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Sihvonen AJ, Pitkäniemi A, Siponkoski ST, Kuusela L, Martínez-Molina N, Laitinen S, Särkämö ER, Pekkola J, Melkas S, Schlaug G, Sairanen V, Särkämö T. Structural neuroplasticity effects of singing in chronic aphasia. eNeuro 2024:ENEURO.0408-23.2024. [PMID: 38688718 DOI: 10.1523/eneuro.0408-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 05/02/2024] Open
Abstract
Singing-based treatments of aphasia can improve language outcomes, but the neural benefits of group-based singing in aphasia are unknown. Here, we set out to determine the structural neuroplasticity changes underpinning group-based singing induced treatment effects in chronic aphasia. Twenty-eight patients with at least mild nonfluent post-stroke aphasia were randomized into two groups that received a 4-month multicomponent singing intervention (singing group) or standard care control group). High-resolution T1-images and multi-shell diffusion-weighted MRI data were collected in two time points (baseline / 5-month). Structural grey and white matter neuroplasticity changes were assessed using language network region-of-interest based voxel-based morphometry (VBM) and quantitative anisotropy based connectometry, and their associations to improved language outcomes (WAB Naming and Repetition) were evaluated. Connectometry analyses showed that the singing group enhanced structural white matter connectivity in the left arcuate fasciculus and corpus callosum as well as in the frontal aslant tract, superior longitudinal fasciculus, and corticostriatal tract bilaterally compared to the control group. Moreover, in VBM, the singing group showed grey matter volume increase in the left inferior frontal cortex (BA44) compared to the control group. The neuroplasticity effects in the left BA44, arcuate fasciculus, and frontal aslant tract correlated with improved naming abilities after the intervention. These findings suggest that in post-stroke aphasia group singing can bring about structural neuroplasticity changes in left frontal language areas and in bilateral language pathways, which underpin treatment-induced improvement in speech production.Significance Statement Understanding the neural underpinnings of improved language outcomes in aphasia is vital. We utilize longitudinal neuroplasticity measures of both grey and white matter and evaluate their contribution to group-based singing treatment effects in chronic aphasia. The results show that singing intervention induced grey and white matter neuroplasticity changes in the left frontal language-related structures, but also in the right hemisphere (white matter), correlating with improved naming abilities. These results shine light on treatment-induced structural changes in chronic aphasia and improve our understanding of aphasia rehabilitation.
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Affiliation(s)
- Aleksi J Sihvonen
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014, Finland
- School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, QLD 4072, Australia
- Department of Neurology, University of Helsinki and Helsinki University Hospital, 00029, Finland
| | - Anni Pitkäniemi
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014, Finland
| | - Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014, Finland
| | - Linda Kuusela
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, 00029, Finland
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014, Finland
| | | | | | - Johanna Pekkola
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, 00029, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, 00029, Finland
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School, Springfield & Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA 01655, USA
| | - Viljami Sairanen
- HUS Helsinki Medical Imaging Center, Helsinki University Hospital, 00029, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit and Centre of Excellence in Music, Mind, Body and Brain, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014, Finland
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Mäki K, Nybo T, Hietanen M, Huovinen A, Marinkovic I, Isokuortti H, Melkas S. Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. J Rehabil Med 2024; 56:jrm13438. [PMID: 38436399 PMCID: PMC10926572 DOI: 10.2340/jrm.v56.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE To examine the associations between recent stressful life events and self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. DESIGN Observational cohort study. PARTICIPANTS Patients (aged 18-68 years) with mild traumatic brain injury (n = 99) or lower extremity orthopaedic injury (n = 34). METHODS Data on stressful life events and self-reported symptoms were collected 3 months post-injury. Stressful life events in the last 12 months were assessed as part of a structured interview using a checklist of 11 common life events, self-reported fatigue with Barrow Neurological Institute Fatigue Scale, and depressive symptoms with Beck Depression Inventory - Fast Screen. RESULTS Median number of stressful life events was 1 (range 0-7) in the mild traumatic brain injury group and 1.5 (range 0-6) in the orthopaedic injury group. The groups did not differ significantly in terms of fatigue or depressive symptoms. In the mild traumatic brain injury group, the total number of recent stressful life events correlated significantly with self-reported fatigue (rs = 0.270, p = 0.007) and depressive symptoms (rs = 0.271, p = 0.007). CONCLUSION Stressful life events are associated with self-reported fatigue and depressive symptoms in patients with mild traumatic brain injury. Clinicians should consider stressful life events when managing patients who experience these symptoms, as this may help identifying potential targets for intervention.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
| | - Taina Nybo
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neurology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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3
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van Voorst H, Pitkänen J, van Poppel L, de Vries L, Mojtahedi M, Martou L, Emmer BJ, Roos YBWEM, van Oostenbrugge R, Postma AA, Marquering HA, Majoie CBLM, Curtze S, Melkas S, Bentley P, Caan MWA. Deep learning-based white matter lesion volume on CT is associated with outcome after acute ischemic stroke. Eur Radiol 2024:10.1007/s00330-024-10584-z. [PMID: 38285103 DOI: 10.1007/s00330-024-10584-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) before endovascular treatment (EVT) for acute ischemic stroke might induce intracerebral hemorrhages which could negatively affect patient outcomes. Measuring white matter lesions size using deep learning (DL-WML) might help safely guide IVT administration. We aimed to develop, validate, and evaluate a DL-WML volume on CT compared to the Fazekas scale (WML-Faz) as a risk factor and IVT effect modifier in patients receiving EVT directly after IVT. METHODS We developed a deep-learning model for WML segmentation on CT and validated with internal and external test sets. In a post hoc analysis of the MR CLEAN No-IV trial, we associated DL-WML volume and WML-Faz with symptomatic-intracerebral hemorrhage (sICH) and 90-day functional outcome according to the modified Rankin Scale (mRS). We used multiplicative interaction terms between WML measures and IVT administration to evaluate IVT treatment effect modification. Regression models were used to report unadjusted and adjusted common odds ratios (cOR/acOR). RESULTS In total, 516 patients from the MR CLEAN No-IV trial (male/female, 291/225; age median, 71 [IQR, 62-79]) were analyzed. Both DL-WML volume and WML-Faz are associated with sICH (DL-WML volume acOR, 1.78 [95%CI, 1.17; 2.70]; WML-Faz acOR, 1.53 95%CI [1.02; 2.31]) and mRS (DL-WML volume acOR, 0.70 [95%CI, 0.55; 0.87], WML-Faz acOR, 0.73 [95%CI 0.60; 0.88]). Only in the unadjusted IVT effect modification analysis WML-Faz was associated with more sICH if IVT was given (p = 0.046). Neither WML measure was associated with worse mRS if IVT was given. CONCLUSION DL-WML volume and WML-Faz had a similar relationship with functional outcome and sICH. Although more sICH might occur in patients with more severe WML-Faz receiving IVT, no worse functional outcome was observed. CLINICAL RELEVANCE STATEMENT White matter lesion severity on baseline CT in acute ischemic stroke patients has a similar predictive value if measured with deep learning or the Fazekas scale. Safe administration of intravenous thrombolysis using white matter lesion severity should be further studied. KEY POINTS White matter damage is a predisposing risk factor for intracranial hemorrhage in patients with acute ischemic stroke but remains difficult to measure on CT. White matter lesion volume on CT measured with deep learning had a similar association with symptomatic intracerebral hemorrhages and worse functional outcome as the Fazekas scale. A patient-level meta-analysis is required to study the benefit of white matter lesion severity-based selection for intravenous thrombolysis before endovascular treatment.
