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Abujaber AA, Imam Y, Albalkhi I, Yaseen S, Nashwan AJ, Akhtar N. Utilizing machine learning to facilitate the early diagnosis of posterior circulation stroke. BMC Neurol 2024; 24:156. [PMID: 38714968 PMCID: PMC11075305 DOI: 10.1186/s12883-024-03638-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/11/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Posterior Circulation Syndrome (PCS) presents a diagnostic challenge characterized by its variable and nonspecific symptoms. Timely and accurate diagnosis is crucial for improving patient outcomes. This study aims to enhance the early diagnosis of PCS by employing clinical and demographic data and machine learning. This approach targets a significant research gap in the field of stroke diagnosis and management. METHODS We collected and analyzed data from a large national Stroke Registry spanning from January 2014 to July 2022. The dataset included 15,859 adult patients admitted with a primary diagnosis of stroke. Five machine learning models were trained: XGBoost, Random Forest, Support Vector Machine, Classification and Regression Trees, and Logistic Regression. Multiple performance metrics, such as accuracy, precision, recall, F1-score, AUC, Matthew's correlation coefficient, log loss, and Brier score, were utilized to evaluate model performance. RESULTS The XGBoost model emerged as the top performer with an AUC of 0.81, accuracy of 0.79, precision of 0.5, recall of 0.62, and F1-score of 0.55. SHAP (SHapley Additive exPlanations) analysis identified key variables associated with PCS, including Body Mass Index, Random Blood Sugar, ataxia, dysarthria, and diastolic blood pressure and body temperature. These variables played a significant role in facilitating the early diagnosis of PCS, emphasizing their diagnostic value. CONCLUSION This study pioneers the use of clinical data and machine learning models to facilitate the early diagnosis of PCS, filling a crucial gap in stroke research. Using simple clinical metrics such as BMI, RBS, ataxia, dysarthria, DBP, and body temperature will help clinicians diagnose PCS early. Despite limitations, such as data biases and regional specificity, our research contributes to advancing PCS understanding, potentially enhancing clinical decision-making and patient outcomes early in the patient's clinical journey. Further investigations are warranted to elucidate the underlying physiological mechanisms and validate these findings in broader populations and healthcare settings.
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Affiliation(s)
- Ahmad A Abujaber
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Yahia Imam
- Neurology Section, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahem Albalkhi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Said Yaseen
- School of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdulqadir J Nashwan
- Nursing Department, Hamad Medical Corporation (HMC), Doha, Qatar.
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
| | - Naveed Akhtar
- Neuroradiology Department, Neuroscience Institute, Hamad Medical Corporation (HMC), Doha, Qatar
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Frid P, Drake M, Giese AK, Wasselius J, Schirmer MD, Donahue KL, Cloonan L, Irie R, Bouts MJRJ, McIntosh EC, Mocking SJT, Dalca AV, Sridharan R, Xu H, Giralt-Steinhauer E, Holmegaard L, Jood K, Roquer J, Cole JW, McArdle PF, Broderick JP, Jimenez-Conde J, Jern C, Kissela BM, Kleindorfer DO, Lemmens R, Meschia JF, Rundek T, Sacco RL, Schmidt R, Sharma P, Slowik A, Thijs V, Woo D, Worrall BB, Kittner SJ, Mitchell BD, Petersson J, Rosand J, Golland P, Wu O, Rost NS, Lindgren A. Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study. J Neurol 2020; 267:649-658. [PMID: 31709475 PMCID: PMC7035231 DOI: 10.1007/s00415-019-09613-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS. METHODS Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression. RESULTS PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions. CONCLUSION Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.
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Affiliation(s)
- Petrea Frid
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden.
