1
|
Nasreldein A, Ahmed M, Shehab M, Abdelhaleem M, Lioutas VA. Clinical Characteristics, Functional Outcome, and Socioeconomic Impact of Ischemic Stroke among Young Egyptian Adults. Neuroepidemiology 2024:1-10. [PMID: 38934173 DOI: 10.1159/000539778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Stroke in young patients results in disproportionately high societal cost given the productive life-years lost. Little is known about stroke in young Egyptian patients. We aimed to analyze clinicodemographic characteristics, functional outcome, and socioeconomic impact of ischemic stroke among young Egyptian adults. METHODS This is a prospective, observational cohort study of consecutively recruited patients with acute ischemic stroke (AIS), 18-50 years, between September 2022 and September 2023 at a tertiary stroke center in the south of Egypt. We recorded baseline demographic and cardiovascular risk factors, stroke severity, stroke subtype according to the TOAST classification, intravenous thrombolysis, employment, and ambulation status pre- and post-stroke, post-stroke complications, and 90-day functional outcome measured by the modified Rankin Scale (mRS). RESULTS Our cohort comprised 210 patients, 38.0 (±7.8) years, 89 (42%) females. Mean NIHSS score was 11.2 (±4.8); in-hospital case fatality was 9% (19 patients). Dyslipidemia (n = 105, 50%), smoking (n = 105, 50%), and hypertension (n = 67, 32%) were the most prevalent cardiovascular risk factors. At 90 days, 58 (29%) patients had a 90-day mRS 0-1 and 53 (26%) met criteria for depression diagnosis. Sixty-nine of the 116 employed individuals (59%) remained out of work after 90 days of stroke, 61 of whom were single earners in their household. 36/60 (60%) thrombolysis-eligible patients received it; an additional 98 otherwise thrombolysis-eligible patients presented >4.5 h from symptom onset. Patients receiving IV thrombolysis were significantly more likely to have resumed full-time work at 90 days (32% vs. 11%, p = 0.006) but with no significant difference in 90-day mRS. CONCLUSIONS Young adult AIS patients in Egypt experience high rates of post-stroke depression and face challenges in their ability to work and provide for their families. Since most patients have treatable cardiovascular risk factors and only about two-thirds of eligible patients receive thrombolysis, reinforcing primary prevention, education about early stroke signs, and benefits of acute can improve outcomes and have significant potential societal benefit.
Collapse
Affiliation(s)
| | - Mohamed Ahmed
- Department of Neurology, Assiut University, Assiut, Egypt
| | - Mohamed Shehab
- Department of Neurology, Assiut University, Assiut, Egypt
| | | | - Vasileios-Arsenios Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA,
| |
Collapse
|
2
|
Tian Y, Zhang Y, He J, Hao P, Li T, Xiao Y, Peng L, Feng Y, Cheng X, Deng H, Wang P, Chong W, Hai Y, Chen L, You C, Fang F. Association of anemia with mortality in young adult patients with intracerebral hemorrhage. Sci Rep 2023; 13:19711. [PMID: 37953289 PMCID: PMC10641070 DOI: 10.1038/s41598-023-46941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 11/07/2023] [Indexed: 11/14/2023] Open
Abstract
This study aimed to examine the association of hemoglobin concentration with a 90-day mortality of young adult patients with ICH in a large retrospective cohort. A retrospective observational study was conducted between December 2013 and June 2019 in two tertiary academic medical centers in China. We defined patients with hemoglobin concentration < 80 g/L as severe anemia and 80-120/130 g/L as mild to moderate anemia. We also defined patients with hemoglobin concentration > 160 g/L as high hemoglobin. Associations of hemoglobin and outcomes were evaluated in multivariable regression analyses. The primary outcome was mortality at 90 days. We identified 4098 patients with ICH who met the inclusion criteria. After adjusting primary confounding variables, the 90-day mortality rate was significantly higher in young patients with severe anemia (OR, 39.65; 95% CI 15.42-101.97), moderate anemia (OR, 2.49; 95% CI 1.24-5.00), mild anemia (OR, 1.89; 95% CI 1.20-2.98), and high hemoglobin (OR, 2.03; 95% CI 1.26-3.26) group than in young patients of the normal group. The younger age was associated with a higher risk of death from anemia in patients with ICH (P for interaction = 0.01). In young adult patients with ICH, hemoglobin concentration was associated with 90-day mortality, and even mild to moderate anemia correlated with higher mortality. We also found that in ICH patients with anemia, younger age was associated with higher risk.