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Affiliation(s)
- Henk van Voorst
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
| | - Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura van Poppel
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Lucas de Vries
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Informatics Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Mahsa Mojtahedi
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Laura Martou
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Bart J Emmer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Robert van Oostenbrugge
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental health and sciences (Mhens), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Henk A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charles B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Paul Bentley
- Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, England
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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4
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Arola A, Laakso HM, Heinonen H, Pitkänen J, Ahlström M, Lempiäinen J, Paajanen T, Virkkala J, Koikkalainen J, Lötjönen J, Korvenoja A, Melkas S, Jokinen H. Subjective vs informant-reported cognitive complaints have differential clinical significance in covert cerebral small vessel disease. Cereb Circ Cogn Behav 2023; 5:100182. [PMID: 37745893 PMCID: PMC10514088 DOI: 10.1016/j.cccb.2023.100182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/30/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
Objective Subjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI. Method In the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15). Results Subjective cognitive complaints correlated significantly with informant reports (r=0.40-0.50, p<0.001). After controlling for demographics, subjective and informant DEX and PRMQ were not related to MCI, memory or executive functions. Instead, subjective DEX and PRMQ significantly associated with GDS-15 and informant DEX and PRMQ with WMH volume and A-IADL. Conclusions Neither subjective nor informant-reported cognitive complaints associated with objective cognitive performance. Informant-evaluations were related to functional impairment and more severe WMH, whereas subjective complaints only associated with mild depressive symptoms. These findings suggest that awareness of cognitive impairment may be limited in early-stage cSVD and highlight the value of informant assessments in the identification of patients with functional impairment.
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Affiliation(s)
- Anne Arola
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M. Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Heidi Heinonen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Matti Ahlström
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Lempiäinen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teemu Paajanen
- Work ability and working careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jussi Virkkala
- Department of Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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5
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Kartau M, Melkas S, Kartau J, Arola A, Laakso H, Pitkänen J, Lempiäinen J, Koikkalainen J, Lötjönen J, Korvenoja A, Ahlström M, Herukka SK, Erkinjuntti T, Jokinen H. Neurofilament light level correlates with brain atrophy, and cognitive and motor performance. Front Aging Neurosci 2023; 14:939155. [PMID: 36688160 PMCID: PMC9849573 DOI: 10.3389/fnagi.2022.939155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Background The usefulness of neurofilament light (NfL) as a biomarker for small vessel disease has not been established. We examined the relationship between NfL, neuroimaging changes, and clinical findings in subjects with varying degrees of white matter hyperintensity (WMH). Methods A subgroup of participants (n = 35) in the Helsinki Small Vessel Disease Study underwent an analysis of NfL in cerebrospinal fluid (CSF) as well as brain magnetic resonance imaging (MRI) and neuropsychological and motor performance assessments. WMH and structural brain volumes were obtained with automatic segmentation. Results CSF NfL did not correlate significantly with total WMH volume (r = 0.278, p = 0.105). However, strong correlations were observed between CSF NfL and volumes of cerebral grey matter (r = -0.569, p < 0.001), cerebral cortex (r = -0.563, p < 0.001), and hippocampi (r = -0.492, p = 0.003). CSF NfL also correlated with composite measures of global cognition (r = -0.403, p = 0.016), executive functions (r = -0.402, p = 0.017), memory (r = -0.463, p = 0.005), and processing speed (r = -0.386, p = 0.022). Regarding motor performance, CSF NfL was correlated with Timed Up and Go (TUG) test (r = 0.531, p = 0.001), and gait speed (r = -0.450, p = 0.007), but not with single-leg stance. After adjusting for age, associations with volumes in MRI, functional mobility (TUG), and gait speed remained significant, whereas associations with cognitive performance attenuated below the significance level despite medium to large effect sizes. Conclusion NfL was strongly related to global gray matter and hippocampal atrophy, but not to WMH severity. NfL was also associated with motor performance. Our results suggest that NfL is independently associated with brain atrophy and functional mobility, but is not a reliable marker for cerebral small vessel disease.
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Affiliation(s)
- Marge Kartau
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland,*Correspondence: Marge Kartau, ✉
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joonas Kartau
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Anne Arola
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Lempiäinen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Ahlström
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Siponkoski ST, Pitkäniemi A, Laitinen S, Särkämö ER, Pentikäinen E, Eloranta H, Tuomiranta L, Melkas S, Schlaug G, Sihvonen AJ, Särkämö T. Efficacy of a multicomponent singing intervention on communication and psychosocial functioning in chronic aphasia: a randomized controlled crossover trial. Brain Commun 2022; 5:fcac337. [PMID: 36687394 PMCID: PMC9847537 DOI: 10.1093/braincomms/fcac337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/10/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The ability to produce words through singing can be preserved in severe aphasia, but the benefits of group-based singing rehabilitation in aphasia are largely unknown. Our aim was to determine the efficacy of a multicomponent singing intervention on communication and speech production, emotional-social functioning and caregiver well-being in aphasia. Fifty-four patients with acquired brain injury and chronic aphasia and their family caregivers (n = 43) were recruited. Using a crossover randomized controlled trial design, participants were randomized to two groups who received a 4-month singing intervention either during the first or second half of the study in addition to standard care. The intervention comprised weekly group-based training (including choir singing and group-level melodic intonation therapy) and tablet-assisted singing training at home. At baseline, 5- and 9-month stages, patients were assessed with tests and questionnaires on communication and speech production, mood, social functioning, and quality of life and family caregivers with questionnaires on caregiver burden. All participants who participated in the baseline measurement (n = 50) were included in linear mixed model analyses. Compared with standard care, the singing intervention improved everyday communication and responsive speech production from baseline to 5-month stage, and these changes were sustained also longitudinally (baseline to 9-month stage). Additionally, the intervention enhanced patients' social participation and reduced caregiver burden. This study provides novel evidence that group-based multicomponent singing training can enhance communication and spoken language production in chronic aphasia as well as improve psychosocial wellbeing in patients and caregivers. https://www.clinicaltrials.gov, Unique identifier: NCT03501797.
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Affiliation(s)
| | - Anni Pitkäniemi
- Correspondence to: Anni Pitkäniemi Cognitive Brain Research Unit Department of Psychology and Logopedics University of Helsinki, Helsinki, Finland E-mail:
| | - Sari Laitinen
- Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland,Espoo Hospital, 00029 HUS, Espoo, Finland
| | | | - Emmi Pentikäinen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland,Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland
| | - Heidi Eloranta
- Helsinki-Uusimaa Stroke Association, 00610 Helsinki, Finland
| | - Leena Tuomiranta
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School, Springfield & Department of Biomedical Engineering and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA 01003, USA
| | - Aleksi J Sihvonen
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland,Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland,Department of Neurology, University of Helsinki and Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland,School of Health and Rehabilitation Sciences, Queensland Aphasia Research Centre and UQ Centre for Clinical Research, The University of Queensland, QLD 4029, Brisbane, Australia
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland,Centre of Excellence in Music, Mind, Body and Brain, University of Helsinki, 00014 Helsingin yliopisto, Helsinki, Finland
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Abstract
OBJECTIVE To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). DESIGN Observational study. SETTING TBI outpatient unit. PARTICIPANTS Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). MAIN MEASURES The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. RESULTS Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance. CONCLUSIONS Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.
