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Bardugo A, Bendor CD, Libruder C, Lutski M, Zucker I, Tsur AM, Derazne E, Yaniv G, Gardner RC, Gerstein HC, Cukierman-Yaffe T, Lebenthal Y, Batty D, Tanne D, Furer A, Afek A, Twig G. Cognitive function in adolescence and the risk of early-onset stroke. J Epidemiol Community Health 2024; 78:570-577. [PMID: 38937113 DOI: 10.1136/jech-2024-222114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Stroke is increasingly prevalent at younger ages but the risk factors are uncertain. We examined the association between adolescent cognitive function and early-onset stroke. METHODS This was a nationwide population-based cohort study of 1 741 345 Israeli adolescents (42% women) who underwent comprehensive cognitive function tests at age 16-20 years, before mandatory military service, during 1987-2012. Cognitive function (range: 1-9) was categorised as low (1-3, corresponding to IQ score below 89), medium (4-7, IQ score range: 89-118), or high (8-9, IQ score above 118). Participant data were linked to the Israeli National Stroke Registry. Cox proportional hazard models were used to estimate risks for the first occurrence of ischaemic stroke during 2014-2018. RESULTS During 8 689 329 person-years of follow-up, up to a maximum age of 50 years, 908 first stroke events occurred (767 ischaemic and 141 haemorrhagic). Compared with a reference group of people with high cognitive function, body mass index-adjusted and sociodemographic-adjusted HRs (95% CIs) for early-onset stroke were 1.78 (1.33-2.38) in medium and 2.68 (1.96-3.67) in low cognitive function groups. There was evidence of a dose-response relationship (P for trend <0.0001) such that one-unit of lower cognitive function z-score was associated with a 33% increased risk of stroke (1.33; 1.23-1.42). These associations were similar for ischaemic stroke but lower for haemorrhagic stroke; persisted in sensitivity analyses that accounted for diabetes status and hypertension; and were evident before age 40 years. CONCLUSIONS Alongside adolescent obesity and hypertension, lower cognitive function may be a risk factor for early-onset stroke.
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmit Libruder
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Miri Lutski
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel Center for Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Avishai M Tsur
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gal Yaniv
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
| | - Raquel C Gardner
- The Joseph Sagol Neuroscience Center, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Tali Cukierman-Yaffe
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Lebenthal
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - David Tanne
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Furer
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | | | - Gilad Twig
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
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Behl T, Kaur I, Sehgal A, Khandige PS, Imran M, Gulati M, Khalid Anwer M, Elossaily GM, Ali N, Wal P, Gasmi A. The link between Alzheimer's disease and stroke: A detrimental synergism. Ageing Res Rev 2024; 99:102388. [PMID: 38914265 DOI: 10.1016/j.arr.2024.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/26/2024]
Abstract
Being age-related disorders, both Alzheimer's disease (AD) and stroke share multiple risk factors, such as hypertension, smoking, diabetes, and apolipoprotein E (APOE) Ɛ4 genotype, and coexist in patients. Accumulation of amyloid-β plaques and neurofibrillary tangled impair cognitive potential, leading to AD. Blocked blood flow in the neuronal tissues, causes neurodegeneration and cell death in stroke. AD is commonly characterized by cerebral amyloid angiopathy, which significantly elevates the risk of hemorrhagic stroke. Patients with AD and stroke have been both reported to exhibit greater cognitive impairment, followed by multiple pathophysiological mechanisms shared between the two. The manuscript aims to elucidate the relationship between AD and stroke, as well as the common pathways and risk factors while understanding the preventive therapies that might limit the negative impacts of this correlation, with diagnostic modalities and current AD treatments. The authors provide a comprehensive review of the link and aid the healthcare professionals to identify suitable targets and risk factors, that may retard cognitive decline and neurodegeneration in patients. However, more intricate research is required in this regard and an interdisciplinary approach that would target both the vascular and neurodegenerative factors would improve the quality of life in AD patients.
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Affiliation(s)
- Tapan Behl
- Amity School of Pharmaceutical Sciences, Amity University, Mohali, Punjab, India.
| | - Ishnoor Kaur
- University of Glasgow, College of Medical, Veterinary and Life Sciences, Glasgow, United Kingdom
| | - Aayush Sehgal
- GHG Khalsa College of Pharmacy, Gurusar Sadhar, Ludhiana, Punjab, India
| | - Prasanna Shama Khandige
- NITTE (Deemed to be University), NGSM Institute of Pharmaceutical Sciences, Department of Pharmacology, Mangaluru, Karnataka, India
| | - Mohd Imran
- Department of Pharmaceutical Chemistry, College of Pharmacy, Northern Border University, Rafha 91911, Saudi Arabia
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab 1444411, India; ARCCIM, Faculty of Health, University of Technology Sydney, Ultimo, NSW 20227, Australia
| | - Md Khalid Anwer
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Gehan M Elossaily
- Department of Baisc Medical Sciences, College of Medicine, AlMaarefa University, P.O. Box 71666, Riyadh 11597, Saudi Arabia
| | - Nemat Ali
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia
| | - Pranay Wal
- PSIT Kanpur, Department of Pharmacy, Uttar Pradesh, India
| | - Amin Gasmi
- Societe Francophone de Nutritherapie et de Nutrigenetique Appliquee, Villeurbanne, France; International Institute of Nutrition and Micronutrition Sciences, Saint Etienne, France
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3
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Walker RM, Chong M, Perrot N, Pigeyre M, Gadd DA, Stolicyn A, Shi L, Campbell A, Shen X, Whalley HC, Nevado-Holgado A, McIntosh AM, Heitmeier S, Rangarajan S, O'Donnell M, Smith EE, Yusuf S, Whiteley WN, Paré G. The circulating proteome and brain health: Mendelian randomisation and cross-sectional analyses. Transl Psychiatry 2024; 14:204. [PMID: 38762535 PMCID: PMC11102511 DOI: 10.1038/s41398-024-02915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024] Open
Abstract
Decline in cognitive function is the most feared aspect of ageing. Poorer midlife cognitive function is associated with increased dementia and stroke risk. The mechanisms underlying variation in cognitive function are uncertain. Here, we assessed associations between 1160 proteins' plasma levels and two measures of cognitive function, the digit symbol substitution test (DSST) and the Montreal Cognitive Assessment in 1198 PURE-MIND participants. We identified five DSST performance-associated proteins (NCAN, BCAN, CA14, MOG, CDCP1), with NCAN and CDCP1 showing replicated association in an independent cohort, GS (N = 1053). MRI-assessed structural brain phenotypes partially mediated (8-19%) associations between NCAN, BCAN, and MOG, and DSST performance. Mendelian randomisation analyses suggested higher CA14 levels might cause larger hippocampal volume and increased stroke risk, whilst higher CDCP1 levels might increase intracranial aneurysm risk. Our findings highlight candidates for further study and the potential for drug repurposing to reduce the risk of stroke and cognitive decline.
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Affiliation(s)
- Rosie M Walker
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
- School of Psychology, University of Exeter, Perry Road, Exeter, UK.
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK.
| | - Michael Chong
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Nicolas Perrot
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Marie Pigeyre
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Danni A Gadd
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Aleks Stolicyn
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Liu Shi
- Department of Psychiatry, University of Oxford, Oxford, UK
- Nxera Pharma UK Limited, Cambridge, UK
| | - Archie Campbell
- Generation Scotland, Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | - Xueyi Shen
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Heather C Whalley
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Generation Scotland, Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, EH4 2XU, UK
| | | | - Andrew M McIntosh
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Martin O'Donnell
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Health Research Board Clinical Research Facility, University of Galway, Galway, Ireland
| | - Eric E Smith
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, AB, Canada
- University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Department of Medicine, Michael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - William N Whiteley
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- MRC Centre for Population Health, University of Oxford, Oxford, UK
| | - Guillaume Paré
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada.
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Li Y, Geng W, Zhang X, Mi B. Risk factors and characteristics analysis of cognitive impairment in patients with cerebral infarction during recovery period. Int J Neurosci 2024:1-6. [PMID: 38536759 DOI: 10.1080/00207454.2024.2336189] [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: 02/23/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To analyze the risk factors and characteristics of cognitive impairment in patients with cerebral infarction during the recovery period. METHODS This retrospective case-control study included 183 patients with cerebral infarction in the recovery period. According to the MMSE score, they were divided into a cognitive impairment group of 79 cases and a cognitive normal group of 104 cases. Collect clinical data from all patients, including age, gender, body mass index, laboratory test results, past medical history, National Institute of Health Stroke Scale (NIHSS) score, modified Barthel index, Oxfordshire Community Stroke Project (OCSP) classification, and number of infarcted lesions. Multiple logistic regression analysis was used to identify risk factors related to cognitive impairment in patients with cerebral infarction. RESULT There were significant differences (p < 0.05) between the cognitive impairment group and the cognitive normal group in terms of age, body mass index, low-density lipoprotein level, NIHSS score, modified Barthel index, and number of infarcted lesions. Multivariate logistic regression analysis showed that age ≥ 65 years, stroke, carotid artery plaques, NIHSS score ≥ 5, anterior circulation infarction type, and multiple infarcted lesions were important risk factors for cognitive impairment. CONCLUSION Elderly age, presence of carotid artery plaques, high NIHSS score, multiple infarct lesions, and specific infarct types are important risk factors for cognitive dysfunction in patients during the recovery period of cerebral infarction.
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Affiliation(s)
- Yan Li
- Department of Neurology, Huantai County People's Hospital, Huantai County, Shandong, China
| | - Wenjuan Geng
- Department of Neurology, Huantai County People's Hospital, Huantai County, Shandong, China
| | - Xiaomeng Zhang
- Department of Neurology, Huantai County People's Hospital, Huantai County, Shandong, China
| | - Baobin Mi
- Department of Geriatrics, Binzhou Medical University Affiliated Hospital, Binzhou, Shandong, China
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5
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Schmidt K, Power MC, Ciarleglio A, Nadareishvili Z. Effect of pioglitazone on vascular events in post-stroke cognitive impairment: Post hoc analysis of the IRIS trial. Int J Stroke 2024; 19:414-421. [PMID: 38148372 DOI: 10.1177/17474930231225568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
BACKGROUND In stroke patients with insulin resistance (IR), post-stroke cognitive impairment (PSCI) is associated with higher risk of recurrent stroke, but the effect of pioglitazone on that risk has not been explored. The goal of this study was to compare the secondary stroke prevention effect of pioglitazone against placebo in patients with versus without PSCI. METHODS We studied patients enrolled in the Insulin Resistance Intervention after Stroke (IRIS) trial with a post-stroke modified Mini-Mental State Examination (3MS) cognitive assessment (mean time of assessment: 79 days post-stroke). We considered a baseline score of ⩽ 88 on the 3MS to indicate global PSCI, and domain-specific summary scores in the lowest quartile to indicate attention, language, memory, orientation, and visuospatial impairments. RESULTS In n = 3338 patients with IR, the effect of pioglitazone versus placebo on secondary stroke significantly differed by initial post-stroke global (interaction p = 0.0127) and memory impairment status (interaction p = 0.0003). Hazard ratios (HRs) were time-dependent such that, among those with either global or memory impairment, pioglitazone has an increasingly stronger protective effect at later timepoints. There was no statistically significant effect of pioglitazone among those without either global or memory impairment. The effect of pioglitazone versus placebo on myocardial infarction (MI) also significantly differed by global impairment status (interaction p = 0.030). Pioglitazone was protective among those with global impairment (HR = 0.23 [95% CI: 0.08, 0.71]) but not among those without (HR = 0.88 [95% CI: 0.59, 1.31]). CONCLUSION These data indicate that pioglitazone treatment may be more effective at reducing risk of recurrent stroke and MI in stroke patients with PSCI. Simple cognitive testing 2-3 months post-stroke may identify patients for whom treatment would be most beneficial.