- Department of Neurology, Skåne University Hospital, Jan Waldenströms gata 19, 205 02, Malmö, Sweden.
| | - Mattias Drake
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - A K Giese
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - J Wasselius
- Department of Clinical Sciences Lund, Radiology, Lund University, Lund, Sweden
- Department of Radiology, Neuroradiology, Skåne University Hospital, Lund, Sweden
| | - M D Schirmer
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
- Department of Population Health Sciences, German Centre for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - K L Donahue
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Cloonan
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Irie
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - M J R J Bouts
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - E C McIntosh
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - S J T Mocking
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - A V Dalca
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - R Sridharan
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
| | - H Xu
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - E Giralt-Steinhauer
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - L Holmegaard
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - J Roquer
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - J W Cole
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - P F McArdle
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - J Jimenez-Conde
- Neurovascular Research Group (NEUVAS), Department of Neurology, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Barcelona, Spain
| | - C Jern
- Institute of Biomedicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - B M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - D O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - R Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Louvain, Belgium
- VIB Center for Brain and Disease Research, Louvain, Belgium
- Department of Neurology, University Hospitals Leuven, Louvain, Belgium
| | - J F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - T Rundek
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - R L Sacco
- Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - R Schmidt
- Clinical Division of Neurogeriatrics, Department of Neurology, Medical University Graz, Graz, Austria
| | - P Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London (ICR2UL), Egham, UK
- Ashford and St Peter's Hospital, Ashford, UK
| | - A Slowik
- Department of Neurology, Jagiellonian University Medical College, Kraków, Poland
| | - V Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
- Department of Neurology, Austin Health, Heidelberg, Australia
| | - D Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - B B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - S J Kittner
- Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore, MD, USA
| | - B D Mitchell
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Geriatric Research and Education Clinical Center, Veterans Administration Medical Center, Baltimore, MD, USA
| | - J Petersson
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Malmö, Sweden
| | - J Rosand
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
- Center for Genomic Research, Massachusetts General Hospital, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - P Golland
- Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, USA
| | - O Wu
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital (MGH), Harvard Medical School, Charlestown, MA, USA
| | - N S Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden
- Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
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Walas D, Nowicki-Osuch K, Alibhai D, von Linstow Roloff E, Coghill J, Waterfall C, Paton JF. Inflammatory pathways are central to posterior cerebrovascular artery remodelling prior to the onset of congenital hypertension. J Cereb Blood Flow Metab 2019; 39:1803-1817. [PMID: 29651914 PMCID: PMC6724458 DOI: 10.1177/0271678x18769180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cerebral artery hypoperfusion may provide the basis for linking ischemic stroke with hypertension. Brain hypoperfusion may induce hypertension that may serve as an auto-protective mechanism to prevent ischemic stroke. We hypothesised that hypertension is caused by remodelling of the cerebral arteries, which is triggered by inflammation. We used a congenital rat model of hypertension and examined age-related changes in gene expression of the cerebral arteries using RNA sequencing. Prior to hypertension, we found changes in signalling pathways associated with the immune system and fibrosis. Validation studies using second harmonics generation microscopy revealed upregulation of collagen type I and IV in both tunica externa and media. These changes in the extracellular matrix of cerebral arteries pre-empted hypertension accounting for their increased stiffness and resistance, both potentially conducive to stroke. These data indicate that inflammatory driven cerebral artery remodelling occurs prior to the onset of hypertension and may be a trigger elevating systemic blood pressure in genetically programmed hypertension.
