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Impact of loneliness on stroke survivors revealed

The psychological impact can cause or exacerbate additional medical conditions, the study finds

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“Serious attention” must be paid to the wider psychological impact of stroke, including loneliness, which can lead to additional medical conditions or exacerbate existing symptoms, a new study has revealed. 

The study, the first to focus solely on the impact of loneliness on stroke survivors, finds a desire for survivors to maintain their pre-stroke identity, dignity and independence – but a perceived undesirable self-image and the fear of negative labels being put on them is a significant barrier to that. 

And the research team, from the University of Durham and University of Sunderland, also stress the importance of developing a new scale to accurately chart the experiences of stroke survivors specifically, which could result in increased detection of loneliness and other psychological effects and enable intervention. 

The need to act is becoming ever greater, the study urged, with more than 100,000 strokes recorded annually in the UK and survivor numbers expected to rise by 123 per cent from 2018 to 2035. Currently, the cost of care is estimated at £25billion each year. 

The study – The meaning of loneliness to stroke survivors: A qualitative study in Northeast England – focused on 29 stroke survivors across the region, and saw loneliness described as “probably the worst thing in the world”. It gives further insight into the loneliness experienced by so many people, following a study into the experiences of people with brain injury during the pandemic.

Major contributing factors were the loss of independence, which for some people meant they could no longer drive, forcing them into a “loneliness you can’t get out of”, and the perception of stigma and negative appearance, both from themselves and from others. 

“The new but unfavourable self-image—the previously capable, free, and outgoing me is no more—compounded by reduced opportunities to interact with others socially, appears to be a key source of loneliness among stroke survivors,” the research finds. 

“Stroke survivors were especially wary of the possible undesirable labels either they themselves or others put on them. This is why they cared and worried about losing their independence, or taking on a new identity of “the dependent,” or “the sick one.” 

“To stroke survivors, any loss of independence means increased dependence on others, which they may interpret as being burdensome or a nuisance, even if that may not be what others believe. Understandably, they became much more sensitive to the way in which others treat them after stroke. 

“Even if they could accept their “new you,” they found it a daunting task to make others understand this “new you” without putting a negative label to it.

“To be different from others is not necessarily an issue, but to be different from others with an undesirable label is, and such difference is an important source of loneliness.”

This perception of difference is a key factor in the feeling of “loneliness among others”, where stroke survivors find it difficult to fit into an existing social circle through fears of stigma and are loathe to disclose how they truly feel, the study finds. 

“Stroke survivors are caught in a conundrum: they have a desire for others to understand their feelings, but at the same time, their desire to protect their self-image makes it more difficult to achieve such understanding,” it said. 

“Rather than voluntarily telling others they need help, they would wait for others to ask. Even when others did, they may not tell the truth because it would also depend on how they asked. 

“To stroke survivors, stigma means not only the embarrassment of acknowledging one’s vulnerability to others, but also the low probability of obtaining genuine sincerity from others.”

To properly understand the extent of the challenges facing stroke survivors, a new scale should be developed, building further on the existing three- and six-point scales to chart loneliness more generally. 

“Future research will benefit from creating and employing a scale of loneliness customised for stroke survivors, which should incorporate items on self-identity and social relation perception,” the study concludes. 

Research

Blood test for Glioblastoma moves closer

University of Sussex breakthrough hailed as ‘major step forward’ in the development of an accurate, non-invasive and time-saving diagnosis method

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The quest to develop a blood test capable of diagnosing the most aggressive form of brain tumour – Glioblastoma – has moved one step closer. 

Researchers at the University of Sussex have identified distinctive biomarkers within patient blood samples, which could signal the presence of Glioblastoma. 

The biomarkers were identified within extracellular vesicles – small particles which all cells secrete which carry different information, such as DNA or proteins. 

The ability to identify these biomarkers within the extracellular vesicles suggests that a liquid biopsy approach could be a viable option for glioblastoma diagnosis, providing both a quicker and less invasive alternative to current diagnostic methods.

More than 11,000 people are diagnosed with a primary brain tumour in the UK each year, with efforts ongoing to find effective treatments. 

Glioblastoma is the most common high grade primary brain tumour in adults, which means it can grow and spread exceptionally quickly. As a result, it is important for diagnosis to be quick, so patients can access treatment as soon as possible.

Professor Georgios Giamas and his team are leading the research in collaboration with Mr Giles Critchley, consultant neurosurgeon and spinal surgeon at University Hospitals Sussex.

“Currently, Glioblastoma detection relies on the display of symptoms, magnetic resonance imaging and invasive tissue biopsies – all of which can delay the identification of the rapidly growing malignant mass,” said Prof Giamas. 

“A growing body of research is looking into the possibility of developing liquid biopsies which would afford timely and non-invasive assessment of the disease in patients, starting from just a small sample of blood.

“Our study, which effectively does this in a small patient group, is a major step forward in the development of an accurate, non-invasive and time-saving diagnosis method.”

In November 2019, Prof Giamas’s lab at Sussex identified specific biomarkers that Glioblastoma cell lines are able to ‘package’ within extracellular vesicles allowing for better classification between those cell lines (e.g. less vs more aggressive). 

Biomarkers can be considered as biological signatures for a disease, and can therefore indicate the presence of cancer in the body. 

This new stage of research now proves that a liquid biopsy approach can successfully determine the presence of such biomarkers in a Glioblastoma patient and therefore improve the disease diagnosis and ultimately the patients’ prognosis and quality of life.