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Affiliation(s)
- Kat Schmidt
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Adam Ciarleglio
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Zurab Nadareishvili
- Department of Neurology, School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
- Stroke Center, Virginia Hospital Center, Arlington, VA, USA
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6
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Rawat P, Sehar U, Bisht J, Reddy AP, Reddy PH. Alzheimer's disease and Alzheimer's disease-related dementias in Hispanics: Identifying influential factors and supporting caregivers. Ageing Res Rev 2024; 93:102178. [PMID: 38154509 PMCID: PMC10807242 DOI: 10.1016/j.arr.2023.102178] [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: 07/20/2023] [Revised: 10/04/2023] [Accepted: 12/23/2023] [Indexed: 12/30/2023]
Abstract
Alzheimer's disease (AD) and Alzheimer's disease-related dementias (ADRD) are the primary public health concerns in the United States and around the globe. AD/ADRD are irreversible mental illnesses that primarily impair memory and thought processes and may lead to cognitive decline among older individuals. The prevalence of AD/ADRD is higher in Native Americans, followed by African Americans and Hispanics. Increasing evidence suggests that Hispanics are the fastest-growing ethnic population in the USA and worldwide. Hispanics develop clinical symptoms of AD/ADRD and other comorbidities nearly seven years earlier than non-Hispanic whites. The consequences of AD/ADRD can be challenging for patients, their families, and caregivers. There is a significant increase in the burden of illness, primarily affecting Hispanic/Latino families. This is partly due to their strong sense of duty towards family, and it is exacerbated by the inadequacy of healthcare and community services that are culturally and linguistically suitable and responsive to their needs. With an increasing age population, low socioeconomic status, low education, high genetic predisposition to age-related conditions, unique cultural habits, and social behaviors, Hispanic Americans face a higher risk of AD/ADRD than other racial/ethnic groups. Our article highlights the status of Hispanic older adults with AD/ADRD. We also discussed the intervention to improve the quality of life in Hispanic caregivers.
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Affiliation(s)
- Priyanka Rawat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Ujala Sehar
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA
| | - Jasbir Bisht
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - Arubala P Reddy
- Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock 79409, TX, USA; Department of Speech, Language and Hearing Sciences, School Health Professions, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Public Health, School of Population and Public Health, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Neurology, Departments of School of Medicine, Texas Tech University Health Sciences Center, Lubbock 79430, TX, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Sabayan B, Goudarzi R, Ji Y, Borhani‐Haghighi A, Olson‐Bullis BA, Murray AM, Sedaghat S. Intracranial Atherosclerosis Disease Associated With Cognitive Impairment and Dementia: Systematic Review and Meta-Analysis. J Am Heart Assoc 2023; 12:e032506. [PMID: 37955546 PMCID: PMC10727275 DOI: 10.1161/jaha.123.032506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intracranial atherosclerosis disease (ICAD) alters cerebrovascular hemodynamics and brain structural integrity. Multiple studies have evaluated the link between ICAD and cognitive impairment, with mixed results. This study aims to systematically review and summarize the current evidence on this link. METHODS AND RESULTS PubMed, EMBASE, PsycInfo, and Web of Science were searched from 2000 to 2023 without language restriction. Cross-sectional and prospective cohort studies as well as postmortem studies were included. Studies containing data on the link between ICAD, defined as at least 50% stenosis in 1 intracranial vessel, and cognitive impairment and dementia were screened by 2 independent reviewers. A total of 22 (17 observational and 5 postmortem) unique studies, comprising 11 184 individuals (average age range, 59.8-87.6 years; 45.7% women; 36.5% Asian race), were included in the systematic review. Seven of 10 cross-sectional studies and 5 of 7 prospective studies showed a significant association between ICAD and cognitive impairment. In the pooled analysis, ICAD was associated with greater cognitive impairment (measure of association, 1.87 [95% CI, 1.49-2.35]). Meta-regression analyses did not show a significant impact of age, sex, and race. All postmortem studies showed that patients with Alzheimer disease and vascular dementia had a higher burden of ICAD compared with controls. CONCLUSIONS This study shows that ICAD is associated with cognitive impairment and dementia across age, sex, and race groups. Our findings may underscore the need to develop individualized dementia preventive care plans in patients with ICAD.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, Hennepin Healthcare Research InstituteHennepin County Medical CenterMinneapolisMN
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | - Roham Goudarzi
- Faculty of ScienceUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
| | | | | | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research and Geriatrics Division, Department of MedicineHennepin Healthcare Research InstituteMinneapolisMN
| | - Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMN
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Zou J, Yin Y, Lin Z, Gong Y. The analysis of brain functional connectivity of post-stroke cognitive impairment patients: an fNIRS study. Front Neurosci 2023; 17:1168773. [PMID: 37214384 PMCID: PMC10196111 DOI: 10.3389/fnins.2023.1168773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Background Post-stroke cognitive impairment (PSCI) is a considerable risk factor for developing dementia and reoccurrence of stroke. Understanding the neural mechanisms of cognitive impairment after stroke can facilitate early identification and intervention. Objectives Using functional near-infrared spectroscopy (fNRIS), the present study aimed to examine whether resting-state functional connectivity (FC) of brain networks differs in patients with PSCI, patients with Non-PSCI (NPSCI), and healthy controls (HCs), and whether these features could be used for clinical diagnosis of PSCI. Methods The present study recruited 16 HCs and 32 post-stroke patients. Based on the diagnostic criteria of PSCI, post-stroke patients were divided to the PSCI or NPSCI group. All participants underwent a 6-min resting-state fNRIS test to measure the hemodynamic responses from regions of interests (ROIs) that were primarily distributed in the prefrontal, somatosensory, and motor cortices. Results The results showed that, when compared to the HC group, the PSCI group exhibited significantly decreased interhemispheric FC and intra-right hemispheric FC. ROI analyses showed significantly decreased FC among the regions of somatosensory cortex, dorsolateral prefrontal cortex, and medial prefrontal cortex for the PSCI group than for the HC group. However, no significant difference was found in the FC between the PSCI and the NPSCI groups. Conclusion Our findings provide evidence for compromised interhemispheric and intra-right hemispheric functional connectivity in patients with PSCI, suggesting that fNIRS is a promising approach to investigate the effects of stroke on functional connectivity of brain networks.
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Affiliation(s)
- Jiahuan Zou
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan, China
| | - Yongyan Yin
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan, China
| | - Zhenfang Lin
- Department of Neurology, Sichuan Bayi Rehabilitation Center (Sichuan Provincial Rehabilitation Hospital), Chengdu, Sichuan, China
| | - Yulai Gong
- Department of Neurology, Sichuan Bayi Rehabilitation Center (Sichuan Provincial Rehabilitation Hospital), Chengdu, Sichuan, China
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Manwani B, Finger C, Lisabeth L. Strategies for Maintaining Brain Health: The Role of Stroke Risk Factors Unique to Elderly Women. Stroke 2022; 53:2662-2672. [PMID: 35652344 PMCID: PMC10911965 DOI: 10.1161/strokeaha.121.036894] [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] [Indexed: 11/16/2022]
Abstract
Stroke risk and prevalence increase with advanced age and women tend to be older than men at the time of their first stroke. Advanced age in women confers unique stroke risks that are beyond reproductive factors. Previous reviews and guidelines have largely focused on risk factors specific to women, with a predominant focus on reproductive factors and, therefore, younger to middle-aged women. This review aims to specifically describe stroke risk factors in elderly women, the population of women where the majority of strokes occur, with a focus on atrial fibrillation, hormone therapy, psychosocial risk factors, and cognitive impairment. Our review suggests that prevention and management of stroke risks that are unique or more prevalent in elderly women needs a coordinated system of care from general physicians, general neurologists, vascular and cognitive neurologists, psychologists, cardiologists, patients, and their caretakers. Early identification and management of the elderly woman-specific and traditional stroke risk factors is key for decreasing stroke burden in elderly women. Increased education among elderly women regarding stroke risk factors and their identification should be considered, and an update to the guidelines for prevention of stroke in women is strongly encouraged.
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Affiliation(s)
- Bharti Manwani
- Department of Neurology, University of Texas Health Science Center at Houston (B.M., C.F.)
| | - Carson Finger
- Department of Neurology, University of Texas Health Science Center at Houston (B.M., C.F.)
| | - Lynda Lisabeth
- Department of Epidemiology, University of Michigan, Ann Arbor (L.L.)
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10
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de Havenon A, Sharma R, Falcone GJ, Prabhakaran S, Sheth KN. Effect of Intensive Blood Pressure Control on Incident Stroke Risk in Patients With Mild Cognitive Impairment. Stroke 2022; 53:e242-e245. [PMID: 35502662 PMCID: PMC9246875 DOI: 10.1161/strokeaha.122.038818] [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: 01/24/2022] [Accepted: 03/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with mild cognitive impairment may be at higher risk of incident stroke, but the effect of intensive blood pressure (BP) control on that risk has not been explored. METHODS We performed a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial) and included patients with a baseline Montreal Cognitive Assessment score of 19 to 25 and without a prior history of stroke. The primary outcome was incident stroke (ischemic and hemorrhagic) during follow-up. We report the unadjusted cumulative risk of our primary outcome by SPRINT randomization arm (intensive versus standard BP control) and also fit Cox models to the primary outcome and adjusted for patient age at randomization, race/ethnicity, sex, baseline BP, atrial fibrillation, diabetes, and smoking. RESULTS We included 5091 patients (mean age 68.2, 44% female, 56.7% non-Hispanic White, and 50.2% randomized to intensive BP control), of which 95/5091 (1.9%) had an incident stroke during a mean of 3.8±0.9 years of follow-up. The risk of incident stroke in patients randomized to standard BP control was 57/2536 (2.3%) and to intensive BP control was 38/2555 (1.5%; P=0.045). In the adjusted Cox model, the hazard ratio for incident stroke events with intensive BP control was 0.65 (95% CI, 0.43-0.98; P=0.040). CONCLUSIONS Although the SPRINT trial failed to show a reduction in stroke with intensive BP control for all subjects, those with a Montreal Cognitive Assessment score consistent with mild cognitive impairment at baseline had an association between intensive BP control and lower risk of incident stroke. Future trials of primary prevention of stroke may benefit from enrichment using baseline vascular biomarkers of elevated risk, such as mild cognitive impairment.