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Affiliation(s)
- Dawid Walas
- 1 School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | | | - Dominic Alibhai
- 3 Wolfson Bioimaging Facility, School of Biochemistry, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Eva von Linstow Roloff
- 1 School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Jane Coghill
- 4 Genomics Facility, School of Biological Sciences, Bristol, UK
| | | | - Julian Fr Paton
- 1 School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK.,5 Department of Physiology, Faculty of Medical and Health Sciences, University of Auckland, Grafton, New Zealand
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Zheng J, Xu R, Guo Z, Sun X. Small ruptured intracranial aneurysms: the risk of massive bleeding and rebleeding. Neurol Res 2019; 41:312-318. [PMID: 30638157 DOI: 10.1080/01616412.2018.1563737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The risk of hemorrhagic events in small ruptured aneurysms remains unclear. Due to less arterial wall, small ruptured aneurysms may be correlated with massive bleeding and rebleeding. Therefore, it may contribute to treatment to evaluate the amount of bleeding and the risk of rebleeding in small ruptured aneurysms. METHODS A retrospective cohort study of all consecutive patients with intracranial aneurysms admitted to our hospital from February 2013 to December 2017 was carried out. Ruptured aneurysms were divided into small ruptured aneurysm (0-5 mm) group and large ruptured aneurysm (5 mm) group for analysis. The difference of bleeding volume, rebleeding and clinical outcome were analyzed between the two groups. RESULTS A total of 738 patients with aneurysmal subarachnoid hemorrhage (SAH) were included in this study and small ruptured aneurysms accounted for 49.2% of all ruptured aneurysms. Univariate analysis showed that the amount of bleeding (14.5 ± 7.1 vs. 14.4 ± 7.3; P = 0.867), rebleeding (8.3% vs. 10.9%; P = 0.261) and poor outcome (29.6% vs. 23.1%; P = 0.055) were similar between the two groups. Multivariable analysis showed that hypertension was obviously associated with the amount of bleeding (adjusted odds ratio (aOR), 3.25 [1.81-4.69]; P < 0.001) and rebleeding (aOR, 3.31 [1.10-9.99]; P = 0.034) in small ruptured aneurysms, and its effect on rebleeding of small ruptured aneurysms is greater than that of large ruptured aneurysms. CONCLUSIONS The risk of hemorrhagic events in small ruptured aneurysms is similar to that in large ruptured aneurysms, especially those patients with small ruptured aneurysms that complicated with hypertension are at an increased risk of massive SAH and rebleeding.
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Affiliation(s)
- Jianfeng Zheng
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Rui Xu
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Zongduo Guo
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Xiaochuan Sun
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Vianna LC, Fernandes IA, Barbosa TC, Amaral TG, Rocha NG, Secher NH, Nóbrega AC. Absent increase in vertebral artery blood flow during l-arginine infusion in hypertensive men. Am J Physiol Regul Integr Comp Physiol 2018; 315:R820-R824. [DOI: 10.1152/ajpregu.00088.2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction is observed in the peripheral vasculature of hypertensive patients, but it is unclear how the cerebral circulation is affected. More specifically, little is known about the impact of human hypertension on vertebral artery (VA) endothelial function. This study evaluated whether the endothelial function of the VA is impaired in hypertensive men. For 13 male hypertensive subjects (46 ± 3 yr) and eight age-matched male controls (46 ± 4 yr), blood pressure (BP; photoplethysmography), VA, and common carotid (CC) blood flow (duplex ultrasound) were determined at rest and during 30 min of intravenous l-arginine (30 g; a precursor of nitric oxide) or isotonic saline infusion. Controls and hypertensive subjects demonstrated a similar resting CC (601 ± 30 vs. controls 570 ± 43 ml/min; P = 0.529) and VA blood flow (119 ± 11 vs. controls 112 ± 9 ml/min; P = 0.878). During administration of l-arginine, CC blood flow increased similarly between groups (hypertensive 12 ± 3%, controls 13 ± 2%; P = 0.920). In contrast, the increase in VA blood flow was nonexistent in the hypertensive subjects (0.8 ± 3% vs. controls: 16 ± 4%; P = 0.015) with no significant change in BP. Both CC and VA flow returned to near-resting values within 30 min after the infusion, and for four hypertensive subjects and three controls, time-control experiments using 0.9% saline did not affect VA or CC blood flow significantly. The results demonstrate endothelial dysfunction in the posterior cerebral circulation of middle-aged hypertensive men.
