled child with a high level of stress have more emotional
difficulties and show more depression symptoms than parents whose children are not disabled.
Goal: To examine the effects of the motor development level (KMFSS levels) and functional level of a
child with cerebral palsy (CP) on family beck depression.
Results: In this study, which investigated the relationship between gross motor function and familial
beck depression in CP patients, it was evaluated that families of children with Spli with different
disability rates differ in depression scores.
This significant relationship between the disability rate and depression score in CP patients can be
associated with the physical and functional consequences of the disability rate in the child and family,
and with the social and cognitive consequences of the disease.

83
COMMUNITY HEALTH WORKERS IN STROKE PREVENTION: WHAT IS THE EVIDENCE?
Jeyaraj Pandian
Christian Medical College, Ludhiana, India
Neurological disorders are the leading causes of DALYs lost in the world, and among the neurological
diseases stroke is the number one cause DALYS. There is a rising burden of stroke in low-and-middle
income countries (LMICs) whereas stroke incidence and mortality are on the declining trend in high
income countries. Hypertension is the single most important risk factor for ischemic and hemorrhagic
stroke. The health systems in LMICs are fragmented with shortage of personnel and lack of
infrastructure. Community health workers have been used in the screening and prevention
(vaccination) of many communicable diseases. There is emerging evidence in the use of community
health workers as a task shifting measure in implementing prevention strategies for stroke. In India
training accredited social health activists (ASHAs) have been successful in the management of
hypertension using mHealth in the prevention of cardiovascular diseases and stroke. There is evidence
of control of risk factors in secondary prevention of stroke as well. Large scale population-based
studies are needed using frontline community health workers in the prevention of stroke.

84
STROKE MORTALITY TREND IN URUGUAY: A 60 YEARS’ NATIONAL STUDY
Stephanie Pino Salgado; Denisse Rada; Heber Hackembruch; Cristina Vázquez; Andrés Gaye Saavedra
Hospital de Clínicas, Montevideo, Uruguay
Objectives: 1: To describe national stroke mortality trend from 1957 to 2017; 2: To analyze possible
causes of our results.
Methods: All cerebrovascular deaths from 1957 to 2017 were registered according to International
Classification of Diseases (ICD codes I60-69).
Anonymous data was provided by Uruguayan Ministry of Health. Population at risk was determined
by national census from National Statistics Institute. Stroke Age Standardized Death Rate (sASDR) per
100,000 was calculated (direct method, WHO standard population).
Temporal trend analysis was performed (linear regression, significance α = 5%). Three 20-year periods
(1957-1977; 1978 -1997; 1998-2017) were established. Joinpoint regression was made to determine
stroke mortality trends significant changes. Local Ethical Committee approved the study.
Results: sASDR showed a global decreasing trend during the whole analyzed period (r2 = - 0.653 p <
0.0001). When analyzed in 20 years intervals, there was an increase in sASDR from 1957 to 1977 (r2
=0.315 p < 0.0001, maximum sASDR 97/100.000). In the 1978-1997 period a decrease was observed
(r2 = -0.895 p < 0.0001, minimum sASDR 59/100.000), and in the latter period (1998-2017) the
decrease was more prominent (r2 = -0.947 p < 0.0001, minimum sASDR 29/100.000).
Conclusions: sASDR continuously decreased from 1977 to 2017. Most significant change occurred in
2004-2017 period. Implementation of intensive care units, computed tomography and prehospital
system are probably the most important factors for the initial decreasing trend. Inclusion of almost
100% of population in National Health System in the 2000-decade, better risk factors control and
improves in acute stroke care may have played a role in the most significant change occurred in the
last period.
Figure 1: Figure 2:
sASDR per 100.000 inhabitants (y) Joinpoint analysis showing most
during the whole analyzed period significant change in linear slope of
(years in x) sASDR in 2004-2017 period.

85
EARLY ONSET AND INCREASED RISK OF ALS IN ITALIAN PROFESSIONAL SOCCER TEAMS
Elisabetta Pupillo; Elisa Bianchi; Ettore Beghi
Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
Objectives: To quantify the risk of ALS in a wide and well-structured cohort of former professional
soccer players with long follow-up.
Methods: Using “Almanacchi Panini” ‘s archives, we identified all male professional soccer players
included in the three Italian professional soccer leagues (A; B; C) from 1959 to 2000 and followed until
December 31, 2018. ALS cases were identified, along with year of death, year of diagnosis and site of
onset using different sources. The total number of cases expected in the cohort was calculated using
ALS incidence in the general population as reference. The observed number of cases was then
compared to the expected calculating standardized incidence ratios (SIR) with 95% confidence interval
(CI) in the entire cohort, by age categories, by playing role and by division.
Results: 23,586 players were included and followed for 1,001,318 person-years. 34 ALS cases were
identified, with an observed SIR of 1.91 (95% CI 1.32–2.67). Risk increase was highest among players
younger than 45 years (SIR 4.66; 95% CI 2.66–7.57); midfielders (SIR 2.37; 95% CI 1.32–3.90); players
in the first division (A) (SIR; 5.69; 95% CI 2.73–10.47). Mean age at diagnosis in soccer players was 20.2
years younger than in the general population (p<0.0001, t-test) (mean age at diagnosis of ALS in
Europe is 65.2 years). No differences were found across teams.
Conclusion: Soccer players show an increased risk of developing ALS. Midfielders and players in the
first division are at highest risk. The disease develops at an earlier than expected age. Repeated
traumatic events and heavy physical exercise may be all implicated, but the role of genetic
predisposition cannot be likewise excluded. In contrast with the media news, data suggested that no
teams have a risk higher than others.