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Affiliation(s)
| | - Richa Sharma
- Department of Neurology, Yale University, New Haven, CT
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11
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Fawns-Ritchie C, Price J, Deary IJ. Association of functional health literacy and cognitive ability with self-reported diabetes in the English Longitudinal Study of Ageing: a prospective cohort study. BMJ Open 2022; 12:e058496. [PMID: 36691240 PMCID: PMC9171267 DOI: 10.1136/bmjopen-2021-058496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES We investigated whether functional health literacy and cognitive ability were associated with self-reported diabetes. DESIGN Prospective cohort study. SETTING Data were from waves 2 (2004-2005) to 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA), a cohort study designed to be representative of adults aged 50 years and older living in England. PARTICIPANTS 8669 ELSA participants (mean age=66.7, SD=9.7) who completed a brief functional health literacy test assessing health-related reading comprehension, and 4 cognitive tests assessing declarative memory, processing speed and executive function at wave 2. PRIMARY OUTCOME MEASURE Self-reported doctor diagnosis of diabetes. RESULTS Logistic regression was used to examine cross-sectional (wave 2) associations of functional health literacy and cognitive ability with diabetes status. Adequate (compared with limited) functional health literacy (OR 0.71, 95% CI 0.61 to 0.84) and higher cognitive ability (OR per 1 SD=0.73, 95% CI 0.67 to 0.80) were associated with lower odds of self-reporting diabetes at wave 2. Cox regression was used to test the associations of functional health literacy and cognitive ability measured at wave 2 with self-reporting diabetes over a median of 9.5 years follow-up (n=6961). Adequate functional health literacy (HR 0.64; 95% CI 0.53 to 0.77) and higher cognitive ability (HR 0.77, 95% CI 0.69 to 0.85) at wave 2 were associated with lower risk of self-reporting diabetes during follow-up. When both functional health literacy and cognitive ability were added to the same model, these associations were slightly attenuated. Additionally adjusting for health behaviours and body mass index fully attenuated cross-sectional associations between functional health literacy and cognitive ability with diabetes status, and partly attenuated associations between functional health literacy and cognitive ability with self-reporting diabetes during follow-up. CONCLUSIONS Adequate functional health literacy and better cognitive ability were independently associated with lower likelihood of reporting diabetes.
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Affiliation(s)
| | - Jackie Price
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
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12
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Gupta A, Uthayaseelan K, Uthayaseelan K, Kadari M, Subhan M, Saji Parel N, Krishna PV, Sange I. Alzheimer's Disease and Stroke: A Tangled Neurological Conundrum. Cureus 2022; 14:e25005. [PMID: 35712342 PMCID: PMC9194877 DOI: 10.7759/cureus.25005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2022] [Indexed: 11/05/2022] Open
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13
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Correlation between psychological rumination and symptoms of traumatic stress in patients with mild paralysis in acute phase of stroke: A preliminary and cross-sectional study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2021.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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15
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Ojagbemi A, Bello T, Owolabi M, Baiyewu O. Prestroke cognitive decline in africans: Prevalence, predictors and association with poststroke dementia. J Neurol Sci 2021; 429:117619. [PMID: 34425399 DOI: 10.1016/j.jns.2021.117619] [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: 02/24/2021] [Revised: 08/05/2021] [Accepted: 08/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pre-existing cognitive decline is a risk factor for stroke onset and poststroke dementia. There is a knowledge gap on prestroke cognitive decline in indigenous Africans. We estimated prevalence and predictors of prestroke cognitive decline, as well as its association with poststroke dementia at one year in Nigerian survivors of a first ever stroke. METHODS Prospective observational study. Prestroke cognitive decline was ascertained using an average score > 3.31 on the 16-item Informant Questionnaire for Cognitive Decline in the Elderly (IQ-CODE). Poststroke dementia was ascertained according to the 'National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria'. Associations were investigated using multivariate logistic regression models and presented as odds ratios (O.R) within 95% confidence intervals (C.I). RESULTS Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I = 11.5%-23.6%). In analyses adjusting for the effect of age, education and stroke severity, prestroke cognitive decline was associated with diabetes mellitus (O.R = 3.0, 95% C.I = 1.2-7.6). Ten (62.5%) survivors in the prestroke cognitive decline sub-sample developed dementia at one-year poststroke. In analyses adjusting for the effects of age, education, stroke severity and comorbid diabetes mellitus, survivors with prestroke cognitive decline had six times the odds of dementia at one year poststroke (O.R = 6.2, 95% C.I = 1.3-30.4). CONCLUSION Prestroke cognitive decline is common, assessment is feasible and identifying pre-stroke problems has prognostic implications.
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Affiliation(s)
- Akin Ojagbemi
- World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria; Department of Psychiatry, College of Medicine University of Ibadan, Nigeria.
| | - Toyin Bello
- World Health Organization (WHO) Collaborating centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Division of Neurology, Department of Medicine, College of Medicine University of Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry, College of Medicine University of Ibadan, Nigeria
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16
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Verdelho A, Biessels GJ, Chabriat H, Charidimou A, Duering M, Godefroy O, Pantoni L, Pavlovic A, Wardlaw J. Cerebrovascular disease in patients with cognitive impairment: A white paper from the ESO dementia committee - A practical point of view with suggestions for the management of cerebrovascular diseases in memory clinics. Eur Stroke J 2021; 6:111-119. [PMID: 34414285 PMCID: PMC8370070 DOI: 10.1177/2396987321994294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Practical suggestions on clinical decisions about vascular disease management in patients with cognitive impairment are proposed. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO) based on the evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Vascular risk factors and cerebrovascular disease are frequent in patients with cognitive impairment. While acute stroke treatment has evolved substantially in last decades, evidence of management of cerebrovascular pathology beyond stroke in patients with cognitive impairment and dementia is quite limited. Additionally, trials to test some daily-life clinical decisions are likely to be complex, difficult to undertake and take many years to provide sufficient evidence to produce recommendations. This document was conceived to provide some suggestions until data from field trials are available. It was conceived for the use of clinicians from memory clinics or involved specifically in cognitive disorders, addressing practical aspects on diagnostic tools, vascular risk management and suggestions on some therapeutic options. DISCUSSION AND CONCLUSIONS The authors did not aim to do an exhaustive or systematic review or to cover all current evidence. The document approach in a very practical way frequent issues concerning cerebrovascular disease in patients with known cognitive impairment.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saude Ambiental-ISAMB, Faculdade de Medicina. University of Lisbon, Lisbon, Portugal
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris and INSERM U1141, Paris, France
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Olivier Godefroy
- Departments of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Leonardo Pantoni
- Stroke and Dementia Lab, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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17
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Luksiene D, Sapranaviciute-Zabazlajeva L, Tamosiunas A, Radisauskas R, Bobak M. Lowered cognitive function and the risk of the first events of cardiovascular diseases: findings from a cohort study in Lithuania. BMC Public Health 2021; 21:792. [PMID: 33894765 PMCID: PMC8070287 DOI: 10.1186/s12889-021-10843-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this prospective cohort study was to examine whether the level of cognitive function at the baseline expressed as a cognitive function composite score and score of specific domains predict the risk of first cardiovascular disease (CVD) events in middle-aged and older populations. Methods Seven thousand eighty-seven participants, men and women aged 45–72 years, were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008 in the city of Kaunas, Lithuania. During 10 years of follow-up, the risk of first non-fatal events of CVD and death from CVD (excluding those participants with a documented history of CVD and/or ischemic heart disease (IHD) diagnosed at the baseline survey) was evaluated. Cox proportional hazards regression models were applied to examine how cognitive function predicts the first events of CVD. Results During the follow-up, there were 156 deaths from CVD (49 women and 107 men) and 464 first non-fatal CVD events (195 women and 269 men) registered. The total number of first CVD events was 620 (11.5%). After adjustment for sociodemographic factors, biological and lifestyle risk factors and illnesses, a decrease per 1 standard deviation in different cognitive function scores significantly increased the risk of a first event of CVD (immediate verbal recall score - by 17% in men and 32% in women; delayed verbal recall score – by 17% in men and 24% in women; and a composite score of cognitive function – by 15% in men and 29% in women). Kaplan-Meier survival curves for the probability of a first cardiovascular event according to the categories of a composite score of cognitive function, revealed that a lowered cognitive function predicts a higher probability of the events compared to normal cognitive function (p < 0.05). Conclusions The findings of this follow-up study suggest that men and women with lower cognitive functions have an increased risk for a first event of CVD compared to participants with a higher level of cognitive functions.
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Affiliation(s)
- Dalia Luksiene
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania. .,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania.
| | | | - Abdonas Tamosiunas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Laboratory of Population Studies of the Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, LT-50162, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, LT-47181, Kaunas, Lithuania
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, UK
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18
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van Nieuwkerk AC, Pendlebury ST, Rothwell PM. Accuracy of the Informant Questionnaire on Cognitive Decline in the Elderly for Detecting Preexisting Dementia in Transient Ischemic Attack and Stroke: A Population-Based Study. Stroke 2021; 52:1283-1290. [PMID: 33682451 PMCID: PMC7610483 DOI: 10.1161/strokeaha.120.031961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Astrid C. van Nieuwkerk
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
| | - Sarah T. Pendlebury
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
| | - for the Oxford Vascular Study
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
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19
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Kupferman JC, Lande MB, Stabouli S, Zafeiriou DI, Pavlakis SG. Hypertension and childhood stroke. Pediatr Nephrol 2021; 36:809-823. [PMID: 32350664 DOI: 10.1007/s00467-020-04550-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
Cerebrovascular disease (stroke) is one of the ten leading causes of death in children and adolescents. Multiple etiologies, from arteriopathies to prothrombic states, can cause stroke in youth. In adult stroke, hypertension has been shown to be the single most important modifiable risk factor. Although hypertension has not been strongly identified as a risk factor in childhood stroke to date, there is preliminary evidence that suggests that hypertension may also be associated with stroke in children. In this review, we summarize the literature that may link hypertension to stroke in the young. We have identified a series of barriers and limitations in the fields of pediatric hypertension and pediatric neurology that might explain why hypertension has been overlooked in childhood stroke. We suggest that hypertension may be a relevant risk factor that, alone or in combination with other multiple factors, contributes to the development of stroke in children. Currently, there are no consensus guidelines for the management of post-stroke hypertension in children. Thus, we recommend that blood pressure be assessed carefully in every child presenting with acute stroke in order to better understand the effects of hypertension in the development and the outcome of childhood stroke. We suggest a treatment algorithm to help practitioners manage hypertension after a stroke.