Collapse
Affiliation(s)
- Yixin Tian
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Pengfei Hao
- Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Tiangui Li
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Yangchun Xiao
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Liyuan Peng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuning Feng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Xin Cheng
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Haidong Deng
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Peng Wang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Weelic Chong
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Thomas Jefferson University, Philadelphia, PA, USA
| | - Lvlin Chen
- Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Chao You
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Fang Fang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
3
|
Weterings RPC, Kessels RPC, de Leeuw FE, Piai V. Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis. Int J Stroke 2023; 18:888-897. [PMID: 36765436 PMCID: PMC10507997 DOI: 10.1177/17474930231159267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Information about cognitive functioning is vital in the management of stroke, but the literature is mostly based on data from individuals older than 50 years of age who make up the majority of the stroke population. As cognitive functioning is subject to change due to aging, it is unclear whether such cognitive impairment patterns from the general stroke literature apply to the growing population of younger people with a stroke. AIM The aim of the study was to conduct a systematic review and meta-analysis of the proportion and severity of cognitive impairment in young-stroke patients. SUMMARY OF REVIEW MEDLINE, Embase, PsycINFO, and Web of Science were systematically searched up to 11 October 2022. Studies were included if they reported on a population of young-stroke patients, evaluated cognitive functioning as an outcome measure, and reported original data. We estimated the pooled prevalence rates for cognitive impairment and for aphasia. In addition, we calculated the pooled estimates for the severity of impairment per cognitive domain in the chronic phase (defined as >6 months post-stroke). Six hundred thirty-five articles were identified, of which 29 were eligible for inclusion. The pooled prevalence of cognitive impairment was 44% (k = 10; 95% confidence interval (CI): 34-54%) and of aphasia 22% (k = 13; 95% CI: 12-39%). Young-stroke patients in the chronic phase performed worse than stroke-free healthy age-appropriate controls across all cognitive domains examined, with Hedges' g effect sizes ranging from -0.49 to -1.64. CONCLUSION Around half of all young-stroke patients present with cognitive impairment and around a quarter with aphasia. Our data suggest that patterns of impairment in young-stroke patients follow those in the general stroke literature.
Collapse
Affiliation(s)
- Rosemarije PC Weterings
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roy PC Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vitória Piai
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Stroke in young adults, stroke types and risk factors: a case control study. BMC Neurol 2022; 22:335. [PMID: 36068544 PMCID: PMC9446773 DOI: 10.1186/s12883-022-02853-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stroke is the second leading cause of death above the age of 60 years, and the fifth leading cause in people aged 15 to 59 years old as reported by the World Health Organization global burden of diseases. Stroke in the young is particularly tragic because of the potential to create long-term disability, burden on the victims, their families, and the community at large. Despite this, there is limited data on stroke in young adults, and its risk factors in Uganda. Therefore, we determined the frequency and risk factors for stroke among young adults at Mulago hospital. Methods A case control study was conducted among patients presenting consecutively to the general medical wards with stroke during the study period September 2015 to March 2016. A brain Computerized Tomography scan was performed to confirm stroke and classify the stroke subtype. Controls were patients that presented to the surgical outpatient clinic with minor surgical conditions, matched for age and sex. Social demographic, clinical and laboratory characteristics were assessed for both cases and controls. Descriptive statistics including frequencies, percentages, means, and standard deviation were used to describe the social demographics of case and controls as well as the stroke types for cases. To determine risk factors for stroke, a conditional logistic regression, which accounts for matching (e.g., age and sex), was applied. Odds ratio (with 95% confidence interval) was used as a measure for associations. Results Among 51 patients with stroke, 39(76.5%) had ischemic stroke and 12(23.5%) had hemorrhagic stroke. The mean age was 36.8 years (SD 7.4) for stroke patients (cases) and 36.8 years (SD 6.9) for controls. Female patients predominated in both groups 56.9% in cases and 52.9% in controls. Risk factors noted were HIV infection, OR 3.57 (95% CI 1.16–10.96), elevated waist to hip ratio, OR 11.59(95% CI 1.98–68.24) and sickle cell disease, OR 4.68 (95% CI 1.11–19.70). This study found a protective effect of oral contraceptive use for stroke OR 0.27 95% CI 0.08–0.87. There was no association between stroke and hypertension, diabetes, and hyperlipidemia. Conclusion Among young adults with stroke, ischemic stroke predominated over hemorrhagic stroke. Risk factors for stroke were HIV infection, elevated waist to hip ratio and sickle cell disease.