86
ELECTRODE OPTIMIZATION FOR HOME-BASED HEALTH MONITORING EEG ACQUISITION
Theeban Raj Shivaraja1; Wan Asyraf Wan Zaid2; Noorfazila Kamal1; Kalaivani Chellappan1
1
Department of Electrical, Electronics and System Engineering, Faculty of Engineering & Built
Environment, Universiti Kebangsaan Malaysia, Malaysia; 2Department of Medicine, Faculty of
Medicine, University Kebangsaan Malaysia, Malaysia
Introduction: Epilepsy is the fourth most common neurological disorder with approximately 50 million
cases worldwide, according to the World Health Organization. In Malaysia, an estimated 1% of overall
population is epileptic patients, with 230000 diagnosed cases. As patients need to follow up on
medical check-ups and might even stay overnight at the hospital, home-based monitoring has become
a priority. The proposed solution matches the needs especially amidst the recent pandemic which has
restricted travelling and emphasized social distancing.
Problem Statement: EEG aids to detect abnormal activity in the brain and distinguish between
generalized or focal seizures. Present EEG tests are often a time-consuming process as practitioners
are required to attach numerous electrodes on subjects. A test typically takes up to 60 minutes and
even longer in some conditions. These devices are neither conducive for home-based monitoring nor
user-friendly for screening.
Objective: This research is to optimize and validate the number of electrodes for epileptic EEG test
while establishing a potential home-based EEG recorder with mobile application enabler.
Method: The research aims to use Gibbs sampling method as it can identify minimal electrode sets
that are significant for epileptic EEG screening across a subject population without compromising
information transfer. The method will be tested on EEG data of 15 epilepsy patients using established
32-electrode pattern. Resulting electrode configuration will be validated using naïve Bayes classifier
in 15 additional data. Naïve Bayes is preferred as it is extremely fast relative to other classification
algorithms.
Results: The expected outcome is reduced electrode configuration which will produce results that are
likely adequate to be clinically implied. In the event of not achieving clinical accuracy, framework of
the study comprises using of an iterative method.
Conclusions: The proposed home-based EEG recorder with mobile application is expected to provide
expedient monitoring for epilepsy patients.

87
ASSOCIATION OF ANKLE-BRACHIAL INDEX WITH ISCHEMIC STROKE OUTCOME IN DIABETIC

PATIENTS: A CASE-CONTROL STUDY
Fakhrur Razy1; Silvia Manurung2; Agus Yuwono3; Husnul Khatimah4
1
Department of Neurology, Faculty of Medicine, University of Lambung Mangkurat, Banjarmasin,
Indonesia; 2Sultan Suriansyah Hospital, Banjarmasin, Indonesia; 3Department of Internal Medicine,
Faculty of Medicine, University of Lambung Mangkurat, Banjarmasin, Indonesia; 4Department of
Biomedical Sciences, Faculty of Medicine, University of Lambung Mangkurat, Banjaarmasin, Indonesia
Objectives: This study investigated the association of ankle-brachial index (ABI) with short outcomes
in acute ischemic stroke patients with and without diabetes mellitus (DM).
Methods: In a case-control study, we studied 30 first-time ischemic stroke patients with DM and 30
without DM. ABI measured by an automatic device. during hospitalization in Ulin hospital and Ansari
Saleh hospital Banjarmasin, Indonesia. Patients were categorized into the normal (≥0.90) and
abnormal (<0.90) ABI group. Basic characteristics of subject and stroke outcome were measured using
modified Rankin Scale (mRS) on discharge day and were compared between the groups.
Results: The result shows that ABI was abnormal in 41 (68.3%) patients. In univariate analysis, stroke
severity (p=0.12, OR 0.304 CI 95% 0.204-0.451), DM (p=0.003, OR 5.714 CI 95% 1.724-18.944 and ABI
(p=0.000, OR 13.600 CI 95% 3.686-50.180 were factors associated with worsening mRS. After
adjustment for these factors in the logistic regression analysis, ABI was an independent factor
associated with worsening mRS.
Conclusion: The presence of low ABI (less than 0.9) is related to a more severe ischemic stroke
outcome in patient with DM.

88
EARLY REHABILITATION APPROACHES IN SEVERE ACQUIRED BRAIN INJURY
Christian Gunge Riberholt
Rigshospitalet / Department of Neurorehabilitation, Copenhagen, Denmark
Early rehabilitation has been advocated as one of the main contributors to the effect of stroke ward
rehabilitation within the last decades. Until the AVERT trial contradicted this belief, many guidelines
enforced early mobilisation. Nevertheless, many questions remain regarding early rehabilitation,
particularly in severe brain injuries.
In contrast to the stroke patients in the AVERT trial, patients with severe acquired brain injury are
often receiving early mobilisation at a later stage due to the initial critical condition. The response to
the treatment may also differ due to the aetiology, age or other comorbidities.
Several means of mobilisation have been introduced in the neurological departments and the
intensive care units to mobilise patients with severe brain injury. While some of these are founded in
the therapies, some are also inspired by the growing technology within rehabilitation. While these
methods can be easy to use, they lack fundamental evidence-based research on harms and benefits
from randomised clinical trials.

89
LONG-TERM RISK OF STROKE IN 123,696 PEOPLE WITH EXISTING CARDIAC DISEASE: A STUDY USING
DATA LINKAGE
Keira Robinson1; Judith Katzenellenbogen1; Amanda Thrift2; Lee Nedkoff1
1
The University of Western Australia, Perth, Australia; 2Monash University, Melbourne, Victoria,
Australia
Objectives: Identifying those at risk of stroke promotes better targeting of clinical and policy
interventions. People with cardiac conditions are at high risk of stroke in the short-term, but the
longer-term risk of stroke is unclear. We aim to determine the incidence of stroke in patients with
prevalent cardiac disease.
Methods: This retrospective cohort study utilised linked hospitalisation and mortality data from
Western Australia (1985-2017). Historical records were reviewed (27-year lookback) to identify a
prevalent patient cohort hospitalised for coronary heart disease (CHD), atrial fibrillation (AF) or
valvular heart disease (VHD) with no prior stroke hospitalisation. Co-morbidities were identified from
the same records. We identified first-ever strokes (hospitalisations and deaths) occurring from 2012
to 2017. We defined non-fatal strokes as those surviving >28 days post admission. A fatal stroke was
any death ≤28 days post-stroke admission; a stroke death ≤28 days following non-stroke admission or
a stroke-coded death with no admission in the past 28 days.
Results: The cohort comprised 123,696 patients with prevalent cardiac disease (93,746 CHD, 49,056
AF, 19,857 VHD). The most common comorbidities were hypertension (56.4%), diabetes (20.1%) and
COPD (13.3%). During the 5-year study period, 4524 stroke events occurred in 4285 people (59.9%
non-fatal), with 210 experiencing ≥2 strokes. Stroke incidence was greatest in those with prevalent AF
(6.0%), followed by VHD (4.7%) and CHD (3.5%). Of first-ever strokes, 1760 (41%) were fatal. 41.6% of
fatal cases were stroke deaths with no recent admission.
Conclusion: This cohort provides a novel opportunity to determine incidence and recurrence of stroke
in cardiac cohorts. Incidence during the 2012-2017 study period will be calculated by sex, age and
Indigenous status. These preliminary findings highlight the strength of linked databases in enabling
the study of long-term outcomes in large patient cohorts.