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Affiliation(s)
- Kaisa Mäki
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Nybo
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Hietanen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Huovinen
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Neuropsychology (Ms Mäki and Drs Nybo and Hietanen) and Neurology (Drs Huovinen, Marinkovic, Isokuortti, and Melkas), University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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8
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Martínez-Molina N, Siponkoski ST, Pitkäniemi A, Moisseinen N, Kuusela L, Pekkola J, Laitinen S, Särkämö ER, Melkas S, Kleber B, Schlaug G, Sihvonen A, Särkämö T. Neuroanatomical correlates of speech and singing production in chronic post-stroke aphasia. Brain Commun 2022; 4:fcac001. [PMID: 35174327 PMCID: PMC8842683 DOI: 10.1093/braincomms/fcac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/26/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
A classical observation in neurology is that aphasic stroke patients with impairments in speech production can nonetheless sing the same utterances. This preserved ability suggests a distinctive neural architecture for singing that could contribute to speech recovery. However, to date, these structural correlates remain unknown. Here, we combined a multivariate lesion-symptom mapping and voxel-based morphometry approach to analyse the relationship between lesion patterns and grey matter volume and production rate in speech and singing tasks. Lesion patterns for spontaneous speech and cued repetition extended into frontal, temporal and parietal areas typically reported within the speech production network. Impairment in spontaneous singing was associated with damage to left anterior-posterior superior and middle temporal gyri. Preservation of grey matter volume in the same regions where damage led to poor speech and singing production supported better performance in these tasks. When dividing the patients into fluent and dysfluent singers based on singing performance from demographically matched controls, we found that preservation of left middle temporal gyrus was related to better spontaneous singing. These findings provide insights into the structural correlates of singing in chronic aphasia and may serve as biomarkers to predict treatment response in clinical trials using singing-based interventions for speech rehabilitation.
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Affiliation(s)
- Noelia Martínez-Molina
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Correspondence to: Noelia Martínez Molina Music, Ageing and Rehabilitation Team Cognitive Brain Research Unit Department of Psychology and Logopedics University of Helsinki, Helsinki, Finland E-mail:
| | - Sini-Tuuli Siponkoski
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Anni Pitkäniemi
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Nella Moisseinen
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Linda Kuusela
- Department of Physics, University of Helsinki, Helsinki, Finland
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pekkola
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, Helsinki, Finland
| | - Sari Laitinen
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Espoo Hospital, Espoo, Finland
| | - Essi-Reetta Särkämö
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Private Choir Conductor, Vantaa, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Boris Kleber
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University and The Royal Academy of Music, Aarhus/Aalborg, Denmark
| | - Gottfried Schlaug
- Department of Neurology, UMass Medical School—Baystate and Institute of Applied Life Sciences, UMass Amherst, Amherst, MA, USA
| | - Aleksi Sihvonen
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Teppo Särkämö
- Music, Ageing and Rehabilitation Team, Cognitive Brain Research Unit, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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9
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Moliis H, Jokinen H, Parkkonen E, Kaste M, Erkinjuntti T, Melkas S. Post-Stroke Cognitive Impairment is Frequent After Infra-Tentorial Infarct. J Stroke Cerebrovasc Dis 2021; 30:106108. [PMID: 34547675 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/21/2021] [Accepted: 09/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Post-stroke cognitive impairment is a common and well-known consequence of supra-tentorial infarct, but its prevalence and severity after infra-tentorial infarct is unclear. We compared the frequencies and prognostic value of domain-specific cognitive deficits after supra-tentorial and infra-tentorial infarct. METHODS In a consecutive cohort of patients with first-ever stroke (N = 244) admitted to Helsinki University Hospital, 37 patients had an infra-tentorial infarct. Patients were assessed with a comprehensive neuropsychological examination 3 months post-stroke covering 9 cognitive domains and functional disability was assessed at 15 months with the modified Rankin Scale. RESULTS There were no statistically significant differences between the frequencies of cognitive deficits in patients with infra-tentorial vs supra-tentorial infarct. Altogether 73% of patients with infra-tentorial infarct and 82% of patients with supra-tentorial infarct had impairment in at least one cognitive domain. Further 42% of patients with infra-tentorial infarct and 47% of those with supra-tentorial infarct had deficits in 3 or more cognitive domains. In patients with infra-tentorial infarct, visuo-constructional deficits were significantly associated with functional disability at 15 months (OR 9.0, 95%CI 1.3-62.5, p = 0.027). In patients with supratentorial infarct, executive deficits (OR 2.9, 95%CI 1.5-5.8, p = 0.002) and visuo-constructional deficits (OR 2.9, 95%CI 1.5-5.7, p = 0.001) showed associations with functional disability at 15 months. CONCLUSION Cognitive deficits are as common in patients with infra-tentorial infarct as in those with supra-tentorial infarct, and it is important to recognize them to meet the needs of rehabilitation.
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Affiliation(s)
- Henrik Moliis
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Hanna Jokinen
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.
| | - Eeva Parkkonen
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Markku Kaste
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Timo Erkinjuntti
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Susanna Melkas
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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10
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Jokinen H, Laakso HM, Ahlström M, Arola A, Lempiäinen J, Pitkänen J, Paajanen T, Sikkes SAM, Koikkalainen J, Lötjönen J, Korvenoja A, Erkinjuntti T, Melkas S. Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease. Eur J Neurol 2021; 29:158-167. [PMID: 34528346 DOI: 10.1111/ene.15108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cognitive and motor impairments are the key clinical manifestations of cerebral small vessel disease (SVD), but their combined effects on functional outcome have not been elucidated. This study investigated the interactions and mediating effects of cognitive and motor functions on instrumental activities of daily living (IADL) and quality of life in older individuals with various degrees of white matter hyperintensities (WMH). METHODS Participants of the Helsinki Small Vessel Disease Study (n = 152) were assessed according to an extensive clinical, physical, neuropsychological and MRI protocol. Volumes of WMH and gray matter (GM) were obtained with automated segmentation. RESULTS Cognitive (global cognition, executive functions, processing speed, memory) and motor functions (gait speed, single-leg stance, timed up-and-go) had strong interrelations with each other, and they were significantly associated with IADL, quality of life as well as WMH and GM volumes. A consistent pattern on significant interactions between cognitive and motor functions was found on informant-evaluated IADL, but not on self-evaluated quality of life. The association of WMH volume with IADL was mediated by global cognition, whereas the association of GM volume with IADL was mediated by global cognition and timed up-and-go performance. CONCLUSION The results highlight the complex interplay and synergism between motor and cognitive abilities on functional outcome in SVD. The combined effect of motor and cognitive disturbances on IADL is likely to be greater than their individual effects. Patients with both impairments are at disproportionate risk for poor outcome. WMH and brain atrophy contribute to disability through cognitive and motor impairment.