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Affiliation(s)
- Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios I Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steven G Pavlakis
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
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20
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Kwan A, Wei J, Dowling NM, Power MC, Nadareishvili Z. Cognitive Impairment after Lacunar Stroke and the Risk of Recurrent Stroke and Death. Cerebrovasc Dis 2021; 50:383-389. [PMID: 33752211 PMCID: PMC8266725 DOI: 10.1159/000514261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with poststroke cognitive impairment appear to be at higher risk of recurrent stroke and death. However, whether cognitive impairment after lacunar stroke is associated with recurrent stroke and death remains unclear. We assessed whether global or domain-specific cognitive impairment after lacunar stroke is associated with recurrent stroke and death. METHODS We considered patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial with a baseline cognitive exam administered in English by certified SPS3 personnel, 14-180 days after qualifying lacunar stroke. We considered a baseline score of ≤86 on the Cognitive Assessment Screening Instrument to indicate global cognitive impairment, <10 on the Clock Drawing on Command test to indicate executive function impairment, and domain-specific summary scores in the lowest quartile to indicate memory and nonmemory impairment. We used Cox proportional hazards models to estimate the association between poststroke cognitive impairment and subsequent risk of recurrent stroke and death. RESULTS The study included 1,528 participants with a median enrollment time of 62 days after qualifying stroke. During a mean follow-up of 3.9 years, 11.4% of participants had recurrent stroke and 8.2% died. In the fully adjusted models, memory impairment was independently associated with an increased risk of recurrent stroke (hazard ratio, 1.48; 95% confidence interval [95% CI]: 1.04-2.09) and death (hazard ratio, 1.87; 95% CI: 1.25-2.79). Global impairment (hazard ratio, 1.66; 95% CI: 1.06-2.59) and nonmemory impairment (hazard ratio, 1.74; 95% CI: 1.14-2.67) were associated with an increased risk of death. DISCUSSION/CONCLUSION After lacunar stroke, memory impairment was an independent predictor of recurrent stroke and death, while global and nonmemory impairment were associated with death. Cognitive screening in lacunar stroke may help identify populations at higher risk of recurrent stroke and death.
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Affiliation(s)
- Abraham Kwan
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - N Maritza Dowling
- Department of Acute and Chronic Care, School of Nursing, George Washington University, Washington, District of Columbia, USA
| | - Melinda C Power
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Zurab Nadareishvili
- Department of Neurology, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA,
- Stroke Center, Virginia Hospital Center, Arlington, Virginia, USA,
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21
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He W, Ji Y, Wei X, Wang F, Xu F, Lu C, Ma Q, Wang K. Eye Movement Technique to Improve Executive Function in Patients With Stroke: A Randomized Controlled Trial. Front Neurol 2021; 12:599850. [PMID: 33776878 PMCID: PMC7988201 DOI: 10.3389/fneur.2021.599850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/17/2021] [Indexed: 12/04/2022] Open
Abstract
Objective: To investigate the efficacy of eye movement technique for the treatment of executive dysfunction of patients with stroke. Methods: This was a prospective, single-blinded, randomized, controlled, single-center clinical trial conducted from June 2018 to December 2019 in patients with stroke. The patients were randomized 1:1 to the routine (conventional management) and eye-move group (routine management plus eye movement technique: 5-min goal management training, 5-min computer-aided working memory, and 10 min of inhibitory control training and set conversion training). The intervention lasted 6 weeks, followed by a 4-week follow-up. The primary endpoint was the Behavioral Assessment of the Dysexecutive Syndrome (BADS) score. The secondary endpoints mainly included the Montreal Cognitive Assessment (MoCA), Wisconsin Card Sorting Test (WCST), and modified Barthel Index (MBI) scores. Results: Sixty-four patients were enrolled (32/group). After the 6-week intervention, the BADS and WCST scores of the eye-move group were significantly improved than those of the routine group (all P < 0.05), but the effects were attenuated in certain subscores after follow-up (all P > 0.05). The MoCA and MBI scores of the eye-move group were significantly higher, and the reaction time was significantly lower than those of the routine group at 4 weeks after the intervention (all P < 0.05). After follow-up, the MBI scores of the eye-move group were still higher than that of the routine group (P < 0.001), but there were no differences for MoCA scores and reaction time (both P > 0.05). Conclusion: The eye movement technique could improve the executive function of patients with stroke. These results have to be confirmed. This was a prospective, single-blinded, randomized, controlled, single-center clinical trial (ChiCTR2000036393). Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2000036393].
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Affiliation(s)
- Wen He
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Yazheng Ji
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Xiating Wei
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Fan Wang
- Rehabilitation Treatment Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Feng Xu
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Chengyi Lu
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Qianqian Ma
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
| | - Kai Wang
- Rehabilitation Department, Shanghai Fourth Rehabilitation Hospital, Shanghai, China
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22
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Wardlaw JM, Doubal F, Brown R, Backhouse E, Woodhouse L, Bath P, Quinn TJ, Robinson T, Markus HS, McManus R, O’Brien JT, Werring DJ, Sprigg N, Parry-Jones A, Touyz RM, Williams S, Mah YH, Emsley H. Rates, risks and routes to reduce vascular dementia (R4vad), a UK-wide multicentre prospective observational cohort study of cognition after stroke: Protocol. Eur Stroke J 2021; 6:89-101. [PMID: 33817339 PMCID: PMC7995325 DOI: 10.1177/2396987320953312] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stroke commonly affects cognition and, by definition, much vascular dementia follows stroke. However, there are fundamental limitations in our understanding of vascular cognitive impairment, restricting understanding of prevalence, trajectories, mechanisms, prevention, treatment and patient-service needs. AIMS Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. We aim to recruit a wide range of patients with stroke, presenting to geographically diverse UK hospitals, into a longitudinal study to determine rates of, and risk factors for, cognitive and related impairments after stroke, to assess potential mechanisms and improve prediction models. METHODS We will recruit at least 2000 patients within six weeks of stroke with or without capacity to consent and collect baseline demographic, clinical, socioeconomic, lifestyle, cognitive, neuropsychiatric and informant data using streamlined patient-centred methods appropriate to the stage after stroke. We will obtain more detailed assessments at four to eight weeks after the baseline assessment and follow-up by phone and post yearly to at least two years. We will assess diagnostic neuroimaging in all and high-sensitivity inflammatory markers, genetics, blood pressure and diffusion tensor imaging in mechanistic sub-studies.Planned outputs: R4VaD will provide reliable data on long-term cognitive function after stroke, stratified by prior cognition, stroke- and patient-related variables and improved risk prediction. It will create a platform enabling sharing of data, imaging and samples. Participants will be consented for re-contact, facilitating future clinical trials and providing a resource for the stroke and dementia research communities.
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Affiliation(s)
- Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Fergus Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rosalind Brown
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ellen Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Philip Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, UK
| | - Hugh S Markus
- Department of Neurology, University of Cambridge, Cambridge, UK
| | | | - John T O’Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David J Werring
- National Hospital for Neurology and Neurosurgery, London, UK
- NHS Foundation Trust and Stroke Research Centre, University College Hospitals, London, UK
- Institute of Neurology, University College, London, UK
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Adrian Parry-Jones
- Division of Cardiovascular Sciences, School of Medicine, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Steven Williams
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Yee-Haur Mah
- King’s College Hospital NHS Foundation Trust, School of Biomedical Engineering and Imaging Sciences, King’s College London, UK
| | - Hedley Emsley
- Department of Neurology, Lancashire Teaching Hospitals NHS Foundation Trust & Lancaster Medical School, Lancaster University, UK
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D'Souza CE, Greenway MRF, Graff-Radford J, Meschia JF. Cognitive Impairment in Patients with Stroke. Semin Neurol 2021; 41:75-84. [PMID: 33418591 DOI: 10.1055/s-0040-1722217] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in stroke care, vascular cognitive impairment remains a prominent source of disability. Unlike sensorimotor impairments, cognition often continues to decline after stroke. An aging population will increase the prevalence of vascular cognitive impairment, with stroke playing an important role. Ten percent of patients presenting with stroke have pre-stroke dementia; an additional 10% will develop incident dementia with a first stroke, and 30% with a recurrent stroke. While stroke increases the risk of cognitive impairment, the presence of cognitive impairment also impacts acute stroke treatment and increases risk of poor outcome by nearly twofold. There is substantial overlap in the clinical and pathological aspects of vascular and degenerative dementias in many patients. How they relate to one another is controversial. The treatment of vascular cognitive impairment remains supportive, focusing on treating vascular risk factors. Cognitive rehabilitation after stroke is an area of active research, and existing pharmacologic treatments have limited benefit. Heightened awareness of cognitive impairment in the setting of stroke is imperative for prognostication and management, impetus for research and, ultimately, the discovery of efficacious treatments.
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Affiliation(s)
- Caitlin E D'Souza
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida.,Department of Neurology, Baptist Health, Jacksonville, Florida
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida
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Pavol MA, Boehme AK, Willey JZ, Festa JR, Lazar RM, Nakagawa S, Casida J, Yuzefpolskaya M, Colombo PC. Predicting post-LVAD outcome: Is there a role for cognition? Int J Artif Organs 2020; 44:237-242. [DOI: 10.1177/0391398820956661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Cognition has been found to influence risk of stroke and death for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implant. We aimed to study the relationship between cognition, stroke, and death in a cohort of patients who received LVAD therapy. It was hypothesized that cognitive test results obtained prior to LVAD placement would predict stroke and death after surgery. Methods: We retrospectively identified 59 HF patients who had cognitive assessment prior to LVAD placement. Cognitive assessment included measures of attention, memory, language, and visualmotor speed and were averaged to produce one z-score variable per patient. Survival analyses, censored for transplant, evaluated predictors for stroke and death within a follow-up period of 900 days. Results: For patients with stroke or death during the follow up period, the average cognitive z-score predicted post-LVAD stroke (HR = 0.513, 95% CI = 0.31–0.86, p = 0.012) and death (HR = 0.166, 95% CI = 0.06–0.47, p = 0.001). Cognitive performances were worse in the patients who suffered stroke or died. No other variable predicted stroke and death within the follow up period when the cognitive variable was in the model. Conclusion: Cognitive performance was predictive of post-LVAD risk of stroke and death. Results are consistent with findings from other studies in non-LVAD samples and may reflect early signs of neurologic vulnerability. Further studies are needed to clarify the relationship between cognition and LVAD outcomes in order to optimize patient selection, management, and advanced care planning.
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Affiliation(s)
- Marykay A Pavol
- Division of Stroke, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Amelia K Boehme
- Division of Neurology Clinical Outcomes Research and Population Science, Department of Neurology, Columbia University, New York, NY, USA
| | - Joshua Z Willey
- Division of Stroke, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald M Lazar
- UAB Evelyn F. McKnight Brain Institute, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shunichi Nakagawa
- Palliative Care Services, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jesus Casida
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Melana Yuzefpolskaya
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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25
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Effect of an EMG-FES Interface on Ankle Joint Training Combined with Real-Time Feedback on Balance and Gait in Patients with Stroke Hemiparesis. Healthcare (Basel) 2020; 8:healthcare8030292. [PMID: 32846971 PMCID: PMC7551751 DOI: 10.3390/healthcare8030292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/17/2022] Open
Abstract
This study evaluated the effects of an electromyography-functional electrical stimulation interface (EMG-FES interface) combined with real-time balance and gait feedback on ankle joint training in patients with stroke hemiplegia. Twenty-six stroke patients participated in this study. All subjects were randomly assigned to either the EMG-FES interface combined with real-time feedback on ankle joint training (RFEF) group (n = 13) or the EMG-FES interface on ankle joint training (EF) group (n = 13). Subjects in both groups were trained for 20 min a day, 5 times a week, for 4 weeks. Similarly, all participants underwent a standard rehabilitation physical therapy for 60 min a day, 5 times a week, for 4 weeks. The RFEF group showed significant increases in weight-bearing lunge test (WBLT), Tardieu Scale (TS), Timed Up and Go Test (TUG), Berg Balance Scale (BBS), velocity, cadence, step length, stride length, stance per, and swing per (p < 0.05). Likewise, the EF group showed significant increases in WBLT, TUG, BBS, velocity, and cadence (p < 0.05). Moreover, the RFEF group showed significantly greater improvements than the EF group in terms of WBLT, Tardieu Scale, TUG, BBS, velocity, step length, stride length, stance per, and swing per (p < 0.05). Ankle joint training using an EMG-FES interface combined with real-time feedback improved ankle range of motion (ROM), muscle tone, balance, and gait in stroke patients. These results suggest that an EMG-FES interface combined with real-time feedback is feasible and suitable for ankle joint training in individuals with stroke.