90
HEART-BRAIN AXIS AND BRAIN HEALTH
Behnam Sabayan
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, United
States
The brain is an intensely vascularized organ with an unparalleled metabolic demand. Its biological
structure and functional capacity are closely tied with the integrity of its vascular bed and circulation.
The brain consumes about 15% of the cardiac output and it has been suggested that patients with
heart failure can serve as a human model for accelerated brain aging. More recently, we and others
have shown that even subtle changes in cardiac function, in particular when it occurs in the presence
of pathologies in the heart-brain axis vasculature, can endanger our brain health. The concept of
“brain health” has emerged in recent years with the emphasis on protecting the brain from reaching
a critical point where overt clinical symptoms are present and disease progression is irreversible. Brain
health endorses the importance of protecting brain structural and functional integrity throughout
early, middle and late-life. A comprehensive view towards heart-brain axis, in contrast to the current
fragmented practice, is needed to identify individuals at risk and implement preventive measures to
preserve brain structural and functional integrity at population levels.

91
THE EPIDEMIOLOGY OF NEUROCOGNITIVE DISORDERS FROM AROUND THE GLOBE: FINDINGS FROM
THE COSMIC COLLABORATION
Perminder Sachdev; Darren Lipnicki; Nicole Kochan; Ben Chun Pan Lam; John Crawford; Jessica Lo;
Louise Mewton
Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
Objectives: The last three decades have seen a major international effort to examine the risk and
protective factors for cognitive decline through prospective longitudinal population-based studies. No
single study, however, is likely to have sufficient power to detect modest-sized effects, or to compare
rates, proportions, and antecedents in a large variety of populations. The large international Cohort
Studies of Memory in International Consortium (COSMIC) was formed in 2012 to harmonise and share
data to overcome these limitations.
Methods: Longitudinal population-based studies with cognition as the primary end point are invited
to be part of COSMIC (BMC Neurol. 2013, 6;13:165). Currently, 42 studies from 29 countries in 6
continents, comprising >120,000 participants, contribute participant level data for harmonisation and
individual participant data (IPD) meta-analyses and mega-analyses. Data can be accessed by any
researcher through a formal application process. A data platform (Dementia Platform Australia), which
will offer scientists from around the world a secure online environment to access COSMIC data, is
being developed.
Results: COSMIC has so far resulted in 14 publications, and there are 20 active projects. Prevalence of
MCI was estimated to be 6.7% (range 3.2% to 10.8%) in 11 studies. Subjective cognitive decline (16
cohorts) was observed in one-in-four individuals, with higher rates in men, those with low education
or low income and Asian and Black populations. Cognitive function (in 20 cohorts, N=48,552) declined
significantly with age for nearly every study and for most neuropsychological tests, with processing
speed exhibiting the greatest median decline (0.77 IQ points/year). IPD meta-analyses revealed that
age, APOE*4 and diabetes were independently associated with faster cognitive decline. Stronger
associations were seen for Asian people relative to Whites between ever smoking and poorer
cognition, and between diabetes and cognitive decline.
Conclusions: COSMIC offers an unparalleled resource for the epidemiology of neurocognitive
disorders at the international level, with potential to transform the field.

92
DO DYNAMOMETRIC GRIP AND PINCH STRENGTHS CORRELATE WITH UPPER LIMB CAPACITY
MEASURED USING ACTION RESEARCH ARM TEST IN STROKE SURVIVORS?
Sanjukta Sardesai1; John M Solomon1; Ashokan Arumugam2; Senthil D Kumaran1
1
Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher
Education, Manipal, Karnataka, India; 2Department of Physiotherapy, College of Health Sciences,
University of Sharjah, United Arab Emirates
Background and purpose: Despite considerable advances in the field of neurorehabilitation, post-
stroke recovery of arm capacity is often limited. Grip and pinch strengths are important contributors
for better upper limb functional capacity, which is best assessed using the Action Research Arm Test
(ARAT). However, whether there is a true relationship between grip and pinch strengths and the ARAT
in patients recovering from stroke, remains unknown.
Objective: To determine the correlation between grip and pinch strengths and upper extremity
capacity (measured with the ARAT) up to one-month post-stroke.
Methods: In this prospective cohort study, we recruited 15 stroke survivors within one-week post
stroke onset. Upper extremity motor recovery was assessed at one-week and one-month post-stroke
using the following measures under International Classification of Functioning (ICF) domains: upper
limb motor impairments (handgrip and pinch strength measured using dynamometer and pinch meter
respectively) and activity limitations (assessed with the ARAT). Spearman rank correlation (r) was used
to analyze the relationship between grip and pinch strengths and the ARAT. The r values of <0.50,
0.50-0.74, 0.75-0.89 and 0.90-1.0 were interpreted as poor, moderate, good and excellent,
respectively.
Results: A good positive correlation was found between ARAT1 week and grip strength1 week (r=0.84;
p<0.001) and ARAT1 month and grip strength1 month post-stroke (r=0.79; p<0.01). A moderate
positive correlation was evident between ARAT1 week and pinch strength1 week (r=0.68; p<0.001)
and ARAT1 month and pinch strength1 month (r=0.59; p<0.02) post-stroke.
Conclusion: A substantial or acceptable correlation was observed between handgrip and pinch
strength and upper limb functional capacity (ARAT scores) at one-week and one-month post-stroke.
However, future studies are warranted to substantiate whether an increase in grip and pinch strengths
better predict limb functional capacity, post-stroke, in the short- and long-term.
Note: This is a part of an ongoing large prospective cohort study examining post-stroke upper
extremity recovery.