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Affiliation(s)
- Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matti Ahlström
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anne Arola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Lempiäinen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Teemu Paajanen
- Research and Service Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Sietske A M Sikkes
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands.,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland.,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland.,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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11
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Huovinen A, Marinkovic I, Isokuortti H, Korvenoja A, Mäki K, Nybo T, Raj R, Melkas S. Traumatic Microbleeds in Mild Traumatic Brain Injury Are Not Associated with Delayed Return to Work or Persisting Post-Concussion Symptoms. J Neurotrauma 2021; 38:2400-2406. [PMID: 33847170 DOI: 10.1089/neu.2021.0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The main objective of this prospective cohort study was to evaluate whether traumatic microbleeds (TMBs) are a significant prognostic factor of return to work (RTW), post-traumatic symptoms, and overall recovery in patients with mild traumatic brain injury (mTBI). One hundred and thirteen patients with mTBI were recruited from the Helsinki University Hospital emergency units. All patients underwent multi-contrast 3T magnetic resonance imaging (MRI) 3-17 days after mTBI. Patients were evaluated in the Traumatic Brain Injury Outpatient Clinic of Helsinki University Hospital 1 month after injury. Post-concussion symptoms were assessed with the Post-Concussion Symptom Questionnaire (RPQ) and overall recovery was assessed with the Glasgow Outcome Scale Extended (GOS-E). Their time to RTW was continuously measured up to 1 year after TBI. Median RTW was 9 days (interquartile range [IQR] 4-30) after mTBI and full RTW rate after 1 year was 98%. Patients with TMBs (n = 22) did not have more post-concussion symptoms (median RPQ 10.0 vs. 7.0, p = 0.217) or worse overall recovery (58% vs. 56% with GOS-E = 8, p = 0.853) than patients without TMBs (n = 91). There was no significant difference in time to RTW (13.5 vs. 7.0 days, p = 0.063). In this study, patients with TMBs did not have delayed RTW or more post-concussion symptoms than other patients with mTBI. TMBs in mTBI do not seem to be a significant prognostic factor of RTW.
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Affiliation(s)
- Antti Huovinen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ivan Marinkovic
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Isokuortti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Korvenoja
- Department of HUS Medical Imaging Center, Radiology, and Departments of University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kaisa Mäki
- Department of Neuropsychology and University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taina Nybo
- Department of Neuropsychology and University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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12
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Kaipainen AL, Pitkänen J, Haapalinna F, Jääskeläinen O, Jokinen H, Melkas S, Erkinjuntti T, Vanninen R, Koivisto AM, Lötjönen J, Koikkalainen J, Herukka SK, Julkunen V. A novel CT-based automated analysis method provides comparable results with MRI in measuring brain atrophy and white matter lesions. Neuroradiology 2021; 63:2035-2046. [PMID: 34389887 PMCID: PMC8589740 DOI: 10.1007/s00234-021-02761-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
Purpose Automated analysis of neuroimaging data is commonly based on magnetic resonance imaging (MRI), but sometimes the availability is limited or a patient might have contradictions to MRI. Therefore, automated analyses of computed tomography (CT) images would be beneficial. Methods We developed an automated method to evaluate medial temporal lobe atrophy (MTA), global cortical atrophy (GCA), and the severity of white matter lesions (WMLs) from a CT scan and compared the results to those obtained from MRI in a cohort of 214 subjects gathered from Kuopio and Helsinki University Hospital registers from 2005 - 2016. Results The correlation coefficients of computational measures between CT and MRI were 0.9 (MTA), 0.82 (GCA), and 0.86 (Fazekas). CT-based measures were identical to MRI-based measures in 60% (MTA), 62% (GCA) and 60% (Fazekas) of cases when the measures were rounded to the nearest full grade variable. However, the difference in measures was 1 or less in 97–98% of cases. Similar results were obtained for cortical atrophy ratings, especially in the frontal and temporal lobes, when assessing the brain lobes separately. Bland–Altman plots and weighted kappa values demonstrated high agreement regarding measures based on CT and MRI. Conclusions MTA, GCA, and Fazekas grades can also be assessed reliably from a CT scan with our method. Even though the measures obtained with the different imaging modalities were not identical in a relatively extensive cohort, the differences were minor. This expands the possibility of using this automated analysis method when MRI is inaccessible or contraindicated. Supplementary Information The online version contains supplementary material available at 10.1007/s00234-021-02761-4.
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Affiliation(s)
- Aku L Kaipainen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland.
- Neurosurgery of NeuroCenter, Kuopio University Hospital, P.O. Box 100, 70029 KYS, Kuopio, Finland.
| | - Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Fanni Haapalinna
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Olli Jääskeläinen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- University of Eastern Finland, Institute of Clinical Medicine / Radiology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
| | - Anne M Koivisto
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
- Department of Neurosciences, Department of Geriatrics / Rehabilitation and Internal Medicine, University of Helsinki, Helsinki University Hospital, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Jyrki Lötjönen
- Combinostics Oy, Hatanpään valtatie 24, 33100, Tampere, Finland
| | | | - Sanna-Kaisa Herukka
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
| | - Valtteri Julkunen
- University of Eastern Finland, Institute of Clinical Medicine / Neurology, P.O. Box 1627, (Yliopistonranta 1 C), 70211, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland
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13
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Arola A, Laakso HM, Pitkänen J, Koikkalainen J, Lötjönen J, Korvenoja A, Erkinjuntti T, Melkas S, Jokinen H. Associations of cognitive reserve and psychological resilience with cognitive functioning in subjects with cerebral white matter hyperintensities. Eur J Neurol 2021; 28:2622-2630. [PMID: 33977580 DOI: 10.1111/ene.14910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease is characterized by progressive white matter hyperintensities (WMH) and cognitive decline. However, variability exists in how individuals maintain cognitive capabilities despite significant neuropathology. The relationships between individual cognitive reserve, psychological resilience and cognitive functioning were examined in subjects with varying degrees of WMH. METHODS In the Helsinki Small Vessel Disease Study, 152 subjects (aged 65-75 years) underwent a comprehensive neuropsychological assessment, evaluation of subjective cognitive complaints and brain magnetic resonance imaging with volumetric WMH evaluation. Cognitive reserve was determined by education (years) and the modified Cognitive Reserve Scale (mCRS). Psychological resilience was evaluated with the Resilience Scale 14. RESULTS The mCRS total score correlated significantly with years of education (r = 0.23, p < 0.01), but it was not related to age, sex or WMH volume. Together, mCRS score and education were associated with performance in a wide range of cognitive domains including processing speed, executive functions, working memory, verbal memory, visuospatial perception and verbal reasoning. Independently of education, the mCRS score had incremental predictive value on delayed verbal recall and subjective cognitive complaints. Psychological resilience was not significantly related to age, education, sex, WMH severity or cognitive test scores, but it was associated with subjective cognitive complaints. CONCLUSIONS Cognitive reserve has strong and consistent associations with cognitive functioning in subjects with WMH. Education is widely associated with objective cognitive functioning, whereas lifetime engagement in cognitively stimulating leisure activities (mCRS) has independent predictive value on memory performance and subjective cognitive complaints. Psychological resilience is strongly associated with subjective, but not objective, cognitive functioning.
