To investigate potential contributors to mental fatigue after aneurysmal subarachnoid hemorrhage (aSAH) and angiographically negative subarachnoid hemorrhage (anSAH), with a focus on information processing speed, attentional control, and psychological distress.

This observational study included 101 patients (70 aSAH, 31 anSAH) and 86 controls. Neuropsychological assessments and questionnaires were conducted five months post-SAH. Mental and physical fatigue were assessed with the Dutch Multifactor Fatigue Scale, information processing speed and attentional control with the Trail Making Test and Vienna Test System Reaction Time and Determination Test, and psychological distress with the Hospital Anxiety and Depression Scale.

Patients reported significantly higher mental and physical fatigue than controls (p < .001) and information processing speed and attentional control were significantly lower (p < .05), with no differences between aSAH and anSAH groups. Severe mental fatigue was present in 55.7% of patients with aSAH and 61.3% of patients with anSAH, significantly exceeding the prevalence of severe physical fatigue (p < .05). Higher mental fatigue correlated with worse attentional control in aSAH and with lower information processing speed in anSAH. Both mental and physical fatigue correlated with psychological distress, particularly after anSAH.

The factors related to mental fatigue appear to differ based on the type of SAH, potentially involving problems in information processing speed and attentional control, psychological distress, or both. This study emphasizes the need for individualized rehabilitation strategies addressing both cognitive and psychological factors in managing mental fatigue after SAH.

Approximately 24% of stroke survivors develop post-stroke depression (PSD), which is associated with poor psychological recovery, identity disruption, and reduced self-esteem. Psychological interventions often fail to address these broader challenges. The Wisdom Enhancement Timeline technique, which facilitates autobiographical reflection, has shown promise for depression in older adults. It has not yet been studied in a post-stroke population.

This study evaluated the effectiveness of the Wisdom Enhancement Timeline technique in stroke. It was hypothesised that wisdom would improve first, followed by identity/self-esteem and mood.

A multiple-baseline single-case experimental design (SCED) was used across three stroke survivors. Daily visual analogue scale (VAS) ratings measured mood, identity, self-esteem, and wisdom during the trial. The Patient Health Questionnaire-9 (PHQ-9) measured depressive symptoms at pre- and post-intervention. Visual analysis, Tau-U, generalised least squares regression (adjusting for autocorrelation), and piecewise regression evaluated intervention effects.

Improvements were observed across all participants and outcomes. Tau-U analysis indicated small-to-large effect sizes across outcomes (effect size range: 0.30–0.92). Breakpoints confirmed wisdom improved first, followed by identity/self-esteem and mood last. Regression confirmed significant level shifts across all outcomes. All participants showed clinically meaningful reductions in PHQ-9 scores, operationalised as a shift from pre-intervention scores above 10 to post-intervention scores below 10.

Wisdom-based interventions could be beneficial in a stroke population, promoting improvements in mood, identity coherence, self-esteem and wisdom. The Wisdom Enhancement Timeline technique shows promise for PSD treatment, although further research is needed to validate these effects.

Agitation and aggression occur in up to half of people living with dementia over the course of the disease. Although non-pharmacological interventions are used as first-line treatment strategies, antipsychotics may be indicated in severe cases. A major adverse effect of antipsychotics in dementia is stroke; the mechanism of action of atypical antipsychotic risperidone has been linked to cardiovascular disease (CVD) biological pathways in preclinical studies.

To evaluate the risk of stroke associated with risperidone across different patient subgroups defined by stroke and CVD history.

Anonymised primary care data from the UK-based Clinical Practice Research Datalink were used to identify individuals diagnosed with dementia after the age of 65 years between 2004 and 2023. Risk of stroke over 1 year was compared between individuals initiating risperidone and propensity-score-matched controls across subgroups with and without history of stroke and any CVD.

In the overall cohort (28 403 risperidone users and 136 324 mtatched controls), risperidone was associated with increased risk of stroke (adjusted hazard ratio: 1.28; 95% CI: 1.20–1.37). In the risperidone user group, the incidence rate of stroke was substantially higher in those with a prior history of stroke (incidence rate: 222 per 1000 person-years) and CVD (incidence rate: 94.1 per 1000 person-years) than in the overall cohort (incidence rate: 53.3 per 1000 person-years). Relative risks related to risperidone were similar across all CVD and stroke subgroup comparisons (hazard ratios between 1.23 and 1.44).

People with dementia with a prior history of CVD are at a significant increased risk of stroke, and risperidone further exacerbates this risk. Moreover, risperidone increases risk of stroke in patients without a prior history of CVD. This quantification of stroke risk across subgroups with and without history of CVD may help with communication of risk and aid more judicious prescribing.

Post-stroke neurocognitive disorders are highly prevalent, yet screening tools that are fit for culturally diverse populations are scarce. This study evaluates the impact of cultural differences on the Oxford Cognitive Screen (OCS), a stroke-specific screening tool.

To evaluate cultural differences, we compared two populations with varying degrees of cultural diversity and Western, Educated, Industrialized, Rich and Democratic (WEIRD) characteristics. We adapted the Dutch OCS for Suriname through a multi-stage process. Using Bayesian hierarchical regression analysis, we compared 264 Surinamese participants, assessed with the adapted Dutch OCS, with 247 Belgian participants, assessed with the Dutch OCS, while controlling for age and education. We further investigated whether the associations of age and education with performance were comparable between the two populations.

Our findings revealed minimal differences in OCS performance between the Belgian and Surinamese populations. Both populations showed similar age-related decline and education-related improvement across all subtests, except for Picture naming, where the age-related decline was more pronounced in the Belgian population.

These findings suggest that with minimal adaptation, the OCS is a viable tool for screening post-stroke neurocognitive disorders in culturally diverse populations.

Moyamoya disease (MMD) is characterized by progressive carotid fork steno-occlusion and the development of “puff-of-smoke” collaterals on angiography. However, a subset of patients present with similar vascular changes but lack these hallmark collaterals, complicating both diagnosis and management. This “smokeless” phenotype, associated with ring finger protein 213 (RNF213) gene variants, challenges the traditional description of MMD. We describe a series of such patients who responded favorably to revascularization.

In this ambispective observational study, we evaluated 12 patients with carotid fork steno-occlusive disease but without “puff-of-smoke” collaterals. Clinical, radiological and genetic assessments were assessed. Structural modeling of RNF213 protein variants was conducted through 3D homology modeling, validated via Ramachandran plots and further refined with COOT and PyMOL. Functional insights were derived through ConSurf analysis.

Of the 12 patients, 9 carried the RNF213 p.R4810K variant, 1 harboured a novel variant, 1 had both p.R4810K and a novel variant and 1 had p.R4859K. Initial misclassification as intracranial atherosclerosis or vasculitis led to inappropriate treatment. Following genetic confirmation, 9 patients underwent revascularization, with no stroke recurrence and a favorable clinical outcome. Structural modeling revealed minimal functional impact for the Val1529Met variant, whereas other variants significantly disrupted RNF213 stability and functionality.

“Smokeless moyamoya,” characterized by carotid fork steno-occlusion without typical angiographic collaterals, represents a distinct clinical phenotype responsive to revascularization. RNF213 genetic screening enhances diagnostic precision, reshaping traditional paradigms and supporting tailored therapeutic approaches.