93
EFFECT OF VARYING LOOK-BACK PERIODS ON ESTIMATING THE TRENDS IN THE INCIDENCE OF

STROKE OVER TIME, USING LINKED HOSPITALISATION DATA
Rathina Srinivasa Ragavan1; Lee Nedkoff2; Judith Katzenellenbogen2; Joosup Kim1; Keira Robinson2;
Miriam Lum On3; Seana L Gall4; Amanda Thrift1
1
Monash University, Victoria, Australia; 2University of Western Australia, Perth, Australia; 3Australian
Institute of Health and Welfare, Canberra, Australia; 4University of Tasmania, Hobart, Australia
Objectives: Hospital administrative data can be used to longitudinally monitor first-ever stroke. While
longer (>5 years) look-back periods are more likely to identify prior strokes than shorter look-back
periods, this is at the expense of reducing the duration that can be used to analyse trends. We
investigated whether the use of varying look-back periods affected the trends in stroke incidence over
time.
Methods: We identified all presentations (admissions and emergency attendances) for stroke at
Victorian hospitals between 2001 and 2016. Each presentation was person-linked longitudinally with
prior presentations using look-back periods of 1 and 5 years. Unadjusted percentage change in the
annual number of strokes was estimated over 10 years (2006 to 2016) using these look-back periods.
Results: Between 2001 and 2016, there were 167,275 presentations for stroke in Victorian hospitals.
For men aged < 55 years, the percentage increase in the number of events from 2006 to 2016 was
61.3% (573 to 924) using a 1-year look-back period; similar to that estimated using a 5-year look-back
period (522 to 893 cases; 61.7%; Figure 1). For women aged < 55 years, the percentage increase from
2006 to 2016 estimated using a 1-year look back period was 80.6% (454 to 820 cases), also similar to
that estimated using a 5-year look-back period (432 to 783 cases; 81.3%). Overall, the percentage
increase over the 10-year period in number of strokes for men and women of all age groups were
similar between 1- and 5-year look back periods.
Conclusions: Trends in number of strokes over a 10-year period are similar when estimated using look-
back periods of 1 and 5 years, meaning that the duration of time-period assessed could be maximised
by using shorter look-back periods. Further detailed analyses investigating differing lookbacks, study
periods and age/sex differences are currently being undertaken.

94
IMPACT OF VARYING LOOK-BACK PERIODS ON ESTIMATING THE NUMBER OF PERSON-BASED FIRST-

EVER OCCURRENCES OF STROKES USING LINKED HOSPITALISATION DATA
Rathina Srinivasa Ragavan1; Lee Nedkoff2; Judith Katzenellenbogen2; Joosup Kim1; Keira Robinson2;
Miriam Lum On3; Seana L Gall4
1
Monash University, Victoria, Australia; 2University of Western Australia, Perth, Australia; 3Australian
Institute of Health and Welfare, Canberra, Australia; 4University of Tasmania, Hobart, Tasmania
Objectives: Routinely collected hospital administrative data can be used to longitudinally monitor
first-ever stroke. Look-back periods of >5 years are more likely to identify prior strokes than shorter
look-back periods, providing a better estimate of incident stroke, but differences by age may be
important. We investigated varying look-back periods to identify differences in the absolute number
of first-ever strokes according to age.
Methods: We identified all presentations for stroke (principal diagnosis) in Victorian admission and
emergency datasets 2001 to 2016. Stroke admissions for 2016 were person-linked to previous
admissions to differentiate first-ever from recurrent stroke admissions using various look-back periods
(1 to 15 years) and analysed by broad age group and sex.
Results: In 2016, 13,643 stroke admissions were identified. Using a 15-year look-back period, 36.0%
(4,913) were identified as recurrent stroke admissions. Using a 1-year look-back period, 88.4% of men
and 85.5% of women aged <55 years with recurrent stroke were correctly identified compared with
70.5% of men and 73.7% of women in the 75–84 year age group. To capture 90% of recurrent
admissions, a minimum of 8 years’ look-back was required in those aged ≥65 years, whilst a 5-year
look-back was sufficient in those aged <55 years.
Conclusions: While shorter look-back periods of 1-5 years still over-estimate first-ever strokes, the
overestimate is less in those aged <55 years than in older age groups, for whom longer look back
periods are essential. Length of look-back periods could therefore potentially be modified according
to the age focus of the investigation/study, with shorter look-back periods for younger age groups.
This process could enhance the utility of linked hospitalisation data for establishing person-based first-
ever occurrence of stroke.

95
TIMELINE, INCIDENCE, FREQUENCY AND SURVIVAL OF REM SLEEP BEHAVIOR DISORDER IN OVERT
ALPHA-SYNUCLEINOPATHIES
Cole Stang; Aidan Mullan; Emanuele Camerucci; Pierpaolo Turcano; Peter Martin; Michelle Mielke;
Keith Josephs; James Bower; Erik St Louis; Bradley Boeve; Rodolfo Savica
Objective: To analyze the timeline, incidence, and survival of REM sleep-behavior disorder (RBD) in
patients who developed alpha-synucleinopathies compared to age and sex-matched controls in an
incident-cohort study.
Methods: We used an incident cohort study of alpha-synucleinopathies 1991-2010 among Olmsted
County, MN residents. A movement-disorder specialist reviewed medical records to confirm
diagnoses. REM sleep-behavior disorder was diagnosed by reported dream-enactment symptoms
(Probable RBD) or polysomnography. Probable RBD and polysomnography-confirmed RBD were
analyzed singularly and combined.
Results: Among the 444 incident cases of an alpha-synucleinopathy, 86 were clinically diagnosed with
RBD (19.8%) including 30 (35%) by polysomnography and 56 (65%) as probable. The frequency of RBD
within our cohort of alpha-synucleinopathy patients was 3.4%. The frequency of RBD increased to
23.8% after 15 disease years, with an overall incidence of 2.5 cases per 100 person years. The incidence
of RBD in alpha-synucleinopathies was 2.5 cases per 100 patient-years. The odds of developing RBD
were 53 times greater in alpha-synucleinopathy patients than controls (OR=53.1, 95% CI: 13.0- 217.2,
p<.0001), higher in DLB compared to PD, (OR=2.57, 95% CI: 1.50–4.40, p=.0004), higher in men
compared to women with PD/DLB/PDD (OR = 3.70, 95% CI: 2.07–6.62, p<.0001), but was not
associated with mortality. Conversely, the odds of a PDD patient being diagnosed with RBD were
82.6% lower than a PD patients (OR = 0.17, 95% CI: 0.04 – 0.73, p = .008). Median symptom onset of
RBD occurred 0.7 years following PD diagnosis (IQR= -3.3 – 5.4). In DLB patients the median RBD
symptom onset occurred 3.8 years prior to the diagnosis (IQR=-7.1 — -0.4).
Conclusion: The odds of developing RBD were 53 times greater in alpha-synucleinopathy patients
compared to controls. Patients diagnosed with DLB were more likely to develop RBD compared to
patients diagnosed with PDD.