Collapse
|
5
|
Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick SM, Ogeng'o J, Walker R, Kalaria RN. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull 2018; 145:97-108. [PMID: 29807146 DOI: 10.1016/j.brainresbull.2018.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2-3%), delayed dementia after stroke (10-20%) and vascular cognitive impairment (30-40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.
Collapse
Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Catherine Dotchin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
| |
Collapse
|
6
|
Kaddumukasa M, Kayima J, Nakibuuka J, Mugenyi L, Ddumba E, Blixen C, Welter E, Katabira E, Sajatovic M. A cross-sectional population survey on stroke knowledge and attitudes in Greater Kampala, Uganda. COGENT MEDICINE 2017; 4. [PMID: 31098388 DOI: 10.1080/2331205x.2017.1327129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background Stroke is a neurological condition with rapidly increasing burden in many low- and middle income countries. Africa is particularly hard-hit due to rapid population growth, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. Reducing stroke risk factors and teaching people to respond to stroke warning signs can prevent stroke and reduce burden. However, being able to address gaps in knowledge and improving both preventative and early-response care requires a clear understanding of practical and potentially modifiable topics. In this cross sectional study, we assessed the knowledge and attitudes among an urban population residing within the greater Kampala, Uganda. Methods A population cross sectional survey was conducted in urban Mukono, district, central Uganda. Through the systematic sampling method, data were gathered from 440 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception using a pretested structured questionnaire. Results A total of 440 study participants were enrolled. The leading risk factors for stroke identified by the participants were stress (75.7%) and hypertension (45.2%) respectively. Only two (0.5%) of the study participants identified cigarette smoking as a stroke risk factor. Individuals with hypertension have poor knowledge regarding stroke in spite their high risk for stroke. Conclusion Stroke knowledge is poor while, stress and hypertension are the leading perceived risk factors in our settings. While stress is contributing factor, hypertension is likely a more amenable and practical intervention target. Targeting individuals with stroke risk factors to increase stroke knowledge and education is crucial for engagement in healthcare. Implementing a self-management program to support and motivate this high-risk group as well as adopting healthy life-styles may be a way to reduce stroke burden in Uganda.
