European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment.

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research

Roe and fallow deer: are they compatible neighbours?

International audienceThe analysis of the relationships between population density and habitat features is important to evaluate the ecological needs of a species, its potential impact on ecosystems and its interspecific interactions. We analysed the spatial variation of roe deer and fallow deer densities in a Mediterranean area in summer 2007 and winter 2007/2008. Previous research has shown that fallow deer can actively displace and exclude roe deer from natural feeding sites. Here we show that both species have the greatest densities in ecotone habitats between wood and open fields (abandoned olive groves and pastures), but with contrasting geographic patterns. The fallow deer showed the greatest densities in the central northern part of the study area near to local historical release sites. The densities of roe deer were great where fallow deer were rare and low where fallow deer were abundant. Spatial overlap was great at the habitat scale, indicating a high potential for competition, but was low at the plot scale, suggesting that partitioning of space occurred at a fine scale. Supporting great numbers of deer, the ecotone areas are crucial for the management of ecosystems. We suggest that roe deer avoid areas with great densities of fallow deer and that interspecific interference from the latter affects the density and distribution of the former both at a fine and at a large scale

Nicotine Chewing Gum and Group Counseling in Smoking Cessation

To the Editor: In two recent papers Tønnesen et al.12 have presented a simple and promising program for smoking cessation, which combines a pharmacologic agent (nicotine chewing gum) and psychological support (group counseling). Success is related to adjusting the strength of the nicotine chewing gum according to the individual smoker's degree of nicotine dependence. In the first study, published in the Journal (Jan. 7 issue),1 the 4-mg nicotine gum was found to be superior to the 2-mg nicotine gum for highly dependent smokers. In the second study,2 no effect of dose was found. Smokers with moderate to low degrees of

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

The optimal management of post-stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment and prognosis. These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post-stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine nootropics or cognitive rehabilitation. There was limited evidence on the use of prediction tools for post-stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post-stroke cognitive impairment and most acute structural brain imaging features was unclear, although the presence of substantial white matter hyperintensities of presumed vascular origin on acute MRI brain may help predict cognitive outcomes. These guidelines have highlighted fundamental areas where robust evidence is lacking. Further, definitive randomised controlled trials are needed, and we suggest priority areas for future research. </jats:p

sj-pdf-3-eso-10.1177_23969873211042192 – Supplemental Material for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Supplemental Material, sj-pdf-3-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal</p

sj-pdf-2-eso-10.1177_23969873211042192 – Supplemental Material for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Supplemental Material, sj-pdf-2-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal</p

sj-pdf-1-eso-10.1177_23969873211042192 – Supplemental Material for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Supplemental Material, sj-pdf-1-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal</p

sj-pdf-4-eso-10.1177_23969873211042192 – Supplemental Material for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Supplemental Material, sj-pdf-4-eso-10.1177_23969873211042192 for European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment by Terence J Quinn, Edo Richard, Yvonne Teuschl, Thomas Gattringer, Melanie Hafdi, John T O’Brien, Niamh Merriman, Celine Gillebert, Hanne Huyglier, Ana Verdelho, Reinhold Schmidt, Emma Ghaziani, Hysse Forchammer, Sarah T Pendlebury, Rose Bruffaerts, Milija Mijajlovic, Bogna A Drozdowska, Emily Ball and Hugh S Markus in European Stroke Journal</p