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Affiliation(s)
- Anne Arola
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna M Laakso
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Pitkänen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Koikkalainen
- Combinostics Ltd, Tampere, Finland.,Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd, Tampere, Finland.,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Antti Korvenoja
- Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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14
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Siponkoski ST, Koskinen S, Laitinen S, Holma M, Ahlfors M, Jordan-Kilkki P, Ala-Kauhaluoma K, Martínez-Molina N, Melkas S, Laine M, Ylinen A, Zasler N, Rantanen P, Lipsanen J, Särkämö T. Effects of neurological music therapy on behavioural and emotional recovery after traumatic brain injury: A randomized controlled cross-over trial. Neuropsychol Rehabil 2021; 32:1356-1388. [PMID: 33657970 DOI: 10.1080/09602011.2021.1890138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) causes deficits in executive function (EF), as well as problems in behavioural and emotional self-regulation. Neurological music therapy may aid these aspects of recovery. We performed a cross-over randomized controlled trial where 40 persons with moderate-severe TBI received a 3-month neurological music therapy intervention (2 times/week, 60 min/session), either during the first (AB, n = 20) or second (BA, n = 20) half of a 6-month follow-up period. The evidence from this RCT previously demonstrated that music therapy enhanced general EF and set shifting. In the current study, outcome was assessed with self-report and caregiver-report questionnaires performed at baseline, 3-month, 6-month, and 18-month stages. The results showed that the self-reported Behavioural Regulation Index of the Behaviour Rating Inventory of Executive Function (BRIEF-A) improved more in the AB than BA group from baseline to 3-month stage and the effect was maintained in the 6-month follow-up. No changes in mood or quality of life questionnaires were observed. However, a qualitative content analysis of the feedback revealed that many participants experienced the intervention as helpful in terms of emotional well-being and activity. Our results suggest that music therapy has a positive effect on everyday behavioural regulation skills after TBI.
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Affiliation(s)
- Sini-Tuuli Siponkoski
- Cognitive Brain Research Unit, Music, Aging and Rehabilitation Team, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Milla Holma
- Musiikkiterapiaosuuskunta InstruMental (music therapy cooperative InstruMental), Helsinki, Finland
| | | | | | - Katja Ala-Kauhaluoma
- Ludus Oy Tutkimus- ja kuntoutuspalvelut (Assessment and intervention services), Helsinki, Finland
| | - Noelia Martínez-Molina
- Cognitive Brain Research Unit, Music, Aging and Rehabilitation Team, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Helsinki, Finland
| | - Aarne Ylinen
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Tampere University Hospital, Tampere, Finland.,Validia Rehabilitation Helsinki, Helsinki, Finland
| | - Nathan Zasler
- Concussion Care Centre of Virginia, Ltd., and Tree of Life, Richmond, VA, USA
| | - Pekka Rantanen
- Department of Physical and Rehabilitation Medicine, Helsinki University Hospital, Helsinki, Finland.,Department of Physical and Rehabilitation Medicine, Kanta-Häme Central Hospital, Hämeenlinna, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Teppo Särkämö
- Cognitive Brain Research Unit, Music, Aging and Rehabilitation Team, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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15
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Sibolt G, Curtze S, Jokinen H, Pohjasvaara T, Kaste M, Karhunen PJ, Erkinjuntti T, Melkas S, Oksala NKJ. Post-stroke dementia and permanent institutionalization. J Neurol Sci 2021; 421:117307. [PMID: 33454589 DOI: 10.1016/j.jns.2020.117307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/28/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Dementia is among the most frequent causes of institutionalization. To serve the purpose of preventive strategies, there are no follow-up studies that have evaluated the actual impact of post-stroke dementia on institutionalization. We therefore compared the institutionalization rate and length of stay in an institutional care facility of patients with post-stroke dementia with stroke patients without dementia. METHODS We included 410 consecutive patients aged 55 to 85 years with ischemic stroke who were admitted to Helsinki University Hospital (The SAM cohort). Hospitalization and nursing home admissions were reviewed from national registries. Dementia was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders 3rd edition (DSM-III) criteria using extensive clinical assessments performed 3 months post-stroke. The cohort had a follow-up 21 years later. RESULTS Compared to patients without dementia, post-stroke dementia was associated with shorter survival time (6.60 vs 10.10 years, p < 0.001), shorter time spent not institutionalized (5.40 vs 9.37 years, p < 0.001), but not with time spent permanently institutionalized (0.73 vs 1.10 years, p = 0.08). Post-stroke dementia was associated with higher rates and earlier permanent institutionalization compared to absence of post-stroke dementia (HR 1.53, 95% CI 1.07-2.18) in a Cox regression model adjusting for age, status of living alone at baseline, modified Rankin Scale at baseline, history of atrial fibrillation, and cardiac failure. CONCLUSIONS Post-stroke dementia is associated with earlier permanent institutionalization. Due to significantly shorter survival, the time spent in nursing homes was not significantly longer in patients with post-stroke dementia compared with patients without post-stroke dementia.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland.
| | - Hanna Jokinen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tarja Pohjasvaara
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Markku Kaste
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Pekka J Karhunen
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Timo Erkinjuntti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Niku K J Oksala
- Faculty of Medicine and Life Sciences, University of Tampere, Finland
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16
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Pitkänen J, Koikkalainen J, Nieminen T, Marinkovic I, Curtze S, Sibolt G, Jokinen H, Rueckert D, Barkhof F, Schmidt R, Pantoni L, Scheltens P, Wahlund LO, Korvenoja A, Lötjönen J, Erkinjuntti T, Melkas S. Evaluating severity of white matter lesions from computed tomography images with convolutional neural network. Neuroradiology 2020; 62:1257-1263. [PMID: 32281028 PMCID: PMC7478948 DOI: 10.1007/s00234-020-02410-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/24/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Severity of white matter lesion (WML) is typically evaluated on magnetic resonance images (MRI), yet the more accessible, faster, and less expensive method is computed tomography (CT). Our objective was to study whether WML can be automatically segmented from CT images using a convolutional neural network (CNN). The second aim was to compare CT segmentation with MRI segmentation. METHODS The brain images from the Helsinki University Hospital clinical image archive were systematically screened to make CT-MRI image pairs. Selection criteria for the study were that both CT and MRI images were acquired within 6 weeks. In total, 147 image pairs were included. We used CNN to segment WML from CT images. Training and testing of CNN for CT was performed using 10-fold cross-validation, and the segmentation results were compared with the corresponding segmentations from MRI. RESULTS A Pearson correlation of 0.94 was obtained between the automatic WML volumes of MRI and CT segmentations. The average Dice similarity index validating the overlap between CT and FLAIR segmentations was 0.68 for the Fazekas 3 group. CONCLUSION CNN-based segmentation of CT images may provide a means to evaluate the severity of WML and establish a link between CT WML patterns and the current standard MRI-based visual rating scale.