96
ASSOCIATIONS OF HEMATOLOGICAL AND BIOCHEMICAL MARKERS WITH INTRACRANIAL

ATHEROSCLEROSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES
Xuan Tian; Lina Zheng; Thomas W. Leung; Xinyi Leng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales
Hospital, Hong Kong, China
Objectives: Intracranial atherosclerosis (ICAS) is an important cause of ischemic stroke. Revealing

hematological and biochemical markers associated with ICAS in community-dwelling subjects will
facilitate early identification and primary prevention of ICAS. We aimed to systematically review and
synthesize relevant evidence.
Methods: We searched MEDLINE and EMBASE for articles reporting associations of hematological and
biochemical markers with presence of ICAS (with any degree of luminal stenosis) in cohort or cross-
sectional studies of community-dwelling subjects. We quantitatively synthesized evidence on each
marker by obtaining the mean difference (MD) and 95% confidence interval (CI) in subjects with versus
without ICAS using fixed- or random-effects models.
Results: Overall, 21 studies (45413 subjects) with 12 relevant biomarkers were meta-analyzed.
Compared with subjects without ICAS, those with ICAS had significantly higher levels of neutrophil
(4326 subjects, MD 0.24 per 109/L, 95% CI 0.10-0.38), neutrophil/lymphocyte ratio (4326 subjects,
MD 0.16, 0.07-0.26), low-density lipoprotein (LDL; 28344 subjects, MD 0.10 mmol/L, 0.04-0.17), C-
reactive protein (CRP; 5355 subjects, MD 0.06 mg/dL, 0.04-0.07), high-sensitivity CRP (9383 subjects,
MD 0.07 mg/dL, 0.01-0.13), creatinine (5731 subjects, MD 4.03 µmol/L, 0.77-7.29), uric acid (4959
subjects, MD 16.98 µmol/L, 9.72-24.25), and homocysteine (7053 subjects, MD 2.25 µmol/L, 1.02-
3.48), but a lower level of lymphocyte (4326 subjects, MD −0.12 per 109/L, −0.19-−0.04). There was
no significant association of total cholesterol, high-density lipoprotein or triglyceride with presence of
ICAS. Significant associations of LDL, hs-CRP and homocysteine with ICAS remained in sensitivity
analyses.
Conclusions: Previous studies indicated significant associations of several hematological and
biochemical markers with presence of ICAS in community-dwelling subjects, which can be therapeutic
targets in primary prevention of ICAS.

97
FROM EVIDENCE TO PRACTICE: WHAT ARE WE DOING WRONG?
Amytis Towfighi
University of Southern California, Los Angeles, United States
The translation of research discoveries from “bench to bedside” and into improved health is slow and
inefficient. It has been described as a “valley of death”, reflecting few successful enhancements in
population health. Widespread adoption of evidence into policy and practice is hampered when
academicians solely test interventions in controlled settings and conditions. Although Dissemination
and Implementation (D&I) Science methods are gaining momentum, considerable barriers remain,
especially for populations facing health and healthcare inequities.
In order to enhance adoption of evidence-based guidelines and to improve health equity, it is critical
to turn to novel approaches. Healthcare Delivery Science uses data-driven science to improve the
quality, safety and value of health care and create better patient experiences. Using methodology
from a broad array of fields, including D&I, informatics, performance improvement, community and
stakeholder engagement, health economics, engineering, management and leadership, this emerging
field holds promise for enhancing the delivery of healthcare, to ultimately improve health outcomes
and health equity.

98
ADDRESSING LIFESTYLE FOR STROKE PREVENTION
Amytis Towfighi
University of Southern California, Los Angeles, United States
Four out of five strokes can be prevented through optimal management of five key factors: blood
pressure, abdominal obesity, smoking, diet, and physical activity. Yet only half of stroke survivors
achieve blood pressure control, and a small minority reach recommended targets for lifestyle factors.
Several randomized trials have provided evidence regarding the optimal diet and physical activity
goals to reduce risk of primary or recurrent stroke. Yet, providing education through counseling or
pamphlets alone is insufficient to achieve behavioral change. It is critical to use a theory-driven model
of behavior change to invoke and sustain changes. Evidence-based interventions proven to work in
stroke survivors include exercise-based interventions with counselling, intensive counselling and social
support interventions for smoking cessation, nicotine replacement therapy, and intensive lifestyle
coaching.