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Heshmatollah A, Mutlu U, Koudstaal PJ, Ikram MA, Ikram MK. Cognitive and physical impairment and the risk of stroke - A prospective cohort study. Sci Rep 2020; 10:6274. [PMID: 32286410 PMCID: PMC7156475 DOI: 10.1038/s41598-020-63295-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
The manifestation of cognitive and physical impairment in stroke patients before the acute event suggests accumulating subclinical vascular pathology in the brain. We investigated whether impairments in cognitive and physical functioning were associated with an increased stroke risk. Between 2002 and 2008, 8,519 stroke-free non-demented participants from the population-based Rotterdam Study underwent cognition and physical assessments including Mini-Mental State Examination, 15-word learning test, Stroop test, letter-digit substitution test, verbal fluency test, Purdue pegboard test and questionnaires on basic and instrumental activities of daily living (BADL; IADL). Principal component analysis was used to derive global cognition (G-factor). Incident stroke was assessed through continuous monitoring of medical records until 2016. Among 8,519 persons (mean age 66.0 years; 57.8% women), 489 suffered a stroke during mean follow-up of 8.7 years (SD: 2.9). Worse G-factor was associated with higher stroke risk (Hazard Ratio 1.21, 95% CI: 1.06–1.38), largely driven by unspecified stroke. Likewise, worse scores on 15-word learning test, Stroop test, Purdue pegboard test, IADL, and BADL were associated with higher risk of stroke. Thus both worse cognitive and physical functioning were associated with a higher stroke risk, in particular unspecified stroke and persons with worse memory, information processing, executive function, and motor function.
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Affiliation(s)
- A Heshmatollah
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - U Mutlu
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - P J Koudstaal
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M K Ikram
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. .,Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Bogolepova A, Levin O. Cognitive rehabilitation of patients with focal brain damage. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:115-122. [DOI: 10.17116/jnevro2020120041115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cognitive Function in Dementia-Free Subjects and Survival in Old Age: The PROSPER Study. Am J Med 2019; 132:1466-1474.e4. [PMID: 31228412 DOI: 10.1016/j.amjmed.2019.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/05/2019] [Accepted: 06/02/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Impairment in domain-specific cognitive function is associated with the increased risk of mortality. We prospectively evaluated the association of executive function and memory with the risk of long-term mortality in dementia-free older subjects. Moreover, we investigated the role of structural brain abnormalities in this association. METHODS We included 547 dementia-free participants (mean age 78 years, 56.5% male) from the nested magnetic resonance imaging sub-study of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). Cox proportional hazard models were used to model 10-year risk of all-cause, cardiovascular, and noncardiovascular mortality in relation to performance in executive function and memory. Moreover, we evaluated the role of total brain parenchymal volume, cerebral blood flow, white matter hyperintensity, and the presence of microbleeds and infarcts in the link between cognitive function and mortality. RESULTS In the multivariable model, lower performance in executive function was associated with greater risk of all-cause (hazard ratio [HR] 1.49; 95% confidence interval [CI], 1.31-1.70), cardiovascular (HR 1.69; 95% CI, 1.36-2.11), and noncardiovascular (HR 1.36; 95% CI, 1.15-1.62) mortality. Similarly, poorer performance in memory tests associated with higher risk of all-cause (HR 1.47; 95% CI, 1.29-1.68), cardiovascular (HR 1.45; 95% CI, 1.15-1.83), and noncardiovascular (HR 1.49; 95% CI, 1.27-1.76) mortality. The associations were similar in subjects with various levels of brain structural abnormalities and cerebral blood flow (all P for interaction ≫ .05). CONCLUSIONS Poorer performance in both executive function and memory tests associates with all-cause, cardiovascular, and noncardiovascular mortality in elderly individuals. This association is independent of cardiovascular risk factors and diseases, brain structural abnormalities, and cerebral blood flow.
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Wang Z, Chen Z, Yang J, Yang Z, Yin J, Duan X, Shen H, Li H, Wang Z, Chen G. Treatment of secondary brain injury by perturbing postsynaptic density protein-95-NMDA receptor interaction after intracerebral hemorrhage in rats. J Cereb Blood Flow Metab 2019; 39. [PMID: 29513122 PMCID: PMC6681427 DOI: 10.1177/0271678x18762637] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postsynaptic density protein-95 (PSD95) plays important roles in the formation, differentiation, remodeling, and maturation of neuronal synapses. This study is to estimate the potential role of PSD95 in cognitive dysfunction and synaptic injury following intracerebral hemorrhage (ICH). The interaction between PSD95 and NMDA receptor subunit NR2B-neurotransmitter nitric oxide synthase (nNOS) could form a signal protein complex mediating excitatory signaling. Besides NR2B-nNOS, PSD95 also can bind to neurexin-1-neuroligin-1 to form a complex and participates in maintaining synaptic function. In this study, we found that there were an increase in the formation of PSD95-NR2B-nNOS complex and a decrease in the formation of neurexin-1-neuroligin-1-PSD95 complex after ICH, and this was accompanied by increased neuronal death and degeneration, and behavior dysfunction. PSD95 inhibitor Tat-NR2B9c effectively inhibited the interaction between PSD95 and NR2B-nNOS, and promoted the formation of neurexin-1-nueuroligin-1-PSD95 complex. In addition, Tat-NR2B9c treatment significantly reduced neuronal death and degeneration and matrix metalloproteinase 9 activity, alleviated inflammatory response and neurobehavioral disorders, and improved the cognitive and learning ability of ICH rats. Inhibition of the formation of PSD95-NR2B-nNOS complex can rescue secondary brain injury and behavioral cognitive impairment after ICH. PSD95 is expected to be a target for improving the prognosis of patients with ICH.
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Affiliation(s)
- Zhifeng Wang
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhouqing Chen
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junjie Yang
- 2 Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, China
| | - Ziying Yang
- 2 Institute for Cardiovascular Science & Department of Cardiovascular Surgery of the First Affiliated Hospital, Soochow University, Suzhou, China
| | - Jia Yin
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaochun Duan
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Shen
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Li
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhong Wang
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gang Chen
- 1 Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
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Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol 2019; 18:248-258. [PMID: 30784556 PMCID: PMC6390174 DOI: 10.1016/s1474-4422(18)30442-3] [Citation(s) in RCA: 307] [Impact Index Per Article: 61.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Risk of dementia after stroke is a major concern for patients and carers. Reliable data for risk of dementia, particularly after transient ischaemic attack or minor stroke, are scarce. We studied the risks of, and risk factors for, dementia before and after transient ischaemic attack and stroke. METHODS The Oxford Vascular Study is a prospective incidence study of all vascular events in a population of 92 728 people residing in Oxfordshire, UK. Patients with transient ischaemic attack or stroke occurring between April 1, 2002, and March 31, 2012, were ascertained with multiple methods, including assessment in a dedicated daily emergency clinic and daily review of all hospital admissions. Pre-event and post-event (incident) dementia were diagnosed at initial assessment and during 5-years' follow-up on the basis of cognitive testing supplemented by data obtained from hand searches of all hospital and primary care records. We assessed the association between post-event dementia and stroke severity (as measured with the US National Institutes of Health Stroke Scale [NIHSS] score), location (ie, dysphasia), previous events, markers of susceptibility or reserve (age, low education, pre-morbid dependency, leucoaraiosis), baseline cognition, and vascular risk factors with Cox regression models adjusted for age, sex, and education. We compared incidence and prevalence of dementia in our population with published UK population age-matched and sex-matched rates. FINDINGS Among 2305 patients (mean age 74·4 years [SD 13·0]), 688 (30%) had transient ischaemic attacks and 1617 (70%) had strokes. Pre-event dementia was diagnosed in 225 patients; prevalence was highest in severe stroke (ie, NIHSS >10) and lowest in transient ischaemic attack. Of 2080 patients without pre-event dementia, 1982 (95%) were followed up to the end of study or death. Post-event dementia occurred in 432 of 2080 patients during 5 years of follow-up. The incidence of post-event dementia at 1 year was 34·4% (95% CI 29·7-41·5) in patients with severe stroke (NIHSS score >10), 8·2% (6·2-10·2) in those with minor stroke (NIHSS score <3), and 5·2% (3·4-7·0) in those with transient ischaemic attack. Compared with the UK age-matched and sex-matched population, the 1-year standardised morbidity ratio for the incidence of dementia was 47·3 (95% CI 35·9-61·2), 5·8 (4·4-7·5), and 3·5 (2·5-4·8), respectively. Consequently, prevalence of dementia in 1-year survivors was brought forward by approximately 25 years in those who had severe strokes, 4 years in those who had minor strokes, and 2 years in those who had transient ischaemic attacks. 5-year risk of dementia was associated with age, event severity, previous stroke, dysphasia, baseline cognition, low education, pre-morbid dependency, leucoaraiosis, and diabetes (p<0·0001 for all comparisons, except for previous stroke [p=0·006]). INTERPRETATION The incidence of dementia in patients who have had a transient ischaemic attack or stroke varies substantially depending on clinical characteristics including lesion burden and susceptibility factors. Incidence of dementia is nearly 50 times higher in the year after a major stroke compared with that in the general population, but excess risk is substantially lower after transient ischaemic attack and minor stroke. FUNDING Wellcome Trust, Wolfson Foundation, British Heart Foundation, National Institute for Health Research, and the National Institute for Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Sarah T Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK.
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital and University of Oxford, Oxford, UK
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Maximum Walking Speed at Discharge Could Be a Prognostic Factor for Vascular Events in Patients With Mild Stroke: A Cohort Study. Arch Phys Med Rehabil 2019; 100:230-238. [DOI: 10.1016/j.apmr.2018.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 12/25/2022]
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Abstract
Cognitive control refers to our ability to choose courses of thought and action that achieve our goals over habitual but contextually inappropriate ones. Hierarchical control problems are those in which multiple goals or contextual contingency must be managed at once and related to one another. In the open-ended complexity of the real world, hierarchical control arguably characterizes most of the problems faced by our control systems. And, it is these cases of hierarchical control where patients with damage to executive systems are most apt to fail, even those that perform well on simplified laboratory tasks. In this chapter, we consider the functional organization of frontal brain systems that support hierarchical cognitive control. We focus on two particular cases of hierarchical control. First, we discuss a line of work testing how managing multiple contingencies en route to a response relates to processing along the rostrocaudal axis of frontal cortex. Second, we consider cases of sequential tasks that require monitoring and behaving according to a series of tasks performed in time. In this latter case, we focus on the particular role of rostrolateral prefrontal cortex. We conclude with considerations of future directions of basic and clinically relevant research in this domain.