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Affiliation(s)
- Johanna Pitkänen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland.
| | - Juha Koikkalainen
- Combinostics Ltd., Tampere, Finland and VTT Technical Research Centre of Finland, Tampere, Finland
| | - Tuomas Nieminen
- Combinostics Ltd., Tampere, Finland and VTT Technical Research Centre of Finland, Tampere, Finland
| | - Ivan Marinkovic
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
| | - Hanna Jokinen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, UK
- NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London, London, England, UK
| | - Reinhold Schmidt
- Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Leonardo Pantoni
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Antti Korvenoja
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Lötjönen
- Combinostics Ltd., Tampere, Finland and VTT Technical Research Centre of Finland, Tampere, Finland
| | - Timo Erkinjuntti
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, University of Helsinki and Helsinki University Hospital, PO Box 302, 00029 HUS, Helsinki, Finland
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Siponkoski ST, Martínez-Molina N, Kuusela L, Laitinen S, Holma M, Ahlfors M, Jordan-Kilkki P, Ala-Kauhaluoma K, Melkas S, Pekkola J, Rodriguez-Fornells A, Laine M, Ylinen A, Rantanen P, Koskinen S, Lipsanen J, Särkämö T. Music Therapy Enhances Executive Functions and Prefrontal Structural Neuroplasticity after Traumatic Brain Injury: Evidence from a Randomized Controlled Trial. J Neurotrauma 2020; 37:618-634. [DOI: 10.1089/neu.2019.6413] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Sini-Tuuli Siponkoski
- Department of Psychology and Logopedics, Cognitive Brain Research Unit, University of Helsinki, Helsinki, Finland
| | - Noelia Martínez-Molina
- Department of Psychology and Logopedics, Cognitive Brain Research Unit, University of Helsinki, Helsinki, Finland
| | - Linda Kuusela
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, Helsinki, Finland
- Department of Physics, University of Helsinki, Helsinki, Finland
| | | | - Milla Holma
- Musiikkiterapiaosuuskunta InstruMental (Music Therapy Cooperative InstruMental), Helsinki, Finland
| | | | | | - Katja Ala-Kauhaluoma
- Ludus Oy Tutkimus- ja kuntoutuspalvelut (Assessment and Intervention Services), Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology and Brain Injury Outpatient Clinic, Helsinki University Central Hospital, Helsinki, Finland
| | - Johanna Pekkola
- HUS Medical Imaging Center, Department of Radiology, Helsinki Central University Hospital and University of Helsinki, Helsinki, Finland
| | - Antoni Rodriguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies, Barcelona, Spain
| | - Matti Laine
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Aarne Ylinen
- Department of Neurology and Brain Injury Outpatient Clinic, Helsinki University Central Hospital, Helsinki, Finland
- Tampere University Hospital, Tampere, Finland
| | | | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Teppo Särkämö
- Department of Psychology and Logopedics, Cognitive Brain Research Unit, University of Helsinki, Helsinki, Finland
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Lempiäinen J, Ijäs P, Niiranen TJ, Kaste M, Karhunen PJ, Lindsberg PJ, Erkinjuntti T, Melkas S. Haptoglobin Hp1 Variant Does Not Associate with Small Vessel Disease. Brain Sci 2019; 10:brainsci10010018. [PMID: 31905636 PMCID: PMC7016682 DOI: 10.3390/brainsci10010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/16/2019] [Accepted: 12/24/2019] [Indexed: 01/10/2023] Open
Abstract
Haptoglobin (Hp) is a plasma protein that binds free hemoglobin and protects tissues from oxidative damage. An Hp2 allele has been associated with an increased risk of cardiovascular complications. On the other hand, recent studies have suggested that Hp1 allele increases risk to develop severe cerebral small vessel disease. We aimed to replicate this finding in a first-ever stroke patient cohort. Hp was genotyped by PCR and gel electrophoresis in the Helsinki Stroke Aging Memory Study in patients with DNA and magnetic resonance imaging (MRI) available (SAM; n = 316). Lacunar infarcts and white matter lesions (WML) classified by Fazekas grading from brain MRI were associated with Hp genotypes. As population controls, we used participants of Cardiovascular diseases—a sub study of Health 2000 Survey (n = 1417). In the SAM cohort, 63.0% of Hp1-1 carriers (n = 46), 52.5% of Hp1-2 carriers (n = 141) and 51.2% of Hp2-2 carriers (n = 129) had severe WML (p = 0.372). There was no difference in severe WMLs between Hp1-1 vs. Hp1-2 and Hp2-2 carriers (p = 0.201). In addition, 68.9% of Hp1-1 carriers (n = 45), 58.5% of Hp1-2 carriers (n = 135), and 61.8% of Hp2-2 carriers (n = 126) had one or more lacunar lesions (p = 0.472). There was no difference in the number of patients with at least one lacunar infarct between Hp1-1 vs. Hp1-2 and Hp2-2 groups (p = 0.322). Neither was there any difference when diabetic patients (type I and II) were examined separately. Hp1 allele is not associated with an increased risk for cerebral small vessel disease in a well-characterized Finnish stroke patient cohort.
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Affiliation(s)
- Juha Lempiäinen
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
- Correspondence: ; Tel.: +358-407-787-278; Fax: +358-947-185-957
| | - Petra Ijäs
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Teemu J. Niiranen
- Department of Public Health Solutions, National institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland;
- Division of Medicine, Turku University Hospital and University of Turku, 20014 Turku, Finland
| | - Markku Kaste
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Pekka J. Karhunen
- School of Medicine, University of Tampere, 33014 Tampere, Finland;
- FimLab Laboratories Ltd., Tampere University Hospital Region, 33014 Tampere, Finland
| | - Perttu J. Lindsberg
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Timo Erkinjuntti
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
| | - Susanna Melkas
- Clinical Neurosciences, University of Helsinki, 00014 Helsinki, Finland; (P.I.); (M.K.); (P.J.L.); (T.E.); (S.M.)
- Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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19
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Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, Bae HJ, Lim JS, Köhler S, Douven E, Staals J, Chen C, Xu X, Chong EJ, Akinyemi RO, Kalaria RN, Ogunniyi A, Barbay M, Roussel M, Lee BC, Srikanth VK, Moran C, Kandiah N, Chander RJ, Sabayan B, Jukema JW, Melkas S, Erkinjuntti T, Brodaty H, Bordet R, Bombois S, Hénon H, Lipnicki DM, Kochan NA, Sachdev PS. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology 2019; 93:e2257-e2271. [PMID: 31712368 PMCID: PMC6937495 DOI: 10.1212/wnl.0000000000008612] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 07/26/2019] [Indexed: 12/16/2022] Open
Abstract
Objective To address the variability in prevalence estimates and inconsistencies in potential risk factors for poststroke cognitive impairment (PSCI) using a standardized approach and individual participant data (IPD) from international cohorts in the Stroke and Cognition Consortium (STROKOG) consortium. Methods We harmonized data from 13 studies based in 8 countries. Neuropsychological test scores 2 to 6 months after stroke or TIA and appropriate normative data were used to calculate standardized cognitive domain scores. Domain-specific impairment was based on percentile cutoffs from normative groups, and associations between domain scores and risk factors were examined with 1-stage IPD meta-analysis. Results In a combined sample of 3,146 participants admitted to hospital for stroke (97%) or TIA (3%), 44% were impaired in global cognition and 30% to 35% were impaired in individual domains 2 to 6 months after the index event. Diabetes mellitus and a history of stroke were strongly associated with poorer cognitive function after covariate adjustments; hypertension, smoking, and atrial fibrillation had weaker domain-specific associations. While there were no significant differences in domain impairment among ethnoracial groups, some interethnic differences were found in the effects of risk factors on cognition. Conclusions This study confirms the high prevalence of PSCI in diverse populations, highlights common risk factors, in particular diabetes mellitus, and points to ethnoracial differences that warrant attention in the development of prevention strategies.