Collapse
Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - James Kayima
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Jane Nakibuuka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Leviticus Mugenyi
- Infectious Diseases Research Collaboration, Mulago Hill Road, MUJHU3 Building. P.O. Box 7475 Kampala, Uganda
| | - Edward Ddumba
- Department of Medicine, St Raphael of St Francis Nsambya Hospital, Nkozi University, P.O. Box 7146, Kampala, Uganda
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Elisabeth Welter
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Elly Katabira
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| |
Collapse
|
7
|
Sachdev PS, Lo JW, Crawford JD, Mellon L, Hickey A, Williams D, Bordet R, Mendyk AM, Gelé P, Deplanque D, Bae HJ, Lim JS, Brodtmann A, Werden E, Cumming T, Köhler S, Verhey FRJ, Dong YH, Tan HH, Chen C, Xin X, Kalaria RN, Allan LM, Akinyemi RO, Ogunniyi A, Klimkowicz-Mrowiec A, Dichgans M, Wollenweber FA, Zietemann V, Hoffmann M, Desmond DW, Linden T, Blomstrand C, Fagerberg B, Skoog I, Godefroy O, Barbay M, Roussel M, Lee BC, Yu KH, Wardlaw J, Makin SJ, Doubal FN, Chappell FM, Srikanth VK, Thrift AG, Donnan GA, Kandiah N, Chander RJ, Lin X, Cordonnier C, Moulin S, Rossi C, Sabayan B, Stott DJ, Jukema JW, Melkas S, Jokinen H, Erkinjuntti T, Mok VCT, Wong A, Lam BYK, Leys D, Hénon H, Bombois S, Lipnicki DM, Kochan NA. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 7:11-23. [PMID: 28138511 PMCID: PMC5257024 DOI: 10.1016/j.dadm.2016.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The Stroke and Cognition consortium (STROKOG) aims to facilitate a better understanding of the determinants of vascular contributions to cognitive disorders and help improve the diagnosis and treatment of vascular cognitive disorders (VCD). METHODS Longitudinal studies with ≥75 participants who had suffered or were at risk of stroke or TIA and which evaluated cognitive function were invited to join STROKOG. The consortium will facilitate projects investigating rates and patterns of cognitive decline, risk factors for VCD, and biomarkers of vascular dementia. RESULTS Currently, STROKOG includes 25 (21 published) studies, with 12,092 participants from five continents. The duration of follow-up ranges from 3 months to 21 years. DISCUSSION Although data harmonization will be a key challenge, STROKOG is in a unique position to reuse and combine international cohort data and fully explore patient level characteristics and outcomes. STROKOG could potentially transform our understanding of VCD and have a worldwide impact on promoting better vascular cognitive outcomes.
Collapse
Affiliation(s)
- Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Stroke and Geriatric Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Régis Bordet
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Anne-Marie Mendyk
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Patrick Gelé
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Dominique Deplanque
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Amy Brodtmann
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Emilio Werden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Toby Cumming
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Yan-Hong Dong
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Hui Tan
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xu Xin
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raj N Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Vera Zietemann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Hoffmann
- Cognitive Neurology and Stroke Programs, University of Central Florida, Orlando VA Medical Center, Orlando, Florida, USA
| | | | - Thomas Linden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Mélanie Barbay
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen J Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Amanda G Thrift
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Geoffrey A Donnan
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Xuling Lin
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Solene Moulin
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Costanza Rossi
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - David J Stott
- Academic Section of Geriatrics, University of Glasgow, Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Susanna Melkas
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Hanna Jokinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Timo Erkinjuntti
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Didier Leys
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Hilde Hénon
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Stéphanie Bombois
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | | |
Collapse
|
8
|
Seok H, Yoon JH, Won JU, Lee W, Lee JH, Jung PK, Roh J. Concealing Emotions at Work Is Associated with Allergic Rhinitis in Korea. TOHOKU J EXP MED 2016; 238:25-32. [PMID: 26666368 DOI: 10.1620/tjem.238.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Concealing emotions at work can cause considerable psychological stress. While there is extensive research on the adverse health effects of concealing emotions and the association between allergic diseases and stress, research has not yet investigated whether concealing emotions at work is associated with allergic rhinitis. Allergic rhinitis is a common disease in many industrialized countries, and its prevalence is increasing. Thus, our aim was to determine the strength of this association using data from three years (2007-2009) of the 4th Korean National Health and Nutrition Examination Survey. Participants (aged 20-64) were 8,345 individuals who were economically active and who had completed the questionnaire items on concealing emotions at work. Odds ratio (OR) and 95% confidence intervals (95% CIs) were calculated for allergic rhinitis using logistic regression models. Among all participants, 3,140 subjects (37.6%) reported concealing their emotions at work: 1,661 men and 1,479 women. The OR (95% CIs) for allergic rhinitis among those who concealed emotions at work versus those who did not was 1.318 (1.148-1.512). Stratified by sex, the OR (95% CIs) was 1.307 (1.078-1.585) among men and 1.346 (1.105-1.639) among women. Thus, individuals who concealed their emotions at work were significantly more likely to have a diagnosis of AR in comparison to those who did not. Because concealing emotions at work has adverse health effects, labor policies that aim to reduce this practice are needed.