99
PARADOXICAL EFFECT OF SMOKING ON MOTOR PROGRESSION AND DOPAMINERGIC PUTAMINAL

DENERVATION IN PARKINSON’S DISEASE
Daniele Urso1,2; Benedetta Tafuri1,3; Salvatore Nigro1,4; Giancarlo Logroscino1,3
1
Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in
Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Tricase, Lecce, Italy;
2
Department of Neurosciences, King's College London, Institute of Psychiatry, Psychology and
Neuroscience, London, United Kingdom; 3Department of Basic Medicine, Neuroscience, and Sense
Organs, University of Bari 'Aldo Moro', Bari, Italy; 4Institute of Nanotechnology (NANOTEC), National
Research Council, Lecce, Italy
Objectives: Many epidemiological studies have found a highly significant negative association
between cigarette smoking and Parkinson’s Disease (PD). However, previous studies showed no
significant clinical protective effect of cigarette smoking in patients already diagnosed with PD. The
aim of this study is to explore the influence of smoking status on motor progression and changes in
dopaminergic imaging in PD.
Methods: From the Parkinson’s Progression Markers Initiative (PPMI) cohort, we included 140 PD
patients who completed the Parkinson’s Disease Risk Factor Questionnaire (PDRFQ), Smoking History
section. Patients were categorized in “smokers” and “non-smokers” based on the response to the
following question “In your lifetime, have you ever regularly smoked cigarettes, that is, at least one
cigarette per day for 6 months or longer?”. Data extracted included demographics, a battery of motor
assessment and, [123I] FP-CIT SPECT scan to assess dopaminergic striatal denervation. Chi-squared
test and Mann-Whitney U test assessed the differences between groups at baseline.
Linear mixed models (LMM) corrected for possible confounders (age, sex, disease duration) were used
to assess differences between “smokers” and “non-smokers” in the 5-year progression of motor
symptoms and changes in dopaminergic imaging.
Results: There were 45 PD patients who have regularly smoked and 95 PD patients who have never
regularly smoked cigarettes. No statistical differences between “smokers” and “non-smokers” were
seen at baseline for age (P=0.051), sex (P=0.235), disease onset (P=0.638) and any clinical measure.
We observed a trend for faster progression of motor symptoms measured by MDS-UPDRS-III for
“smokers”, compared with “non-smokers” (P=0.054). Furthermore, “smokers” showed a faster
progression in the “Bradykinesia” score (p=0.007, Figure 1) and faster dopaminergic denervation in
the putamen contralateral to the affected side (p=0.034, Figure 2).
Conclusion: Smokers PD patients showed a faster motor progression and dopaminergic denervation
compared with non-smokers PD patients.
Figure 2. Predicted trajectories for the

Figure 1. Predicted trajectories for Bradykinesia contralateral putamen FP-CIT binding in
score in “smokers” and “non-smokers” PD patients “smokers” and “non-smokers” PD patients.

100
INSTRUMENTS FOR INVESTIGATION OF EPILEPSY IN LOW- AND MIDDLE- INCOME COUNTRIES: A

SYSTEMATIC REVIEW
Marion Vergonjeanne; Emilie Auditeau; Farid Boumediene; Pierre-Marie Preux
INSERM, University of Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of
Epidemiology and Tropical Neurology, GEIST, Limoges, France
Objectives: Epilepsy affects more than 50 million people over the world, including 80% of people with
epilepsy living in low- and middle- income countries (LMICs). Studies with a standardized methodology
are required to obtain comparable data on the burden of epilepsy to help implement health policies
in order to reduce the treatment gap and improve management of epilepsy. In 2000, following the
guidelines of the International League Against Epilepsy, the “Questionnaire for investigation of
epilepsy in tropical countries” (IENT questionnaire) was developed to promote epidemiological
surveys on epilepsy using standard methodology. Nowadays, an update of the tool according to
current knowledge and guidelines on epilepsy is need. Firstly, this study aims to identify instruments
that have been developed and validated in low- and middle-income countries for investigation on
epilepsy.
Methods: A systematic review was conducted through international and local bibliographic databases.
Tools’ validation studies carried out between 1980 and 2019 in LMICs, then in English, French, Spanish
or Portuguese language were included. Articles were selected according to PRISMA guidelines. Data
related to characteristics of the tools and their validation processes were collected.
Results: Among the 1351 articles identified, 78 of them corresponding to 76 tools were included.
Higher number of tools was developed and validated in China (n=16) and Brazil (n=14). In opposite,
there have been few in Africa. Main instruments were scales to assess quality of life (n=28) or
comorbidities (n=13) in people with epilepsy and screening tools. Tools’ validation processes were
heterogeneous. However, cultural adaptation for a same tool has often been achieved.
Conclusion: Comparison between the IENT questionnaire and other tools developed and validated in
LMICs allowed to identify new topics and potential tools to include in the updated version of the
standard questionnaire to promote comparisons between epidemiological studies in LMICs on several
epilepsy’s topics.

101
EPIDEMIOLOGY OF EPILEPSY IN LOW- AND MIDDLE-INCOME COUNTRIES: EXPERIENCE OF A

STANDARDIZED QUESTIONNAIRE OVER THE PAST TWO DECADES
Marion Vergonjeanne; Farid Boumediene; Pierre-Marie Preux for the QUINET Collaboration
(QUestionnaire for INvestigation of Epilepsy in the Tropics)
INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of
Epidemiology and Tropical Neurology, GEIST, Limoges, France.
Objectives: Epilepsy affects more than 50 million people over the world, including 80% of people with
epilepsy (PWE) living in low- and middle- income countries (LMICs). Studies with a standardized
methodology are required to obtain comparable data on the burden of epilepsy to help implement
health policies in order to reduce the treatment gap and improve management of epilepsy. In 2000,
following the guidelines of the International League Against Epilepsy (ILAE), the “Questionnaire for
investigation of epilepsy in tropical countries” (IENT questionnaire) was developed to promote
epidemiological surveys on epilepsy using standard methodology. This study aims to describe the use
of the IENT questionnaire over the last two decades.
Methods: Studies that used the IENT questionnaire were searched through international and local
bibliographic databases, then an online survey was carried out, including a snowball effect. Available
original research studies citing use of the tool were included. Characteristics of the studies and
populations, general information on the instrument and its use were collected. Mac-Nemar test was
used with a significant level at 5%.
Results: Eighty-two documents referred to 61 studies which were mostly carried out on the African
continent (n=54). These aimed to determine the prevalence (n=31) and associated factors (n=28) of
epilepsy in LMICs. Among the 61 studies, 35 of them were population-based, and 32 have included all
subjects without selection criteria on age. The IENT questionnaire has been continuously used with 11
to 14 studies every five years. In some cases where the questionnaire alone did not ensure complete
data collection, other tools were used concomitantly (n=40).
Conclusions: Over the two last decades, the IENT questionnaire has been continuously used in
different LMICs. This promotes updating it, including new topics related to epilepsy (e.g.
comorbidities, quality of life, stigma, etc.), current ILAE guidelines and a digital form.