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Affiliation(s)
- Jessica W Lo
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - John D Crawford
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - David W Desmond
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Olivier Godefroy
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Hanna Jokinen
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Simin Mahinrad
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Hee-Joon Bae
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Jae-Sung Lim
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Sebastian Köhler
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Elles Douven
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Julie Staals
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Christopher Chen
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Xin Xu
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Eddie J Chong
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Rufus O Akinyemi
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Rajesh N Kalaria
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Adesola Ogunniyi
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Mélanie Barbay
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Martine Roussel
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Byung-Chul Lee
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Velandai K Srikanth
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Christopher Moran
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Nagaendran Kandiah
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Russell J Chander
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Behnam Sabayan
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - J Wouter Jukema
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Susanna Melkas
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Timo Erkinjuntti
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Henry Brodaty
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Régis Bordet
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Stéphanie Bombois
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Hilde Hénon
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Darren M Lipnicki
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Nicole A Kochan
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France
| | - Perminder S Sachdev
- From the Centre for Healthy Brain Ageing (J.W.L., J.D.C., R.J.C., H.B., D.M.L., N.A.K., P.S.S.), University of New South Wales, Sydney, Australia; Department of Neurology and Laboratory of Functional Neurosciences (O.G., M.B., M.R.), University Hospital of Amiens, France; Clinical Neurosciences (H.J., S.M., T.E.), Neurology, University of Helsinki and Helsinki University Hospital, Finland; Department of Internal Medicine (S.M.), Gerontology and Geriatrics Section, and Department of Cardiology (J.W.J.), Leiden University Medical Center, the Netherlands; Department of Neurology (S.M., B.S.), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Neurology (H.-J.B.), Seoul National University School of Medicine, Seoul National University Bundang Hospital, Seongnam; Department of Neurology (J.-S.L., B.-C.L.), Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Psychiatry and Neuropsychology (S.K., E.D.), School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University; Department of Neurology (J.S.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands; Memory Aging and Cognition Centre (C.C., X.X., E.J.C.), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore; Centre for Population Health Sciences (X.X.), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Neuroscience and Ageing Research Unit (R.O.A., A.O.), Institute for Advanced Medical Research and Training, and Department of Medicine (R.O.A.), College of Medicine, University of Ibadan, Nigeria; Institute of Neuroscience (R.N.K.), Newcastle University, Newcastle Upon Tyne, UK; Peninsula Clinical School (V.K.S., C.M.), Central Clinical School, Monash University; Department of Aged Care (C.M.), Alfred Health, Melbourne, Australia; National Neuroscience Institute (N.K., R.J.C.); Duke-NUS Medical School (N.K.), Singapore; Dementia Collaborative Research Centre (H.B., P.S.S.), University of New South Wales, Sydney, Australia; and University of Lille (R.B., S.B., H.H.), Inserm, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, France.
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20
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Jokinen H, Koikkalainen J, Laakso HM, Melkas S, Nieminen T, Brander A, Korvenoja A, Rueckert D, Barkhof F, Scheltens P, Schmidt R, Fazekas F, Madureira S, Verdelho A, Wallin A, Wahlund LO, Waldemar G, Chabriat H, Hennerici M, O'Brien J, Inzitari D, Lötjönen J, Pantoni L, Erkinjuntti T. Global Burden of Small Vessel Disease-Related Brain Changes on MRI Predicts Cognitive and Functional Decline. Stroke 2019; 51:170-178. [PMID: 31699021 PMCID: PMC6924941 DOI: 10.1161/strokeaha.119.026170] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is available in the text. Cerebral small vessel disease is characterized by a wide range of focal and global brain changes. We used a magnetic resonance imaging segmentation tool to quantify multiple types of small vessel disease–related brain changes and examined their individual and combined predictive value on cognitive and functional abilities.
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Affiliation(s)
- Hanna Jokinen
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Juha Koikkalainen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Faculty of Health Sciences, University of Eastern Finland (J.K.)
| | - Hanna M Laakso
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland.,Department of Psychology and Logopedics, Faculty of Medicine (H.J., H.M.L.), Finland
| | - Susanna Melkas
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
| | | | - Antti Brander
- Department of Radiology, Medical Imaging Center, Tampere University Hospital, Finland (A.B.)
| | - Antti Korvenoja
- Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital (A.K.), Finland
| | - Daniel Rueckert
- Biomedical Image Analysis Group, Department of Computing, Imperial College London, United Kingdom (D.R.)
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine (F.B.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, United Kingdom (F.B.)
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology (P.S.), Neuroscience Campus Amsterdam, VU University Medical Center, the Netherlands.,NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust, University College London, United Kingdom (F.B.)
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Austria (R.S., F.F.)
| | - Sofia Madureira
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Ana Verdelho
- Department of Neurosciences, Santa Maria Hospital, University of Lisbon, Portugal (S. Madureira, A.V.)
| | - Anders Wallin
- Sahlgrenska Academy, Institute of Neuroscience and Physiology, Section for Psychiatry and Neurochemistry, University of Gothenburg, Sweden (A.W.)
| | - Lars-Olof Wahlund
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Sweden (L.-O.W.)
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark (G.W.)
| | - Hugues Chabriat
- Department of Neurology, Hopital Lariboisiere, APHP and INSERM U1161-University Denis Diderot (DHU NeuroVasc), France (H.C.)
| | | | - John O'Brien
- Department of Psychiatry, University of Cambridge, United Kingdom (J.O.)
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council (D.I.).,Department NEUROFARBA, University of Florence, Italy (D.I.)
| | - Jyrki Lötjönen
- Combinostics, Ltd, Finland (J.K., T.N., J.L.).,VTT Technical Research Centre of Finland (J.K., J.L.).,Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Finland (J.L.)
| | - Leonardo Pantoni
- L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Italy (L.P.)