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Affiliation(s)
- Lauro C. Vianna
- NeuroVASQ Integrative Physiology Laboratory, Faculty of Physical Education, University of Brasília, Brasília, Federal District, Brazil
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Igor A. Fernandes
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Thales C. Barbosa
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Tatiana G. Amaral
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Natalia G. Rocha
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Niels H. Secher
- Department of Anaesthesiology, The Copenhagen Muscle Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Antonio C. Nóbrega
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Roloff EVL, Walas D, Moraes DJA, Kasparov S, Paton JFR. Differences in autonomic innervation to the vertebrobasilar arteries in spontaneously hypertensive and Wistar rats. J Physiol 2018; 596:3505-3529. [PMID: 29797726 PMCID: PMC6092310 DOI: 10.1113/jp275973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/03/2018] [Indexed: 01/14/2023] Open
Abstract
KEY POINTS Essential hypertension is associated with hyperactivity of the sympathetic nervous system and hypoperfusion of the brainstem area controlling arterial pressure. Sympathetic and parasympathetic innervation of vertebrobasilar arteries may regulate blood perfusion to the brainstem. We examined the autonomic innervation of these arteries in pre-hypertensive (PHSH) and hypertensive spontaneously hypertensive (SH) rats relative to age-matched Wistar rats. Our main findings were: (1) an unexpected decrease in noradrenergic sympathetic innervation in PHSH and SH compared to Wistar rats despite elevated sympathetic drive in PHSH rats; (2) a dramatic deficit in cholinergic and peptidergic parasympathetic innervation in PHSH and SH compared to Wistar rats; and (3) denervation of sympathetic fibres did not alter vertebrobasilar artery morphology or arterial pressure. Our results support a compromised vasodilatory capacity in PHSH and SH rats compared to Wistar rats, which may explain their hypoperfused brainstem. ABSTRACT Neurogenic hypertension may result from brainstem hypoperfusion. We previously found remodelling (decreased lumen, increased wall thickness) in vertebrobasilar arteries of juvenile, pre-hypertensive spontaneously hypertensive (PHSH) and adult spontaneously hypertensive (SH) rats compared to age-matched normotensive rats. We tested the hypothesis that there would be a greater density of sympathetic to parasympathetic innervation of vertebrobasilar arteries in SH versus Wistar rats irrespective of the stage of development and that sympathetic denervation (ablation of the superior cervical ganglia bilaterally) would reverse the remodelling and lower blood pressure. Contrary to our hypothesis, immunohistochemistry revealed a decrease in the innervation density of noradrenergic sympathetic fibres in adult SH rats (P < 0.01) compared to Wistar rats. Unexpectedly, there was a 65% deficit in parasympathetic fibres, as assessed by both vesicular acetylcholine transporter (α-VAChT) and vasoactive intestinal peptide (α-VIP) immunofluorescence (P < 0.002) in PHSH rats compared to age-matched Wistar rats. Although the neural activity of the internal cervical sympathetic branch, which innervates the vertebrobasilar arteries, was higher in PHSH relative to Wistar rats, its denervation had no effect on the vertebrobasilar artery morphology or persistent effect on arterial pressure in SH rats. Our neuroanatomic and functional data do not support a role for sympathetic nerves in remodelling of the vertebrobasilar artery wall in PHSH or SH rats. The remodelling of vertebrobasilar arteries and the elevated activity in the internal cervical sympathetic nerve coupled with their reduced parasympathetic innervation suggests a compromised vasodilatory capacity in PHSH and SH rats that could explain their brainstem hypoperfusion.