Collapse
Affiliation(s)
- Hongdeok Seok
- Graduate School of Public Health, Yonsei University College of Medicine
| | | | | | | | | | | | | |
Collapse
|
9
|
Ojha R, Huang D, An H, Liu R, Du C, Shen N, Tu Z, Li Y. Distribution of ischemic infarction and stenosis of intra- and extracranial arteries in young Chinese patients with ischemic stroke. BMC Cardiovasc Disord 2015; 15:158. [PMID: 26597918 PMCID: PMC4657340 DOI: 10.1186/s12872-015-0147-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/10/2015] [Indexed: 01/10/2023] Open
Abstract
Background The distribution of cerebral ischemic infarction and stenosis in ischemic stroke may vary with age-group, race and gender. This study was conducted to understand the risk factors and characteristics of cerebral infarction and stenosis of vessels in young Chinese patients with ischemic stroke. Methods This was a retrospective study, from January 2007 to July 2012, of 123 patients ≤50 years diagnosed with acute ischemic stroke. Patient characteristics were compared according to sex (98 males and 25 females) and age group (51 patients were ≤45 years and 72 patients were 46–50 years). Characteristics of acute ischemic infarction were studied by diffusion weighted imaging. Stenosis of intra- and extracranial arteries was diagnosed by duplex sonography, head magnetic resonance angiography (MRA) or cervical MRA. Results Common risk factors were hypertension (72.4 %), dyslipidemia (55.3 %), smoking (54.4 %) and diabetes (33.3 %). Lacunar Infarction was most common in our patients (41.5 %). Partial anterior circulation infarction was predominant in females (52.0 vs 32.7 %; P = 0.073) and posterior circulation infarction in males (19.8 vs 4 %; P = 0.073). Multiple brain infarctions were found in 38 patients (30.9 %). Small artery atherosclerosis was found in 54 patients (43.9 %), with higher prevalence in patients of the 46–50 years age-group. Intracranial stenosis was more common than extracranial stenosis, and middle cerebral artery stenosis was most prevalent (27.3 %). Stenosis in the anterior circulation was more frequent than in the posterior circulation (P < 0.001). Conclusions In these young patients, hypertension, smoking, dyslipidemia and diabetes were common risk factors. Intracranial stenosis was most common. The middle cerebral artery was highly vulnerable.
Collapse
Affiliation(s)
- Rajeev Ojha
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Dongya Huang
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Hedi An
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Rong Liu
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Cui Du
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Nan Shen
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Zhilan Tu
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| | - Ying Li
- Department of Neurology, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200120, China.
| |
Collapse
|
10
|
Terroni L, Sobreiro MFM, Conforto AB, Adda CC, Guajardo VD, de Lucia MCS, Fráguas R. Association among depression, cognitive impairment and executive dysfunction after stroke. Dement Neuropsychol 2012; 6:152-157. [PMID: 29213789 PMCID: PMC5618962 DOI: 10.1590/s1980-57642012dn06030007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The relationship between depression and cognitive impairment, frequent after
stroke, is complex and has not been sufficiently elucidated.