102
WHAT THE COVID-19 CRISIS IS TELLING HUMANITY
David Wiebers
Mayo Clinic and Mayo Foundation, Rochester, United States
Objective: The planet is in a global health emergency exacting enormous medical and economic tolls.
It is imperative for us as a society and species to focus and reflect deeply upon what this and other
related human health crises are telling us about our role in these increasingly frequent events and
about what we can do to prevent them in the future.
Results: It is human behavior that is largely responsible for the alarming increase in lethal zoonotic
diseases that jump the species barrier from animals to humans: (1) hunting, capture, and sale of wild
animals for human consumption, particularly in live-animal markets; (2) massive overcrowding of
animals for human consumption in stressful and unhygienic industrial “factory farm” environments;
and (3) vast numbers of wildlife species threatened with extinction from habitat destruction and
incursion.
Conclusion: The trade and consumption of wild animals in live-animal markets should be banned in
all countries. Intensive confinement of animals in factory farm operations should be discontinued
worldwide for the sake of animals, humans, and the environment, and we should rapidly evolve to
eating other forms of protein that are safer for humans. Additional investment in plant-based
agriculture to grow crops to feed humans rather than livestock for human consumption will feed more
people while utilizing far less land and water, allowing for the preservation of vital ecosystems for
innumerable species. Each of us can have a positive impact, beginning with mindfulness about what
we eat and how all of our daily choices and actions may be affecting animals and natural habitats.
Rather than simply attempting to react to crises like COVID-19 after death and destruction are already
upon us, we need to address underlying causes and act now to prevent future disasters.

103
VALIDATION OF THE NATIONAL INSTITUTES OF HEALTH STROKE SCALE EMPHASIZES ITS MODERATE
PSYCHOMETRIC PROPERTIES
Adam Wiśniewski; Karolina Filipska
Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń Bydgoszcz, Poland
Objectives: The National Institutes of Health Stroke Scale (NIHSS) is a widely accepted tool for
assessing stroke severity. The NIHSS has been adapted to many different languages, but a Polish
language version with large-scale psychometric validation including repeatability and separate
assessment of anterior and posterior strokes has not been developed. We aimed to adapt and validate
a Polish version of the NIHSS (PL-NIHSS) focusing on psychometric properties and stroke location.
Methods: The study included 225 ischemic stroke subjects (102 anterior and 123 posterior circulation
strokes). Four NIHSS-certified stroke researchers estimated stroke severity using the most appropriate
scales to assess psychometric properties (including internal consistency, homogeneity, scalability, and
discriminatory power of individual items), to ultimately determine the reliability, repeatability, and
validity of the PL-NIHSS.
Results: The PL-NIHSS achieved a Cronbach’s alpha coefficient of 0.6885, indicating moderate internal
consistency and homogeneity. Slightly more than half of the individual items provided sufficient
discriminatory power (R> 0.3). A favorable coefficient of repeatability (CR = 0.6267 95%CI 0.5737-
0.6904), narrow limits of inter-rater agreement, and excellent intra-class correlation coefficients or
weighted kappa values (> 0.90), demonstrated high PL-NIHSS reliability. Highly significant correlations
using other tools confirmed PL-NIHSS validity and predictive value. Among posterior strokes, the PL-
NIHSS achieved the required Cronbach's alpha coefficient (0.71070), and stroke location did not affect
other psychometric features or instrument reliability and validity.
Conclusions: We developed a valid and reliable device for assessing stroke severity in Polish-speaking
subjects. Moderate psychometric features were emphasized without limiting clinical applications.

104
PONTINE TEGMENTUM INFARCT WITH UNCROSSED HEMIPARESIS, A CASE REPORT
Ahmed Zamir; Naveed Alam
Department of Neurological Allied Hospital, Faisalabad Medical University, Faisalabad, Pakistan
Objective: We report an unusual case of uncrossed hemiparesis with pontine lesion. In uncrossed
hemiparesis patient present with body weakness and UMN facial palsy on same side, the site of
localization is usually supra nuclear, but rarely imaging studies does not support the clinical findings
and indicate brainstem lesion. There are very few case reports of this presentation, in one case report
series four cases with similar findings was discussed so main objective of this case report is to
determine the rationale behind this presentation.
Methods: We present a case of fifty years old male patient who presented with sudden onset right
sided hemiparesis and right sided UMN facial palsy (uncrossed hemiparesis). We use standard method
of clinical examination to reach provisional diagnosis and then radiological investigations of brain to
confirm the diagnosis.
Results: In this atypical case the clinical examination and MRI brain findings were not supporting each
other. MRI brain with stroke protocol showing left hemipons infarct involving tegmentum.
Conclusions: Brainstem infarcts are usually presented with crossed hemiplegia or hemiparesis. It is
very rare for brainstem infarct to present as uncrossed hemiplegia as it is a feature of supranuclear
lesion. Involvement of descending corticobulbar and corticospinal fibers in pontine tegmentum is the
cause of this presentation as evident by MRI findings.

105
INCIDENCE AND CEREBROSPINALFLUID (CSF) BIOMARKERS PATTERN IN FRONTOTEMPORAL LOBAR

DEGENERATION (FTLD) IN THE SALENTO AREA PUGLIA
Chiara Zecca; Maria Teresa Dell'Abate; Miriam Accogli; Rosa Capozzo; Maria Rosaria Barulli; Maria
Elisa Frisullo; Giancarlo Logroscino
Center for Neurodegenerative Diseases and the Aging Brain University of Bari “Aldo Moro”/ A.O. Card.
G. Panico Hospital Tricase (Lecce), Italy
Objectives: The goals of the present study were: to assess the incidence of Frontotemporal Lobar
Degeneration (FTLD) spectrum disorders in a general population of the province of Lecce; to define
the frequencies of different FTLD phenotypes; to evaluate the prevalence of the neurodegeneration
as assessed by Cerebrospinal Fluid (CSF) Total Tau (t-Tau) biomarker.
Methods: All new cases diagnosed with FTLD spectrum disorders (incident cases), resident in the
Salento Area, Puglia, inhabitants 795.134, ISTAT DATA 2019) from January 1, 2019, to December 31,
2019, were considered. The CSF biomarkers (β-Amyloid, t-Tau, p-Tau) analysis was performed in
incident cases.
Results: 48 patients (mean age: 70.54 years; range: 50-85) were diagnosed. Incidence rate for FTLD
was 6.03 per 100.000 person-years (py). The behavioural variant of frontotemporal dementia (bv-
FTD) was the most common phenotype (52.08%), followed by Primary Progressive Aphasia (PPA)
(18.75%), Progressive Supranuclear Palsy (PSP) (14.58%), Corticobasal Syndrome (CBS) (8.33%),
Frontotemporal Dementia and Amyotrophic Lateral Sclerosis (FTD-SLA) (6.25%). Of all patients, 23
(47.91%) underwent lumbar puncture; of these, 12 subjects (52.17%) presented neurodegeneration.
The amyloidosis pattern was observed in 8 (34.78%) patients. Stratifying by age the highest frequency
of neurodegeneration was in a range of 75-79 years (21.74%). Considering the pattern in the different
clinical phenotype, the neurodegeneration was present predominantly in PPA (26.08%) and bvFTD
(17.39%).
Conclusion: The incident rate found in the Salento region in the year 2019 was higher than previously
reported in a study conducted in 2017, on the general population of the same area [1].
The frequency of tau-related neurodegeneration was present in 52.17% of the patients evaluated. The
presence of amyloidosis was detected, and this could be explained by neuropathological comorbidity
due to aging or by diagnostic misclassification.
1. Logroscino G. et al. Incidence of frontotemporal lobar degeneration in Italy. The Salento-Brescia

Registry study. Neurology 2019;92:e2355-e2363.