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Affiliation(s)
- Eva v. L. Roloff
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Dawid Walas
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Davi J. A. Moraes
- Department of PhysiologySchool of Medicine of Ribeirão PretoUniversity of São PauloRibeirão PretoSP 14049–900Brazil
| | - Sergey Kasparov
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
| | - Julian F. R. Paton
- School of PhysiologyPharmacology and NeuroscienceBiomedical SciencesUniversity of BristolBristol BS8 1TDUK
- Department of PhysiologyFaculty of Medical and Health SciencesThe University of Auckland85 Park RoadGraftonAuckland1142New Zealand
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7
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Hart EC. Human hypertension, sympathetic activity and the selfish brain. Exp Physiol 2018; 101:1451-1462. [PMID: 27519960 DOI: 10.1113/ep085775] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/10/2016] [Indexed: 12/19/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review article revisits an historical hypothesis that cerebral hypoperfusion, caused by elevated cerebral vascular resistances, causes the onset of high sympathetic nerve activity and hypertension in humans. What advances does it highlight? The review article highlights new evidence indicating that congenital cerebrovascular abnormalities, namely vertebral artery hypoplasia and an incomplete posterior circle of Willis, may play a role in the onset of hypertension. Despite the harmful consequences of high blood pressure (hypertension; e.g. stroke, renal failure, dementia and even death), the underlying physiological mechanisms that cause the onset of hypertension are poorly understood. The most established finding is that hypertension occurs alongside activation of the sympathetic nervous system, yet exactly what triggers this in humans is ambiguous. This review discusses evidence for elevated sympathetic nerve activity, particularly in human hypertension, and revisits an historical theory regarding the aetiology underlying human hypertension that was proposed by Seymour Kety and John Dickinson in the 1940s-1950s. My research group hypothesizes that elevated sympathetic nerve activity and hypertension develop as a fundamental mechanism to maintain adequate cerebral blood flow, which is now termed Cushing's mechanism or the selfish brain hypothesis. Moreover, it goes against the traditional belief that high cerebrovascular resistance is a consequence of hypertension; we propose that this elevated resistance drives hypertension. This review discusses historical and new evidence in animals and humans supporting this hypothesis. In particular, unique human data indicating a higher prevalence of congenital cerebral vascular abnormalities in hypertension are considered.
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Affiliation(s)
- Emma C Hart
- School of Physiology, Pharmacology and Neuroscience, Clinical Research and Imaging Centre, University of Bristol, Bristol, UK
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8
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von Sarnowski B, Schminke U, Grittner U, Tanislav C, Böttcher T, Hennerici MG, Tatlisumak T, Putaala J, Kaps M, Fazekas F, Enzinger C, Rolfs A, Kessler C. Posterior versus Anterior Circulation Stroke in Young Adults: A Comparative Study of Stroke Aetiologies and Risk Factors in Stroke among Young Fabry Patients (sifap1). Cerebrovasc Dis 2017; 43:152-160. [PMID: 28088807 DOI: 10.1159/000454840] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/24/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although 20-30% of all strokes occur in the posterior circulation, few studies have explored the characteristics of patients with strokes in the posterior compared to the anterior circulation so far. Especially data on young patients is missing. METHODS In this secondary analysis of data of the prospective multi-centre European sifap1 study that investigated stroke and transient ischemic attack (TIA) patients aged 18-55 years, we compared vascular risk factors, stroke aetiology, presence of white matter hyperintensities (WMH) and cerebral microbleeds (CMB) between patients with ischaemic posterior circulation stroke (PCS) and those having suffered from anterior circulation stroke (ACS) based on cerebral MRI. RESULTS We diagnosed PCS in 612 patients (29.1%, 407 men, 205 women) and ACS in 1,489 patients (70.9%). Their age (median 46 vs. 47 years, p = 0.205) and stroke severity (modified Rankin Scale: both 2, p = 0.375, Barthel Index 90 vs. 85, p = 0.412) were similar. PCS was found to be more frequent among the male gender (66.5 vs. 60.1% with ACS, p = 0.003). Vertebral artery (VA) dissection was more often the cause of PCS (16.8%) than was carotid artery dissection of ACS (7.9%, p < 0.001). Likewise, small vessel disease (Trial of Org 10172 in Acute Stroke Treatment [TOAST] = 3, PCS: 14.7%, ACS: 11.8%) and stroke of other determined aetiology (TOAST = 4, PCS: 24.5%, ACS: 16.0%) were more frequent in those with PCS. Furthermore, patent foramen ovale (PFO; PCS: 31.1%, ACS: 25.4%, p = 0.029) was more often detected in patients with PCS. In contrast, large-artery atherosclerosis (TOAST = 1, PCS: 15.4%, ACS: 22.2%) and cardio-embolic stroke (TOAST = 2, PCS: 15.6%, ACS: 18.0%) were less frequent in those with PCS (p < 0.001) as were preceding cerebrovascular events (10.1 vs. 14.1%, p = 0.014), TIA (4.8 vs. 7.7%, p = 0.016) and smoking (53.2 vs. 61.0%, p = 0.001). The presence, extent, and location of WMH and CMB did not differ between the 2 groups. CONCLUSIONS Our data suggested a different pattern of aetiology and risk factors in young patients with PCS compared to those with ACS. These findings especially call for a higher awareness of VA dissection and potentially for more weight of a PFO as a risk factor in young patients with PCS. Clinical trial registration-URL: http://www.clinicaltrials.gov; NCT00414583.
