WSO - March 2023 - 256

1157479
WSO
International Journal of StrokeEditorial
Editorial
Stroke in China
International Journal of Stroke
2023, Vol. 18(3) 256 -258
© 2023 World Stroke Organization
Article reuse guidelines:
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DOI: 10.1177/17474930231157479
journals.sagepub.com/home/wso
Keywords
China, stroke, ischemic preconditioning, apathy, delirium, attention-deficit hyperactivity disorder
This month's issue of International Journal of Stroke (IJS)
has a particular focus on China. China represents 18% of
the world's population and consistent with its large population
contributes much of the global burden of stroke. In this
month's issue of the IJS, Zhao and colleagues1 review the
prevalence, incidence, mortality, and case fatality of stroke
in China. This review provides a useful benchmark of
where we are at present. It emphasizes that despite improved
public health policy and healthcare delivery, the burden of
stroke remains high in China. The pooled annual prevalence
figures obtained from a review of 26 populationbased
studies was 1329.5/100,000.1 They show that in
contrast to some other developed countries, the prevalence
and incidence of stroke have both increased over recent
decades in China, although stroke-related case fatality has
declined.
A second related article, also in this month's issue, looks
at the quality of stroke care in China between 2011 and
2017. Li and colleagues2 analyzed data from 123,259
patients diagnosed with acute ischemic stroke who were
treated at 109 large tertiary hospitals in China. Twelve
stroke treatment indicators were selected to calculate a process
performance score. After adjusting for confounders,
patients with the highest score were more likely to gain
independence after stroke. A wide variation in quality of
stroke care was found to exist across hospitals, and better
adherence to guideline-based care was associated with
improved outcomes. This work emphasizes that the more
widespread adoption of best practice throughout China is
likely to improve outcomes from Stroke, as it will
elsewhere.
We have many IJS readers, and manuscript submissions,
from China but are keen to welcome more and to be as
accessible as possible. For this reason, we are very pleased
to announce that IJS is now on WeChat. The name of the
official WeChat account is " IntJStroke. " The logo with a
QR code is provided in Figure 1. The titles and abstracts of
selected accepted articles are being uploaded, having been
translated by our editorial board member Xinyi (Cindy)
Leng and associate editor Thomas Leung. A great thanks to
Cindy. From late December 2022 when first launched to 31
January 2023, there have been over 2000 views from over
1300 readers, over 6 posts.
International Journal of Stroke, 18(3)
Apathy is a common and disabling symptom after
stroke.3 It shares some similarities with depression, but
studies have shown it to be a separate entity and that the
two can be distinguished.4 Interestingly, recent studies have
suggested that apathy relates to disruption of white-matter
pathways underlying complex cortical-sub cortical circuits,
while depression is not associated with similar white-matter
tract damage.4,5 Therefore, one might expect the two to
respond differentially to specific therapies. However,
whether apathetic symptoms respond to antidepressants is
uncertain. Small studies have suggested they may do,6 but
robust evidence is lacking. In this issue, Tay and colleagues7
analyzed a large clinical trial data set to answer this question.
They used data from the EFFECTS study, which randomized
patients with recent stroke to fluoxetine versus
placebo. They show that while fluoxetine was associated
with less progression of depressive symptoms after stroke,
apathetic symptoms increased after stroke, and fluoxetine
had no effect on this increase. These data suggest that
Selective serotonin reuptake inhibitors (SSRIs) such as
fluoxetine do not reduce apathy after stroke, and that alternative
therapeutic strategies are required to treat this disabling
symptom.
Post-stroke delirium (PSD) affects up to 39% of patients
with ischemic stroke, is associated with inferior functional
and cognitive outcome, and represents an important, but
modifiable, predictor for poor recovery. Unfortunately, PSD
management is often unrecognized, and initiation of pharmacological
and non-pharmacological interventions is
delayed. While it remains to be clarified to what extent
interventional approaches can reduce the impact of manifest
PSD, prevention of PSD is effective and can avert up to
Figure 1. QR code for IJS on WeChat.
https://doi.org/10.1177/17474930231157479

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WSO - March 2023

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