106
BIOMARKERS FOR ALZHEIMER'S DISEASE
Henrik Zetterberg
University of Gothenburg, Mölndal, Sweden
Four fluid-based biomarkers have been developed into diagnostic tests for Alzheimer’s disease (AD)
pathology: the ratio of 42 to 40 amino acid-long amyloid β, a marker of plaque pathology; total-tau
and phosphorylated tau, markers of AD-related changes in tau metabolism and secretion; and
neurofilament light, a marker of neurodegeneration. When measured in cerebrospinal fluid, these
biomarkers can be used in clinical practice to support a diagnosis of mild cognitive impairment or
dementia due to AD. Recently, technological breakthroughs have made it possible to measure them
in standard blood samples as well. Here, I will give an update on the current state of the fluid-based
AD biomarker research field. I will discuss how the new blood tests may be used in research and clinical
practice, and what role they may play in relation to more established diagnostic tests, such as CSF
biomarkers and amyloid and tau positron emission tomography, to facilitate the effective
implementation of future disease-modifying therapies.

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01

Lund university, Sweden; 2Skåne University Hospital, Lund. Sweden

Neuroepidemiology 2021;55(suppl 1):1-106

POST-STROKE COGNITIVE IMPAIRMENT AND DEMENTIA

University of Ibadan, Nigeria

Neuroepidemiology 2021;55(suppl 1):1-106

INCIDENCE OF STROKE IN ARGENTINA - INITIAL DATA FROM A POPULATION-BASED

Fleni, Buenos Aires, Argentina; 2FINEP, Junín, Argentina

Neuroepidemiology 2021;55(suppl 1):1-106

STROKE SUBTYPES IN CANCER PATIENTS

Farah Aleisa; Lama Alshaikh-Mubarak; Hanouf Samadani

KFSH-D, Dammam, Saudia Arabia

Neuroepidemiology 2021;55(suppl 1):1-106

PREDICTORS FOR STROKE RECOVERY

Margit Alt Murphy

Institute of Neuroscience and Physiology, University of Gothenburg, Sweden

Neuroepidemiology 2021;55(suppl 1):1-106

Abolfazl Avan1; Vladimir Hachinski2

Neuroepidemiology 2021;55(suppl 1):1-106

DEMENTIA PREVENTION INITIATIVE: THE NEED FOR A MORE COMPREHENSIVE APPROACH

Department of Clinical Neurological Sciences, Western University, London, ON, Canada

Dementia Prevention/Brain Health Group

Jason Gilliland, Western U Mark Daley, Western U

Neuroepidemiology 2021;55(suppl 1):1-106

LOW VERSUS STANDARD DOSE OF INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE IN ISCHEMIC

Laura Baptiste1; Stéphane Olindo2; Igor Sibon2; Yannick Béjot1

CHU Dijon Bourgogne, Dijon, France; 2CHU Bordeaux, Bordeaux, France

Neuroepidemiology 2021;55(suppl 1):1-106

IMPACT OF COVID-19 ON NEUROLOGICAL DISORDERS

Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

COVID-19, an infectious disease caused by the coronavirus SARS-CoV-2, is characterized by a complex

Neuroepidemiology 2021;55(suppl 1):1-106

IMPACT OF THE AGEING POPULATION ON THE CONTEMPORARY PROFILE OF STROKE PATIENTS:

Neuroepidemiology 2021;55(suppl 1):1-106

University of Oxford, Oxford, United Kingdom

Medical statistics involves problem solving by a) obtaining sufficient background information to

Neuroepidemiology 2021;55(suppl 1):1-106

GUIDELINES FOR REPORTING NEUROEPIDEMIOLOGICAL STUDIES

University of Oxford, Oxford, United Kingdom

Neuroepidemiology 2021;55(suppl 1):1-106

UPDATES ON POST-STROKE REHABILITATION

Florey Institute of Neuroscience and Mental Health, Melbourne, Australia

Neuroepidemiology 2021;55(suppl 1):1-106

ACUTE TRIAGE OF PEDIATRIC STROKE IN EASTERN DENMARK

Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;

Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

Neuroepidemiology 2021;55(suppl 1):1-106

ENHANCED EFFICACY OF ACUTE INTRA-ARTERIAL RECANALIZATION THERAPIES IN FEMALE STROKE

Neuroepidemiology 2021;55(suppl 1):1-106

COGNITIVE POST-STROKE DISTURBANCES

Disorders of cognition following stroke occur between 7% in population-based studies of first-ever

Neuroepidemiology 2021;55(suppl 1):1-106

THE EFFECTS OF THE POLYPILL IN PRIMARY STROKE PREVENTION

Michael Brainin; Yvonne Teuschl

Neuroepidemiology 2021;55(suppl 1):1-106

Dominique Cadilhac1,2 on behalf of the Australian Stroke Clinical Registry consortium

Neuroepidemiology 2021;55(suppl 1):1-106

INCIDENCE AND PREVALENCE OF MOTOR FLUCTUATIONS AND DEEP BRAIN STIMULATION IN

Mayo Clinic, Rochester, United States

Neuroepidemiology 2021;55(suppl 1):1-106

EARLY-ONSET PARKINSONISM AND EARLY-ONSET PARKINSON’S DISEASE: A POPULATION-BASED

Mayo Clinic, Rochester, United States

Neuroepidemiology 2021;55(suppl 1):1-106