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Affiliation(s)
- Bettina von Sarnowski
- Department of Neurology, University Medicine, Ernst Moritz Arndt University, Greifswald, Germany
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9
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McBryde FD, Malpas SC, Paton JFR. Intracranial mechanisms for preserving brain blood flow in health and disease. Acta Physiol (Oxf) 2017; 219:274-287. [PMID: 27172364 DOI: 10.1111/apha.12706] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/03/2016] [Accepted: 05/06/2016] [Indexed: 12/19/2022]
Abstract
The brain is an exceptionally energetically demanding organ with little metabolic reserve, and multiple systems operate to protect and preserve the brain blood supply. But how does the brain sense its own perfusion? In this review, we discuss how the brain may harness the cardiovascular system to counter threats to cerebral perfusion sensed via intracranial pressure (ICP), cerebral oxygenation and ischaemia. Since the work of Cushing over 100 years ago, the existence of brain baroreceptors capable of eliciting increases in sympathetic outflow and blood pressure has been hypothesized. In the clinic, this response has generally been thought to occur only in extremis, to perfuse the severely ischaemic brain as cerebral autoregulation fails. We review evidence that pressor responses may also occur with smaller, physiologically relevant increases in ICP. The incoming brain oxygen supply is closely monitored by the carotid chemoreceptors; however, hypoxia and other markers of ischaemia are also sensed intrinsically by astrocytes or other support cells within brain tissue itself and elicit reactive hyperaemia. Recent studies suggest that astrocytic oxygen signalling within the brainstem may directly affect sympathetic nerve activity and blood pressure. We speculate that local cerebral oxygen tension is a major determinant of the mean level of arterial pressure and discuss recent evidence that this may be the case. We conclude that intrinsic intra- and extra-cranial mechanisms sense and integrate information about hypoxia/ischaemia and ICP and play a major role in determining the long-term level of sympathetic outflow and arterial pressure, to optimize cerebral perfusion.
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Affiliation(s)
- F. D. McBryde
- Department of Physiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- School of Physiology, Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
| | - S. C. Malpas
- Department of Physiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
| | - J. F. R. Paton
- Department of Physiology; Faculty of Medical and Health Sciences; University of Auckland; Auckland New Zealand
- School of Physiology, Pharmacology & Neuroscience; Biomedical Sciences; University of Bristol; Bristol UK
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10
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Gu J, Chao J, Chen W, Xu H, Wu Z, Chen H, He T, Deng L, Zhang R. Multimorbidity in the community-dwelling elderly in urban China. Arch Gerontol Geriatr 2016; 68:62-67. [PMID: 27654809 DOI: 10.1016/j.archger.2016.09.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/02/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The primary objective of the study was to investigate the prevalence and patterns of multimorbidity in the community-dwelling elderly in urban China. METHODS By a cluster random sampling method, 2452 persons aged 60 years and older were enrolled as the subjects in an urban community in Nanjing, China. Data on 13 chronic diseases were collected by interviews, physical check-ups and support by physicians. Factor analyses and the logistic regression models were performed to analyze the patterns of multimorbidity. RESULTS The prevalence of multimorbidity was 49.4% in the community-dwelling elderly in urban China. The observed prevalence of 6 chronic disease pairs was higher than their expected prevalence, including hypertension and diabetes, hypertension and coronary heart disease, hypertension and dyslipidaemia, diabetes and cataract, diabetes and hearing disorder, hypertension and stroke. Three patterns were detected as follows: the first pattern with a prevalence of 9.5% covered degenerative diseases (hearing disorder, cataract, joint disease) and cancer; The second pattern with a prevalence of 1.7% was characterized by liver disease, lung disease, gastrointestinal disease; And the third pattern with a prevalence of 22.4% was characterized by cardiovascular diseases (dyslipidaemia, hypertension, coronary heart disease), metabolic diseases (diabetes) and kidney disease. Compared with <70 years, ≥80 years were found as the risk factor of the prevalence of three patterns. CONCLUSION A significant proportion of elderly populations was affected by multimorbidity in urban China. Specific patterns of multimorbidity were found at group level and the prevalence was associated with age.