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Affiliation(s)
- David Badre
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States; Carney Institute for Brain Science, Brown University, Providence, RI, United States.
| | - Theresa M Desrochers
- Carney Institute for Brain Science, Brown University, Providence, RI, United States; Department of Neuroscience, Brown University, Providence, RI, United States
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Thingstad P, Askim T, Beyer MK, Bråthen G, Ellekjær H, Ihle-Hansen H, Knapskog AB, Lydersen S, Munthe-Kaas R, Næss H, Pendlebury ST, Seljeseth YM, Saltvedt I. The Norwegian Cognitive impairment after stroke study (Nor-COAST): study protocol of a multicentre, prospective cohort study. BMC Neurol 2018; 18:193. [PMID: 30477436 PMCID: PMC6260901 DOI: 10.1186/s12883-018-1198-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Early and late onset post-stroke cognitive impairment (PCI) contributes substantially to disability following stroke, and is a high priority within stroke research. The aetiology for PCI is complex and related to the stroke itself, brain resilience, comorbid brain diseases, prestroke vulnerability and complications during the hospital stay. The aim of the Norwegian Cognitive Impairment After Stroke study (Nor-COAST) is to quantify and measure levels of cognitive impairments in a general Norwegian stroke population and to identify biological and clinical markers associated with prognosis for cognitive disorders following incident stroke. The study will be organised within five work packages: 1) Incidence and trajectories 2) Pathological mechanisms 3) Development of a risk score 4) Impact of physical activity and 5) Adherence to secondary prevention. METHODS Nor-COAST is an ongoing multicentre (five participating hospitals), prospective, cohort study with consecutive inclusion during the acute phase and with follow-up at three and 18 months, and at three years. Inclusion criteria are stroke defined according to the WHO criteria. During the recruitment period from 18.05.2015 to 31.03.2017, 816 participants have been included. Cognitive impairment will be classified according to the DSM-5 criteria using a consensus group. Cognitive function is assessed by a standardised neuropsychological test battery, the Montreal Cognitive Assessment, Trail making A and B, ten-word immediate and delayed recall test, the Controlled Oral Word Association, Global Deterioration Scale and proxy based information by and the Ascertain Dementia 8 item informant questionnaire. Biomarkers include magnetic resonance imaging, routine blood samples and bio-banking. Clinical assessments include characteristics of the stroke, comorbidity, delirium, frailty and tests for cognitive and physical function, sensor based activity monitoring and adherence to secondary prophylaxis. DISCUSSION Nor-COAST is the first Norwegian multicentre study to quantify burden of PCI that will provide reliable estimates in a general stroke population. A multidisciplinary approach aiming to identify biomarkers and clinical markers of overall prognosis will add new knowledge about risk profiles, including pre-stroke vulnerability and modifiable factors such as physical activity and secondary prophylaxis of relevance for clinical practice and later intervention studies. TRIAL REGISTRATION ClinicalTrials.gov: NCT02650531 . Retrospectively registered January 8, 2016. First participant included May 18, 2015.
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Affiliation(s)
- Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Askim
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona K. Beyer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Bråthen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clin. Neurophysiology, St Olavs University hospital, Trondheim, Norway
| | - Hanne Ellekjær
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Internal Medicine, Stroke Unit, St. Olavs University Hospital, Trondheim, Norway
| | - Hege Ihle-Hansen
- Department of Geriatrics, Oslo University Hospital, Oslo, Norway
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | | | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine, Regional Centre for Child and Youth Mental Health and Child Care, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Ragnhild Munthe-Kaas
- Department of Medicine, Vestre Viken Hospital Trust, Bærum Hospital, Drammen, Norway
| | - Halvor Næss
- Department of neurology, Haukeland University Hospital, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
- Institute of clinical medicine, University of Bergen, Bergen, Norway
| | - Sarah T. Pendlebury
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | | | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, St. Olavs University Hospital, Trondheim, Norway
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Pinar A, Hawi Z, Cummins T, Johnson B, Pauper M, Tong J, Tiego J, Finlay A, Klein M, Franke B, Fornito A, Bellgrove MA. Genome-wide association study reveals novel genetic locus associated with intra-individual variability in response time. Transl Psychiatry 2018; 8:207. [PMID: 30287865 PMCID: PMC6172232 DOI: 10.1038/s41398-018-0262-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 08/18/2018] [Accepted: 09/10/2018] [Indexed: 01/24/2023] Open
Abstract
Intra-individual response time variability (IIRTV) is proposed as a viable endophenotype for many psychiatric disorders, particularly attention-deficit hyperactivity disorder (ADHD). Here we assessed whether IIRTV was associated with common DNA variation genome-wide and whether IIRTV mediated the relationship between any associated loci and self-reported ADHD symptoms. A final data set from 857 Australian young adults (489 females and 368 males; Mage = 22.14 years, SDage = 4.82 years) who completed five response time tasks and self-reported symptoms of ADHD using the Conners' Adult ADHD Rating Scale was used. Principal components analysis (PCA) on these response time measures (standard deviation of reaction times and the intra-individual coefficient of variation) produced two variability factors (labelled response selection and selective attention). To understand the genetic drivers of IIRTV we performed a genome-wide association analysis (GWAS) on these PCA-derived indices of IIRTV. For the selective attention variability factor, we identified one single-nucleotide polymorphism (SNP) attaining genome-wide significance; rs62182100 in the HDAC4 gene located on chromosome 2q37. A bootstrapping mediation analysis demonstrated that the selective attention variability factor mediated the relationship between rs62182100 and self-reported ADHD symptoms. Our findings provide the first evidence of a genome-wide significant SNP association with IIRTV and support the potential utility of IIRTV as a valid endophenotype for ADHD symptoms. However, limitations of this study suggest that these observations should be interpreted with caution until replication samples become available.
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Affiliation(s)
- Ari Pinar
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Ziarih Hawi
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Tarrant Cummins
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Beth Johnson
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Marc Pauper
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janette Tong
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Jeggan Tiego
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Amy Finlay
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Marieke Klein
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alex Fornito
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia
| | - Mark A Bellgrove
- School of Psychological Sciences and Monash Institute for Cognitive and Clinical Neurosciences (MICCN), Monash University, Melbourne, VIC, Australia.
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Madsen TE, Howard VJ, Jiménez M, Rexrode KM, Acelajado MC, Kleindorfer D, Chaturvedi S. Impact of Conventional Stroke Risk Factors on Stroke in Women: An Update. Stroke 2018; 49:536-542. [PMID: 29438086 PMCID: PMC5828997 DOI: 10.1161/strokeaha.117.018418] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/09/2017] [Accepted: 11/10/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Tracy E Madsen
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.).
| | - Virginia J Howard
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Monik Jiménez
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Kathryn M Rexrode
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Maria Czarina Acelajado
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Dawn Kleindorfer
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
| | - Seemant Chaturvedi
- From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H.); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA (M.J., K.M.R.); Department of Medicine, Athens-Limestone Hospital, AL (M.C.); Department of Neurology, University of Cincinnati School of Medicine, OH (D.K.); and Department of Neurology, University of Miami Miller School of Medicine, FL (S.C.)
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Rostamian S, van Buchem MA, Jukema JW, Gussekloo J, Poortvliet RKE, de Cren AJM, Sabayan B. Lower Performance in Orientation to Time and Place Associates with Greater Risk of Cardiovascular Events and Mortality in the Oldest Old: Leiden 85-Plus Study. Front Aging Neurosci 2017; 9:307. [PMID: 29021754 PMCID: PMC5623724 DOI: 10.3389/fnagi.2017.00307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 09/08/2017] [Indexed: 01/01/2023] Open
Abstract
Background: Impairment in orientation to time and place is commonly observed in community-dwelling older individuals. Nevertheless, the clinical significance of this has been not fully explored. In this study, we investigated the link between performance in orientation domains and future risk of cardiovascular events and mortality in a non-hospital setting of the oldest old adults. Methods: We included 528 subjects free of myocardial infarction (Group A), 477 individuals free of stroke/transient ischemic attack (Group B), and 432 subjects free of both myocardial infarction and stroke/transient ischemic attack (Group C) at baseline from the population-based Leiden 85-plus cohort study. Participants were asked to answer five questions related to orientation to time and five questions related to orientation to place. 5-year risks of first-time fatal and non-fatal myocardial infarction, fatal and non-fatal stroke, as well as cardiovascular and non-cardiovascular mortality, were estimated using the multivariate Cox regression analysis. Results: In the multivariable analyses, adjusted for sociodemographic characteristics and cardiovascular risk factors, each point lower performance in "orientation to time" was significantly associated with higher risk of first-time myocardial infarction (hazard ratio [HR] 1.35, 95% confidence interval [CI] 1.09-1.67, P = 0.007), first-time stroke (HR 1.35, 95% CI 1.12-1.64, P = 0.002), cardiovascular mortality (HR 1.28, 95% CI 1.06-1.54, P = 0.009) and non-cardiovascular mortality (HR 1.37, 95% CI 1.20-1.56, P < 0.001). Similarly, each point lower performance in "orientation to place" was significantly associated with higher risk of first-time myocardial infarction (HR 1.67, 95% CI 1.25-2.22, P = 0.001), first-time stroke (HR 1.39, 95% CI 1.05-1.82, P = 0.016), cardiovascular mortality (HR 1.35, 95% CI 1.00-1.82, P = 0.054) and non-cardiovascular mortality (HR 1.45, 95% CI 1.20-1.77, P < 0.001). Conclusions: Lower performance in orientation to time and place in advanced age is independently related to higher risk of myocardial infarction, stroke and mortality. Impaired orientation might be an early sign of covert vascular injuries, putting subjects at greater risk of cardiovascular events and mortality.
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Affiliation(s)
- Somayeh Rostamian
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jacobijn Gussekloo
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anton J M de Cren
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Behnam Sabayan
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands.,Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Lal BK, Dux MC, Sikdar S, Goldstein C, Khan AA, Yokemick J, Zhao L. Asymptomatic carotid stenosis is associated with cognitive impairment. J Vasc Surg 2017; 66:1083-1092. [DOI: 10.1016/j.jvs.2017.04.038] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
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Stephan BCM, Richardson K, Savva GM, Matthews FE, Brayne C, Hachinski V. Potential Value of Impaired Cognition in Stroke Prediction: A U.K. Population-Based Study. J Am Geriatr Soc 2017; 65:1756-1762. [PMID: 28369710 PMCID: PMC5574015 DOI: 10.1111/jgs.14878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To determine whether the association between impaired cognition and greater risk of incident stroke is also observed when cognitive impairment is defined using different criteria for mild cognitive impairment (MCI). Design Prospective cohort study with 10 years of follow‐up. Setting Large multicentre study in the United Kingdom. Participants Individuals (aged 64–105) from the Medical Research Council Cognitive Function and Ageing Study (N = 13,004). From this, a subsample of 2,640 individuals was selected based on age, center, and cognitive ability to undergo a detailed cognitive assessment. Measurements Information on sociodemographic characteristics, health, cognition, and functional ability was collected in an interview. The Geriatric Mental State Automated Geriatric Examination for Computer Assisted Taxonomy and the Cambridge Cognitive Examination were used to determine cognitive status. Stroke incidence was derived from self‐report, informant report, and death certificates. Participants were divided into no, mild, moderate, and severe cognitive impairment according to their baseline Mini‐Mental State Examination (MMSE) score. MCI criteria were used to classify persons into four groups: no cognitive impairment, MCI, severe impairment (i.e. other cognitive impairment no dementia: OCIND) and dementia. Results Over 10 years, 703 incident strokes occurred. Lower MMSE score at baseline was associated with greater risk of incident stroke. When cognitive status was determined according to MCI criteria, those with severe impairment (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.0–2.2) and dementia (OR = 2.6, 95% CI = 1.6–3.4) had a significantly greater risk of stroke than those with no cognitive impairment. Conclusion Criteria for MCI, defined using MMSE scores or clinical criteria, can capture individuals at greater stroke risk. The results highlight the need to focus on stroke risk in individuals even with MCI.