Collapse
Affiliation(s)
- Luisa Terroni
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| | - Matildes F M Sobreiro
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| | - Adriana B Conforto
- Neurology Department, Clinics Hospital, Medical School, University of São Paulo, Teaching and Research Israeli Institute, Albert Einstein Israeli Hospital, São Paulo SP, Brazil
| | - Carla C Adda
- Division of Psychology, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| | - Valeri D Guajardo
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil.,Division of Psychology, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| | - Mara Cristina S de Lucia
- Division of Psychology, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| | - Renério Fráguas
- Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinics Hospital, Medical School, University of São Paulo, São Paulo SP, Brazil
| |
Collapse
|
11
|
Saposnik G, Lanthier S, Mamdani M, Thorpe KE, Melo M, Pope K, Selchen D, Moore DF. Fabry's Disease: A Prospective Multicenter Cohort Study in Young Adults with Cryptogenic Stroke. Int J Stroke 2012; 7:265-73. [DOI: 10.1111/j.1747-4949.2011.00734.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Stroke in young adults is etiologically diverse and may represent a diagnostic challenge remaining cryptogenic in one-fourth of cases. Limited information is available on the prevalence of Fabry's disease, a treatable multisystem inherited lysosomal storage disorder, and disability in young patients with cryptogenic stroke. Design and methods The Canadian Fabry Stroke Screening Initiative (CFSSI) is a prospective multicenter cohort study of young adults (age 18–55) presenting with an ischemic stroke, transient ischemic attack, or intracerebral haemorrhage of unknown etiology to stroke centres across Canada. Diagnosis of Fabry's disease is made by direct DNA analysis of blood samples for α-galactosidase gene mutations or polymorphisms. Demographics, clinical information, and investigations including brain Magnetic Resonance Imaging (MRI) are collected. Functional neurological assessment includes neurological examination, the National Institutes of Health (NIH) stroke scale, modified Rankin scale, and the Barthel index. A follow-up interview is conducted by telephone or in person approximately six-months after the index stroke/transient ischemic attack/intracerebral haemorrhage to determine patient outcomes, quality of life, and patient use of medications. Main outcome Prevalence of positive DNA mutation or single nucleotide polymorphism screens for Fabry's disease as a proportion of total cryptogenic stroke. Secondary outcomes include incident risk of new or recurrent vascular event at six-months, discharge disposition, disability at six-months as measured by the modified Rankin scale, mean time from symptoms onset to the definite etiological diagnosis, and length of hospital stay. Conclusion This study constitutes the first initiative to determine the prevalence of a positive screen for Fabry's disease in young adults with stroke in Canada. Moreover, the Canadian Fabry Stroke Screening Initiative will provide information on recurrent vascular events, disability at six-months (modified Rankin scale), and disposition in this understudied population.
Collapse
Affiliation(s)
- Gustavo Saposnik
- Departments of Medicine and Health Policy, Management and Evaluation, Division of Neurology, Stroke Outcomes Research Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sylvain Lanthier
- Division of Neurology, Centre of Cerebrovascular Diseases, Faculty of Medicine, Centre hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Muhammad Mamdani
- Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Kevin E. Thorpe
- Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Dalla Lana, School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Magda Melo
- Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Karen Pope
- Applied Health Research Centre, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Daniel Selchen
- Department of Medicine, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - David F. Moore
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA
| | | |
Collapse
|
12
|
Adoukonou TA, Vallat JM, Joubert J, Macian F, Kabore R, Magy L, Houinato D, Preux PM. [Management of stroke in sub-Saharan Africa: current issues]. Rev Neurol (Paris) 2011; 166:882-93. [PMID: 20800860 DOI: 10.1016/j.neurol.2010.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 04/25/2010] [Accepted: 06/21/2010] [Indexed: 01/04/2023]
Abstract
In sub-Saharan Africa, stroke is likely to present an increasingly important public health problem with a larger relative share of overall morbidity and mortality. Overall, sub-Saharan Health Care is characterized by a lack of human resources, lack of facilities for special investigations, and especially an absence of specific programs addressing the prevention of cardiovascular conditions. Current data on the epidemiology of stroke in sub-Saharan Africa, although sparse and fragmentary, indicate a comparatively high incidence of cerebral hemorrhage associated with high blood pressure, while ischemic stroke in black Africans still appears to be related primarily to small artery disease, HIV infection, and sickle cell disease. With urbanization, the role of large-vessel atherosclerosis is increasing. It is thus essential to coordinate government funding, health care professionals and development agencies to address this rising health problem. Access to health care needs to be better structured, and screening programs should be developed in order to identify and treat vascular risk factors. Improved training of health care professionals is also required in the areas of prevention, diagnosis and management of stroke. Implementation of best-practice recommendations for the management of stroke adapted to the specificities and resources of African countries would help rationalize the scarce resources currently available.
Collapse
Affiliation(s)
- T A Adoukonou
- Service de neurologie, CHU Dupuytren, EA 3174 neuroépidémiologie tropicale et comparée, université de Limoges, IFR 145 GEIST, institut de neuroépidémiologie et de neurologie tropicale, Limoges, France
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Adams HP. Clinical Scales to Assess Patients with Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|