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Affiliation(s)
- Jiayi Gu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Jianqian Chao
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Wenji Chen
- Zhongda Hospital, Affiliated to Southeast University, Nanjing, Jiangsu, China.
| | - Hui Xu
- Hospital of Qinghuai, Nanjing, Jiangsu, China.
| | - Zhenchun Wu
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Huanghui Chen
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Tingting He
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Lin Deng
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| | - Ruizhi Zhang
- Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
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11
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Turlejski T, Humoud I, Desai R, Smith KJ, Marina N. Immunohistochemical evidence of tissue hypoxia and astrogliosis in the rostral ventrolateral medulla of spontaneously hypertensive rats. Brain Res 2016; 1650:178-183. [PMID: 27616338 PMCID: PMC5069925 DOI: 10.1016/j.brainres.2016.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 12/11/2022]
Abstract
Increased activity of the sympathetic nervous system has been highlighted as a key factor that contributes to the development and maintenance of arterial hypertension. However, the factors that precipitate sustained increases in sympathetic activity remain poorly understood. Resting tissue oxygen partial pressure (PtO2) in the brainstem of anesthetized spontaneously hypertensive rats (SHRs) has been shown to be lower than in normotensive rats despite normal levels of arterial PO2. A hypoxic environment in the brainstem has been postulated to activate astroglial signalling mechanisms in the rostral ventrolateral medulla (RVLM) which in turn increase the excitability of presympathetic neuronal networks. In this study, we assessed the expression of indirect markers of tissue hypoxia and astroglial cell activation in the RVLM of SHRs and age-matched normotensive Wistar rats. Immunohistochemical labelling for hypoxia-induced factor-1α (HIF-1α) and bound pimonidazole adducts revealed the presence of tissue hypoxia in the RVLM of SHRs. Double immunostaining showed co-localization of bound pimonidazole labelling in putative presympathetic C1 neurons and in astroglial cells. Quantification of glial fibrillary acidic protein (GFAP) immunofluorescence showed relatively higher number of astrocytes and increased GFAP mean grey value density, whilst semi-quantitative analysis of skeletonized GFAP-immunoreactive processes revealed greater % area covered by astrocytic processes in the RVLM of adult SHRs. In conclusion, the morphological findings of tissue hypoxia and astrogliosis within brainstem presympathetic neuronal networks in the SHR support previous observations, showing that low brainstem PtO2 and increased astroglial signalling in the RVLM play an important role in pathological sympathoexcitation associated with the development of arterial hypertension. The rostral ventrolateral medulla of spontaneously hypertensive rats is hypoxic. Indirect markers of hypoxia were found in pre-sympathetic neurons and astrocytes. Astrogliosis is present in the rostral ventrolateral medulla of hypertensive rats.
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Affiliation(s)
- Tymoteusz Turlejski
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK; UCL Centre for Cardiovascular and Metabolic Neuroscience University College London, Gower Street, London WC1E 6BT, UK
| | - Ibrahim Humoud
- Department of Neuroscience, Physiology and Pharmacology, University College London, UK; UCL Centre for Cardiovascular and Metabolic Neuroscience University College London, Gower Street, London WC1E 6BT, UK
| | - Roshni Desai
- Department of Neuroinflammation, Institute of Neurology, University College London, UK
| | - Kenneth J Smith
- Department of Neuroinflammation, Institute of Neurology, University College London, UK
| | - Nephtali Marina
- Clinical Pharmacology and Experimental Therapeutics, Division of Medicine, University College London, UK; UCL Centre for Cardiovascular and Metabolic Neuroscience University College London, Gower Street, London WC1E 6BT, UK.