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Affiliation(s)
- Blossom C M Stephan
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona E Matthews
- Newcastle University Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
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Subic A, Cermakova P, Norrving B, Winblad B, von Euler M, Kramberger MG, Eriksdotter M, Garcia-Ptacek S. Management of acute ischaemic stroke in patients with dementia. J Intern Med 2017; 281:348-364. [PMID: 28150348 DOI: 10.1111/joim.12588] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
An estimated 10% of stroke patients have an underlying dementia. As a consequence, health professionals often face the challenge of managing patients with dementia presenting with an acute stroke. Patients with dementia are less likely to receive thrombolysis (0.56-10% vs. 1-16% thrombolysis rates in the general population), be admitted to a stroke unit or receive some types of care. Anticoagulation for secondary stroke prevention is sometimes withheld, despite dementia not being listed as an exclusion criterion in current guidelines. Studies in this population are scarce, and results have been contradictory. Three observational studies have examined intravenous thrombolysis for treatment of acute ischaemic stroke in patients with dementia. In the two largest matched case-control studies, there were no significant differences between patients with and without dementia in the risks of intracerebral haemorrhage or mortality. The risk of intracerebral haemorrhage ranged between 14% and 19% for patients with dementia. Studies of other interventions for stroke are lacking for this population. Patients with dementia are less likely to be discharged home compared with controls (19% vs. 41%) and more likely to be disabled (64% vs. 59%) or die during hospitalization (22% vs. 11%). The aim of this review was to summarize current knowledge about the management of ischaemic stroke in patients with pre-existing dementia, including organizational aspects of stroke care, intravenous thrombolysis, access to stroke unit care and use of supportive treatment. Evidence to support anticoagulation for secondary prevention of stroke in patients with atrial fibrillation and antiplatelet therapy in nonembolic stroke will be discussed, as well as rehabilitation and how these factors influence patient outcomes. Finally, ethical issues, knowledge gaps and pathways for future research will be considered.
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Affiliation(s)
- A Subic
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - P Cermakova
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - B Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - B Winblad
- Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - M von Euler
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.,Karolinska University Hospital, Department of Clinical Pharmacology, Stockholm, Sweden
| | - M G Kramberger
- Department of Neurology, University Medical Center, Ljubljana, Slovenia
| | - M Eriksdotter
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - S Garcia-Ptacek
- Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Zonneveld HI, Ikram MA, Hofman A, Niessen WJ, van der Lugt A, Krestin GP, Franco OH, Vernooij MW. N-Terminal Pro-B-Type Natriuretic Peptide and Subclinical Brain Damage in the General Population. Radiology 2016; 283:205-214. [PMID: 27924720 DOI: 10.1148/radiol.2016160548] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose To investigate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP), which is a marker of heart disease, and markers of subclinical brain damage on magnetic resonance (MR) images in community-dwelling middle-aged and elderly subjects without dementia and without a clinical diagnosis of heart disease. Materials and Methods This prospective population-based cohort study was approved by a medical ethics committee overseen by the national government, and all participants gave written informed consent. Serum levels of NT-proBNP were measured in 2397 participants without dementia or stroke (mean age, 56.6 years; age range, 45.7-87.3 years) and without clinical diagnosis of heart disease who were drawn from the population-based Rotterdam Study. All participants were examined with a 1.5-T MR imager. Multivariable linear and logistic regression analyses were used to investigate the association between NT-proBNP level and MR imaging markers of subclinical brain damage, including volumetric, focal, and microstructural markers. Results A higher NT-proBNP level was associated with smaller total brain volume (mean difference in z score per standard deviation increase in NT-proBNP level, -0.021; 95% confidence interval [CI]: -0.034, -0.007; P = .003) and was predominantly driven by gray matter volume (mean difference in z score per standard deviation increase in NT-proBNP level, -0.037; 95% CI: -0.057, -0.017; P < .001). Higher NT-proBNP level was associated with larger white matter lesion volume (mean difference in z score per standard deviation increase in NT-proBNP level, 0.090; 95% CI: 0.051, 0.129; P < .001), with lower fractional anisotropy (mean difference in z score per standard deviation increase in NT-proBNP level, -0.048; 95% CI: -0.088, -0.008; P = .019) and higher mean diffusivity (mean difference in z score per standard deviation increase in NT-proBNP level, 0.054; 95% CI: 0.018, 0.091; P = .004) of normal-appearing white matter. Conclusion In community-dwelling persons, higher serum NT-proBNP levels are associated with volumetric and microstructural MR imaging markers of subclinical brain damage. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Hazel I Zonneveld
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Albert Hofman
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Wiro J Niessen
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Gabriel P Krestin
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Oscar H Franco
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
| | - Meike W Vernooij
- From the Departments of Epidemiology (H.I.Z., M.A.I., A.H., O.H.F., M.W.V.), Radiology and Nuclear Medicine (H.I.Z., M.A.I., W.J.N., A.v.d.L., G.P.K., M.W.V.), Neurology (M.A.I.), and Medical Informatics (W.J.N.), Erasmus MC, University Medical Center Rotterdam, Room Na28-18, PO Box 2040, 3000 CA Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass (A.H.); and Department of Imaging Physics, Faculty of Applied Sciences, Delft University of Technology, Delft, the Netherlands (W.J.N.)
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Cherbuin N, Carey L, Mortby M, Anstey KJ. Predictors of future stroke in adults 60-64 years living in the community. World J Neurol 2016; 6:14-22. [DOI: 10.5316/wjn.v6.i1.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/20/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate predictors of incident stroke in a large epidemiological sample of cognitively healthy individuals in their early 60’s.
METHODS: Cardiovascular (systolic and diastolic blood pressure, hypertension status and medication, body mass index, lung forced vital capacity), lifestyle (alcohol intake, smoking, physical activity), mental health (anxiety and depression status, medication and symptomatology), cognition (executive function, processing speed, working memory, sensorimotor skills), and personality measures (behavioural inhibition and activation, positive and negative affect, neuroticism, psychoticism, extraversion) were investigated as predictors of incident stroke in 1774 participants from the Personality and Total Health Through Life Project over an 8-year follow-up. Logistic regression analyses controlled for age, gender, and education were conducted in the whole cohort as well as in case-control sub-analyses including precisely matched controls to identify factors associated with stroke incidence.
RESULTS: The cohort selected had a mean age of 62.5 years (SD = 1.5) and was 48.6% female with an average of 14.1 years of education (SD = 2.6). When 28 individuals with incident stroke were compared to 1746 cognitively healthy individuals in multivariate logistic regression analyses the only significant predictors of stroke across the five domains considered (cardiovascular, lifestyle, mental health, cognition, personality) and after controlling for gender, age, and education were systolic blood pressure (per unit above 140 mmHg: OR = 1.04, 95%CI: 1.01-1.07, P = 0.002), smoking (trend OR = 2.28, 95%CI: 0.99-5.24, P = 0.052), and sensorimotor skills (purdue pegboard: OR = 0.80, 95%CI: 0.62-0.96, P = 0.037). Similarly, in matched-control analyses significant group differences were found for systolic blood pressure (P = 0.001), smoking (P = 0.036), and sensorimotor skills (P = 0.028).
CONCLUSION: Identified predictors of incident stroke in community-living individuals included high systolic blood pressure and smoking - but also, sensorimotor performance, a measure which has not yet been reported in the literature.
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Abstract
We reviewed current knowledge about the interaction between stroke and vascular risk factors and the development of cognitive impairment and dementia. Stroke is increasingly recognized as an important cause of cognitive problems and has been implicated in the development of both Alzheimer’s disease and vascular dementia. The prevalence of cognitive impairment after stroke is high, and their combined effects significantly increase the cost of care and health resource utilization, with reflections on hospital readmissions and increased mortality rates. There is also substantial evidence that vascular risk factors (such as hypertension, diabetes, obesity, dyslipidemia, and tobacco smoking) are independently associated with an increased risk of cognitive decline and dementia. Thus, a successful management of these factors, as well as optimal acute stroke management, might have a great impact on the development of cognitive impairment. Notwithstanding, the pathological link between cognitive impairment, stroke, and vascular risk factors is complex and still partially unclear so that further studies are needed to better elucidate the boundaries of this relationship. Many specific pharmacological treatments, including anticholinergic drugs and antihypertensive medications, and nonpharmacological approaches, such as diet, cognitive rehabilitation, and physical activity, have been studied for patients with vascular cognitive impairment, but the optimal care is still far away. Meanwhile, according to the most recent knowledge, optimal stroke care should also include cognitive assessment in the short and long term, and great efforts should be oriented toward a multidisciplinary approach, including quality-of-life assessment and support of caregivers.
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Affiliation(s)
- Daniele Lo Coco
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Gianluca Lopez
- Neurology and Stroke Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Internal Medicine, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy; Centre of Research for Effectiveness and Appropriateness in Medicine (C.R.E.A.M.), Di.Bi.M.I.S., University of Palermo, Palermo, Italy
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Murakami K, Tsubota-Utsugi M, Satoh M, Asayama K, Inoue R, Ishiguro A, Matsuda A, Kanno A, Yasui D, Murakami T, Metoki H, Kikuya M, Imai Y, Ohkubo T. Impaired Higher-Level Functional Capacity as a Predictor of Stroke in Community-Dwelling Older Adults: The Ohasama Study. Stroke 2016; 47:323-8. [PMID: 26732573 DOI: 10.1161/strokeaha.115.011131] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Functional capacity is a predictor, as well as a consequence, of stroke. However, little research has been done to examine whether higher-level functional capacity above basic activities of daily living is a predictor of stroke. METHODS We followed 1493 Japanese community-dwelling adults aged ≥60 years (mean age, 70.1 years) who were independent in basic activities of daily living and had no history of stroke. Baseline data were collected using a self-administered questionnaire. Higher-level functional capacity was measured using the total score and 3 subscales (instrumental activities of daily living, intellectual activity, and social role) derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Adjusted hazard ratios and 95% confidence intervals were calculated by the Cox proportional hazards model. RESULTS During a mean follow-up of 10.4 years, 191 participants developed a first stroke. Impaired higher-level functional capacity based on total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.15-2.33). Among the 3 subscales, only intellectual activity was significantly associated with stroke (hazard ratio, 1.64; 95% confidence interval, 1.21-2.22). Social role was significantly associated with stroke only among those aged ≥75 years (hazard ratio, 1.78; 95% confidence interval, 1.07-2.98). CONCLUSIONS Impaired higher-level functional capacity, especially in the domain of intellectual activity, was a predictor of stroke, even among community-dwelling older adults with independent basic activities of daily living at baseline. Monitoring of higher-level functional capacity might be useful to detect those at higher risk of developing stroke in the future.