Funded by Action Against Cancer, Prof Giamas now hopes to conduct further research into the clinical value of their findings, by analysing blood samples of a larger cohort of Glioblastoma patients obtained from Genomics England.

The team also aims to investigate the presence and levels of such biomarkers in response to specific cancer treatments in an attempt to monitor the progression of the disease and evaluate the importance and role of these biomarkers.

He added: “If we can show that the biomarker signatures of extracellular vesicles obtained from blood samples change/disappear then this could be a huge breakthrough for monitoring the success of treatments too.”

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Neuropsychology

COVID cognitive symptoms linked to cerebrospinal fluid

The study could help increase understanding of ‘brain fog’ among people recovering from COVID and those with Long COVID

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Cognitive symptoms experienced by people recovering from COVID-19 may be linked to abnormalities found in cerebrospinal fluid, new research has revealed. 

The new findings around the role of cerebrospinal fluid, which saw similar changes in those recovering from a mild bout of COVID as people with other infectious diseases, may provide new insight into how the SARS-CoV-2 virus impacts the brain.

‘Brain fog’ has become recognised as a common after effect of COVID and symptom of Long COVID, which can cause varying degrees of cognitive issues.

In a small study with 32 adults, comprising 22 with cognitive symptoms and ten control participants without, researchers from UC San Francisco and Weill Cornell Medicine, New York, analysed the cerebrospinal fluid of 17 of the participants who consented to lumbar puncture. 

All participants had had COVID but had not required hospitalisation.

They found that ten of 13 participants with cognitive symptoms had anomalies in their cerebrospinal fluid – but all four of the cerebrospinal samples from participants with no post-COVID cognitive symptoms were normal. 

Participants with these symptoms presented with executive functioning issues, said senior author Dr Joanna Hellmuth, of the UCSF Memory and Aging Center. 

“They manifest as problems remembering recent events, coming up with names or words, staying focused, and issues with holding onto and manipulating information, as well as slowed processing speed,” she said.

Examinations of the cerebrospinal fluid revealed elevated levels of protein, suggesting inflammation, and the presence of unexpected antibodies found in an activated immune system. 

Some were found in the blood and cerebrospinal fluid, implying a systemic inflammatory response, or were unique to the cerebrospinal fluid, suggesting brain inflammation. 

While the targets of these antibodies are unknown, it is possible that these could be “turncoat” antibodies that attack the body itself.

“It’s possible that the immune system, stimulated by the virus, may be functioning in an unintended pathological way,” said Dr Hellmuth, who is principal investigator of the UCSF Coronavirus Neurocognitive Study and is also affiliated with the UCSF Weill Institute for Neurosciences. 

“This would be the case even though the individuals did not have the virus in their bodies,” she said, noting that the lumbar punctures took place on average ten months after the participants’ first COVID symptom.

The researchers also found that the participants with cognitive symptoms had an average of 2.5 cognitive risk-factors, compared with an average of less than one risk factor for participants without the symptoms. 

These risk-factors included diabetes and hypertension, which can increase the risk of stroke, mild cognitive impairment and vascular dementia; and a history of ADHD, which may make the brain more vulnerable to executive functioning issues. Other risk factors included anxiety, depression, a history of  heavy alcohol or repeated stimulant use, and learning disabilities.

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Brain injury

New light shed on Brazilian Jiu-Jitsu and brain injury

Athletes may be at less risk of causing long-lasting injury than has previously been feared, new research has revealed

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Brazilian Jiu-Jitsu (BJJ) athletes may be at less risk of causing long-lasting injury to the brain than has previously been feared, new research has revealed. 

BJJ is a popular martial art that exposes participants to recurrent intermittent asphyxiation due to controlled application of neck chokes. 

Unlike several combat sports, BJJ categorically prohibits strikes to the body, especially the head, favouring limb manipulation and neck chokes to coerce an opponent into submission.

However, concerns have been raised regarding the potential link between repetitive neck chokes, structural brain damage and implications for cognitive function.

But now, in the first study of its kind, researchers at the University of South Wales (USW) – who have previously led pioneering research to show the extent of rugby players’ cognitive decline in just one season – have shed new light on BJJ. 

The team from the Neurovascular Research Laboratory at USW examined blood flow to the brain using Duplex ultrasonography and cognitive function via neuropsychological tests in elite BJJ athletes. 

They found preliminary evidence that the BJJ athletes had a higher resting blood flow to the brain, alongside intact cognitive function, when compared to a control group of athletes matched by age, gender, and cardiorespiratory fitness.

Benjamin Stacey, lecturer in clinical science, said: “The popularity of BJJ is growing exponentially and is likely attributable to many people witnessing its effectiveness in Mixed Martial Arts (MMA) on promotions such as the Ultimate Fighting Championship (UFC) and Bellator. 

“The inclusivity of BJJ allows for all individuals to train together, regardless of age, sex or physical ability and when compared to other combat sports, BJJ carries a lesser risk to injury.

“Our unique findings argue against the notion that BJJ predisposes an individual to greater risk of long-lasting brain damage and conversely, provides evidence for enhanced protection for the brain. 

“These observations may be attributed to choke-induced pre-conditioning and/or exposure to BJJ-specific high-intensity interval training, which we know can confer protective benefits for the brain.

“These findings can help to inform much-needed follow-up research to extensively examine both the short and long-term implications of participation in the sport.”

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