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12
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Marina N, Ang R, Machhada A, Kasymov V, Karagiannis A, Hosford PS, Mosienko V, Teschemacher AG, Vihko P, Paton JFR, Kasparov S, Gourine AV. Brainstem hypoxia contributes to the development of hypertension in the spontaneously hypertensive rat. Hypertension 2015; 65:775-83. [PMID: 25712724 PMCID: PMC4354460 DOI: 10.1161/hypertensionaha.114.04683] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
Abstract
Systemic arterial hypertension has been previously suggested to develop as a compensatory condition when central nervous perfusion/oxygenation is compromised. Principal sympathoexcitatory C1 neurons of the rostral ventrolateral medulla oblongata (whose activation increases sympathetic drive and the arterial blood pressure) are highly sensitive to hypoxia, but the mechanisms of this O2 sensitivity remain unknown. Here, we investigated potential mechanisms linking brainstem hypoxia and high systemic arterial blood pressure in the spontaneously hypertensive rat. Brainstem parenchymal PO2 in the spontaneously hypertensive rat was found to be ≈15 mm Hg lower than in the normotensive Wistar rat at the same level of arterial oxygenation and systemic arterial blood pressure. Hypoxia-induced activation of rostral ventrolateral medulla oblongata neurons was suppressed in the presence of either an ATP receptor antagonist MRS2179 or a glycogenolysis inhibitor 1,4-dideoxy-1,4-imino-d-arabinitol, suggesting that sensitivity of these neurons to low PO2 is mediated by actions of extracellular ATP and lactate. Brainstem hypoxia triggers release of lactate and ATP which produce excitation of C1 neurons in vitro and increases sympathetic nerve activity and arterial blood pressure in vivo. Facilitated breakdown of extracellular ATP in the rostral ventrolateral medulla oblongata by virally-driven overexpression of a potent ectonucleotidase transmembrane prostatic acid phosphatase results in a significant reduction in the arterial blood pressure in the spontaneously hypertensive rats (but not in normotensive animals). These results suggest that in the spontaneously hypertensive rat, lower PO2 of brainstem parenchyma may be associated with higher levels of ambient ATP and l-lactate within the presympathetic circuits, leading to increased central sympathetic drive and concomitant sustained increases in systemic arterial blood pressure.
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Affiliation(s)
- Nephtali Marina
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.).
| | - Richard Ang
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Asif Machhada
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Vitaliy Kasymov
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Anastassios Karagiannis
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Patrick S Hosford
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Valentina Mosienko
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Anja G Teschemacher
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Pirkko Vihko
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Julian F R Paton
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Sergey Kasparov
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.)
| | - Alexander V Gourine
- From the Centre for Cardiovascular and Metabolic Neuroscience (N.M., R.A., A.M., V.K., A.K., P.S.H., A.V.G.), Department of Clinical Pharmacology and Experimental Therapeutics (N.M., P.S.H.), and Neuroscience, Physiology and Pharmacology (R.A., A.M., V.K., A.K., A.V.G.), University College London, London, United Kingdom; School of Physiology and Pharmacology, University of Bristol, Bristol, United Kingdom (V.M., A.G.T., J.F.R.P., S.K.); and Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland (P.V.).
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13
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Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, Autenrieth CS, Peters A, Ladwig KH, Döring A. Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PLoS One 2012; 7:e30556. [PMID: 22291986 PMCID: PMC3264590 DOI: 10.1371/journal.pone.0030556] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 12/19/2011] [Indexed: 11/23/2022] Open
Abstract
Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.
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Affiliation(s)
- Inge Kirchberger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
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