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Affiliation(s)
- Keiko Murakami
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
| | - Megumi Tsubota-Utsugi
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Michihiro Satoh
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Kei Asayama
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ryusuke Inoue
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Aya Ishiguro
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Ayako Matsuda
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Atsuhiro Kanno
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Daisaku Yasui
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takahisa Murakami
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Masahiro Kikuya
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yutaka Imai
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takayoshi Ohkubo
- From the Department of Hygiene and Public Health, School of Medicine, Teikyo University, Tokyo, Japan (K.M., K.A., A.I., A.M., T.O.); Center for International Collaboration and Partnership/Department of Nutritional Epidemiology, National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Department of Pharmaceutical Sciences (M.S.), and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., Y.I.); Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Japan (A.K.); Embassy of Japan, Italy (D.Y.); Department of Oral Function and Morphology, Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.); and Department of Community Medical Supports (H.M.) and Department of Preventive Medicine and Epidemiology (M.K.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
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Pendlebury ST, Klaus SP, Thomson RJ, Mehta Z, Wharton RM, Rothwell PM. Methodological Factors in Determining Risk of Dementia After Transient Ischemic Attack and Stroke: (III) Applicability of Cognitive Tests. Stroke 2015; 46:3067-73. [PMID: 26463688 DOI: 10.1161/strokeaha.115.010290] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/08/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive assessment is recommended after stroke but there are few data on the applicability of short cognitive tests to the full spectrum of patients. We therefore determined the rates, causes, and associates of untestability in a population-based study of all transient ischemic attack (TIA) and stroke. METHODS Patients with TIA or stroke prospectively recruited (2002-2007) into the Oxford Vascular Study had ≥1 short cognitive test (mini-mental state examination, telephone interview of cognitive status, Montreal cognitive assessment, and abbreviated mental test score) at baseline and on follow-up to 5 years. RESULTS Among 1097 consecutive assessed survivors (mean: age/SD, 74.8/12.1 years; 378 TIA), numbers testable with a short cognitive test at baseline, 1, 6, 12, and 60 months were 835/1097 (76%), 778/947 (82%), 756/857 (88%), 692/792 (87%), and 472/567 (83%). Eighty-eight percent (331/378) of assessed patients with TIA were testable at baseline compared with only 46% (133/290) of major stroke (P<0.001). Untestability was also associated with older age, premorbid dependency, death on follow-up, and with both pre- and postevent dementia (all P<0.01). Untestability (and problems with testing) were commonly caused by acute stroke effects at baseline (153/262 [58%]: dysphasia/anarthria/hemiparesis=84 [32%], drowsiness=58 [22%], and acute confusion=11 [4%]), whereas sensory deficits caused relatively more problems with testing at later time points (24/63 [38%] at 5 years). CONCLUSIONS Substantial numbers of patients with TIA and stroke are untestable with short cognitive tests. Future studies should report data on untestable patients and those with problems with testing in whom the likelihood of dementia is high.
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Affiliation(s)
- Sarah T Pendlebury
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.).
| | - Stephen P Klaus
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.)
| | - Ross J Thomson
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.)
| | - Ziyah Mehta
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.)
| | - Rose M Wharton
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.)
| | - Peter M Rothwell
- From the Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom (S.T.P., S.P.K., R.J.T., Z.M., R.M.W., P.M.R.); and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom (S.T.P.)
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Rajan KB, Schneider JA, Aggarwal NT, Wilson RS, Everson-Rose SA, Evans DA. Racial Differences in Cognitive Function and Risk of Incident Stroke. J Stroke Cerebrovasc Dis 2015; 24:2854-9. [PMID: 26387044 DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/16/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Cognitive impairment is associated with increased risk of stroke; however, it is not known whether this association varies by race. Our objective was to examine the association between cognitive function and the risk of stroke among non-Hispanic blacks and whites with no history of stroke. METHODS Participants were from a population-based cohort study of 7205 older adults (61% black and 59% female) from Chicago's South Side. A standardized composite cognitive function score based on 3 components--global cognition (Mini-Mental State Examination), executive function (Symbol Digits Modalities test), and episodic memory (Delayed and Immediate Story Recall tests)--was used to predict risk of stroke (from Medicare hospitalization data) using a Cox model. RESULTS During 72,868 person-years of follow-up, 16% (N = 1185) developed stroke. After adjusting for vascular risk factors, 1 standard deviation lower composite cognitive function score was associated with increased risk of stroke in blacks (hazard ratio [HR] = 1.76; 95% confidence interval [CI], 1.66-1.88), which was twofold higher than whites (HR = 1.38; 95% CI, 1.26-1.55) (Pdifference = .002). Lower global cognition and executive function were associated with a similarly increased risk of stroke in blacks and whites. Lower episodic memory (composite of recall tests) was associated with increased risk of stroke that was twofold higher in blacks (HR = 1.12; 95% CI, 1.10-1.14) than in whites (HR = 1.06; 95% CI, 1.04-1.09). CONCLUSIONS Lower cognitive function was associated with increased risk of stroke and this association was stronger among blacks than whites. Future studies are needed to determine factors that can explain this finding.
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Affiliation(s)
- Kumar B Rajan
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL.
| | - Julie A Schneider
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Neelum T Aggarwal
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | - Robert S Wilson
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL
| | | | - Denis A Evans
- Rush Institute for Healthy Aging, Department of Internal Medicine, Rush University Medical Center, Chicago, IL
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Rostamian S, van Buchem MA, Westendorp RGJ, Jukema JW, Mooijaart SP, Sabayan B, de Craen AJM. Executive function, but not memory, associates with incident coronary heart disease and stroke. Neurology 2015; 85:783-9. [PMID: 26245926 DOI: 10.1212/wnl.0000000000001895] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/04/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the association of performance in cognitive domains executive function and memory with incident coronary heart disease and stroke in older participants without dementia. METHODS We included 3,926 participants (mean age 75 years, 44% male) at risk for cardiovascular diseases from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score ≥24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite executive function score. Likewise, scores of the Picture Learning Test (immediate and delayed memory) were transformed into a composite memory score. Associations of executive function and memory were longitudinally assessed with risk of coronary heart disease and stroke using multivariable Cox regression models. RESULTS During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, as compared to participants in the highest third, had 1.85-fold (95% confidence interval [CI] 1.39-2.45) higher risk of coronary heart disease and 1.51-fold (95% CI 0.99-2.30) higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease (hazard ratio 0.99, 95% CI 0.74-1.32) or stroke (hazard ratio 0.87, 95% CI 0.57-1.32). CONCLUSION Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke. Lower executive function, as an independent risk indicator, might better reflect brain vascular pathologies.
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Affiliation(s)
- Somayeh Rostamian
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
| | - Mark A van Buchem
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
| | - Rudi G J Westendorp
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
| | - J Wouter Jukema
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
| | - Simon P Mooijaart
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
| | - Behnam Sabayan
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark.
| | - Anton J M de Craen
- From the Departments of Radiology (S.R., M.A.v.B., B.S.), Gerontology and Geriatrics (S.R., R.G.J.W., S.P.M., B.S., A.J.M.d.C.), and Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; and the Department of Public Health (R.G.J.W.), Copenhagen University, Denmark
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Silva B, Sousa L, Miranda A, Vasconcelos A, Reis H, Barcelos L, Arantes R, Teixeira A, Rachid MA. Memory deficit associated with increased brain proinflammatory cytokine levels and neurodegeneration in acute ischemic stroke. ARQUIVOS DE NEURO-PSIQUIATRIA 2015. [DOI: 10.1590/0004-282x20150083] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The present study aimed to investigate behavioral changes and neuroinflammatory process following left unilateral common carotid artery occlusion (UCCAO), a model of cerebral ischemia. Post-ischemic behavioral changes following 15 min UCCAO were recorded 24 hours after reperfusion. The novel object recognition task was used to assess learning and memory. After behavioral test, brains from sham and ischemic mice were removed and processed to evaluate central nervous system pathology by TTC and H&E techniques as well as inflammatory mediators by ELISA. UCCAO promoted long-term memory impairment after reperfusion. Infarct areas were observed in the cerebrum by TTC stain. Moreover, the histopathological analysis revealed cerebral necrotic cavities surrounded by ischemic neurons and hippocampal neurodegeneration. In parallel with memory dysfunction, brain levels of TNF-a, IL-1b and CXCL1 were increased post ischemia compared with sham-operated group. These findings suggest an involvement of central nervous system inflammatory mediators and brain damage in cognitive impairment following unilateral acute ischemia.
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Affiliation(s)
- Bruno Silva
- Universidade Federal de Minas Gerais, Brazil
| | | | | | | | - Helton Reis
- Universidade Federal de Minas Gerais, Brazil
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ERV enhances spatial learning and prevents the development of infarcts, accompanied by upregulated BDNF in the cortex. Brain Res 2015; 1610:110-23. [PMID: 25842373 DOI: 10.1016/j.brainres.2015.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/19/2015] [Accepted: 03/24/2015] [Indexed: 01/18/2023]
Abstract
PURPOSES An anti-allergic and analgesic drug, "an extract derived from the inflamed cutaneous tissue of rabbits inoculated with vaccinia virus (ERV)", has been used in medical practice in Japan and some other countries. We examined the effect of ERV, prior to induction of ischemia, on the development of cerebral infarction, on learning and memory, or on brain-derived neurotrophic factor (BDNF) levels in C57BL/6J mice. METHODS Following oral administration of ERV (the same in humans: ×1) or vehicle, daily for three consecutive weeks, temporary focal ischemia was induced by the three vessel occlusion technique. In the other group of animals, after daily ERV (Low: ×1; Med: ×3, or High dose: ×9) or vehicle administration for three weeks, we performed a quantitative assessment of spatial learning or intracerebral BDNF levels. RESULTS The volumes of infarcted lesions, brain edema and the extent of the neurological deficits were significantly reduced in the ERV-treated group. ERV treatment also enhanced spatial learning, accompanied by upregulated BDNF in the cortex. CONCLUSIONS Daily oral intake of ERV, at a clinically relevant dose, protects the brain from ischemic stroke, and also enhances the learning function in normal mice. As millions of people are currently taking the drug safely, and have been for many years in some cases, there is a need to test the inhibitory actions of the drug on progressive dementia encountered in humans with recurrent ischemic attacks or Alzheimer's disease.
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Sajjad A, Mirza SS, Portegies ML, Bos MJ, Hofman A, Koudstaal PJ, Tiemeier H, Ikram MA. Subjective Memory Complaints and the Risk of Stroke. Stroke 2015; 46:170-5. [DOI: 10.1161/strokeaha.114.006616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ayesha Sajjad
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Saira Saeed Mirza
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Marileen L.P. Portegies
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Michiel J. Bos
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Albert Hofman
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Peter J. Koudstaal
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - Henning Tiemeier
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
| | - M. Arfan Ikram
- From the Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands (A.S., S.S.M., M.L.P.P., M.J.B., A.H., H.T., M.A.I.); Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands (H.T.); Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.A.I.); and Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands (M.L.P.P., P.J.K., M.A.I.)
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