| | - Timo Erkinjuntti
- From the Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital (H.J., H.M.L., S. Melkas, T.E.), Finland
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21
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Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, Bae HJ, Lim JS, Koehler S, Douven E, Staals J, Chen C, Xu X, Chong E, Akinyemi RO, Kalaria RN, Ogunniyi A, Barbay M, Roussel M, Lee BC, Srikanth VK, Moran C, Kandiah N, Chander RJ, Sabayan B, Jukema W, Melkas S, Erkinjuntti T, Brodaty H, Bordet R, Bombois S, Hénon H, Lipnicki DM, Kochan NA, Sachdev PS. O4-03-04: PROFILE OF AND RISK FACTORS FOR POST-STROKE COGNITIVE IMPAIRMENT IN DIVERSE ETHNO-REGIONAL GROUPS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jessica W. Lo
- Centre for Healthy Brain Ageing; UNSW; Sydney Australia
| | | | | | - Olivier Godefroy
- Memory Resource and Research Center of Amiens; CHU Amiens Picardie Hôpital Nord; Amiens France
- CHU Amiens; Amiens France
| | - Hanna Jokinen
- University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | | | - Hee-Joon Bae
- Seoul National University Bundang Hospital; Seongnam Republic of South Korea
| | - Jae-Sung Lim
- Hallym University Sacred Heart Hospital; Anyang Republic of South Korea
| | - Sebastian Koehler
- Alzheimer Center Limburg, School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
| | - Elles Douven
- Alzheimer Center Limburg, School for Mental Health and Neuroscience; Maastricht University; Maastricht Netherlands
| | - Julie Staals
- Maastricht University Medical Center; Cardiovascular Research Institute Maastricht; Maastricht Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre; National University of Singapore; Singapore Singapore
| | - Xin Xu
- Memory Aging and Cognition Centre; National University of Singapore; Singapore Singapore
- Centre for Population Health Sciences; Nanyang Technological University; Singapore Singapore
| | - Eddie Chong
- Memory Aging and Cognition Centre; National University of Singapore; Singapore Singapore
| | - Rufus O. Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training; University of Ibadan; Ibadan Nigeria
- College of Medicine; University of Ibadan; Ibadan Nigeria
| | | | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training; University of Ibadan; Ibadan Nigeria
- College of Medicine; University of Ibadan; Ibadan Nigeria
| | | | | | - Byung-Chul Lee
- Hallym University Sacred Heart Hospital; Anyang Republic of South Korea
| | - Velandai K. Srikanth
- Peninsula Clinical School, Central Clinical School; Monash University; Melbourne Australia
| | - Christopher Moran
- Alfred Health; Melbourne Australia
- Peninsula Clinical School, Central Clinical School; Monash University; Melbourne Australia
| | - Nagaendran Kandiah
- Duke-NUS Graduate Medical School; Singapore Singapore
- National Neuroscience Institute; National Neuroscience Institute; Singapore Singapore
| | - Russell J. Chander
- Centre for Healthy Brain Ageing; UNSW; Sydney Australia
- National Neuroscience Institute; National Neuroscience Institute; Singapore Singapore
| | | | - Wouter Jukema
- Leiden University Medical Center; Leiden Netherlands
| | - Susanna Melkas
- University of Helsinki and Helsinki University Hospital; Helsinki Netherlands
| | - Timo Erkinjuntti
- University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Henry Brodaty
- Centre for Healthy Brain Ageing; UNSW; Sydney Australia
- Dementia Centre for Research Collaboration; UNSW; Sydney Australia
- Prince of Wales Hospital; Sydney Australia
| | - Régis Bordet
- University of Lille; Inserm, CHU Lille; Lille France
| | | | - Hilde Hénon
- University of Lille; Inserm, CHU Lille; Lille France
| | | | - Nicole A. Kochan
- Centre for Healthy Brain Ageing; University of New South Wales, Sydney; Sydney Australia
| | - Perminder S. Sachdev
- Prince of Wales Hospital; Sydney Australia
- Centre for Healthy Brain Ageing; University of New South Wales, Sydney; Sydney Australia
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22
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Ruuth R, Kuusela L, Mäkelä T, Melkas S, Korvenoja A. Comparison of reconstruction and acquisition choices for quantitative T2* maps and synthetic contrasts. Eur J Radiol Open 2019; 6:42-48. [PMID: 30619919 PMCID: PMC6314103 DOI: 10.1016/j.ejro.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 11/23/2022] Open
Abstract
Phase images have artifacts if reconstructed with a vendor’s sum of squares mode. Quantitative T2* values can be obtained from DICOM data instead of k-space data. Reconstruction from DICOM data does not reduce white matter/gray matter contrast.
Aim and scope A Gradient Echo Plural Contrast Imaging technique (GEPCI) is a post-processing method, which can be used to obtain quantitative T2* values and generate multiple synthetic contrasts from a single acquisition. However, scan duration and image reconstruction from k-space data present challenges in a clinical workflow. This study aimed at optimizing image reconstruction and acquisition duration to facilitate a post-processing method for synthetic image contrast creation in clinical settings. Materials and methods This study consists of tests using the American College of Radiology (ACR) image quality phantom, two healthy volunteers, four mild traumatic brain injury patients and four small vessel disease patients. The measurements were carried out on a 3.0 T scanner with multiple echo times. Reconstruction from k-space data and DICOM data with two different coil-channel combination modes were investigated. Partial Fourier techniques were tested to optimize the scanning time. Conclusions Sum of squares coil-channel combination produced artifacts in phase images, but images created with adaptive combination were artifact-free. The voxel-wise median signed difference of T2* between the vendor’s adaptive channel combination and k-space reconstruction modes was 2.9 ± 0.7 ms for white matter and 4.5 ± 0.6 ms for gray matter. Relative white matter/gray matter contrast of all synthetic images and contrast-to-noise ratio of synthetic T1-weighted images were almost equal between reconstruction modes. Our results indicate that synthetic contrasts can be generated from the vendor’s DICOM data with the adaptive combination mode without affecting the quantitative T2* values or white matter/gray matter contrast.
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Affiliation(s)
- Riikka Ruuth
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029, HUS, Finland
- Department of Physics, Faculty of Science, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
- Corresponding author at: HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029, HUS, Finland.
| | - Linda Kuusela
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029, HUS, Finland
- Department of Physics, Faculty of Science, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - Teemu Mäkelä
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029, HUS, Finland
- Department of Physics, Faculty of Science, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - Susanna Melkas
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, P.O. Box 302, FI-00029, HUS, Finland
| | - Antti Korvenoja
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 340, FI-00029, HUS, Finland
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23
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Laakso HM, Hietanen M, Melkas S, Sibolt G, Curtze S, Virta M, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Jokinen H. Executive function subdomains are associated with post‐stroke functional outcome and permanent institutionalization. Eur J Neurol 2018; 26:546-552. [DOI: 10.1111/ene.13854] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- H. M. Laakso
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - M. Hietanen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Melkas
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - G. Sibolt
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - S. Curtze
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Virta
- Department of Psychology and Logopedics Faculty of Medicine University of Helsinki HelsinkiFinland Finland
| | - R. Ylikoski
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Pohjasvaara
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - M. Kaste
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - T. Erkinjuntti
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
| | - H. Jokinen
- Neurology and Neuropsychology University of Helsinki and Helsinki University Hospital HelsinkiFinland
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24
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Ijäs P, Melkas S, Saksi J, Jula A, Jauhiainen M, Oksala N, Pohjasvaara T, Kaste M, Karhunen PJ, Lindsberg P, Erkinjuntti T. Haptoglobin Hp2 Variant Promotes Premature Cardiovascular Death in Stroke Survivors. Stroke 2017; 48:1463-1469. [PMID: 28487337 DOI: 10.1161/strokeaha.116.015683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/13/2017] [Accepted: 03/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Haptoglobin (Hp) is an acute phase plasma protein protecting tissues from oxidative damage. It exists in 2 variant alleles (hp1/hp2) giving rise to 3 protein isoforms with different biochemical properties and efficiency to limit oxidative stress. We previously found that hp2 variant is associated with stroke risk in the patients with carotid stenosis and the risk of ischemic cardiovascular events in a general population cohort. This study examined the hypothesis that Hp genotype is associated with general cardiovascular risk in patients with stroke. METHODS Hp was genotyped in SAM study (Helsinki Stroke Aging Memory, n=378). A total of 1426 individuals ascertained from a nationally representative cross-sectional health survey served as population controls. RESULTS Hp genotype frequencies were 15.6% (hp1-1), 44.2% (hp1-2), and 40.2% (hp2-2) in patients with stroke. During a mean of 7.5-year follow-up after first-ever stroke, hp2 carriers had a substantially higher rate of cardiac deaths (24.5% versus 8.5%; P=0.006) and a trend toward more fatal strokes (23.5% versus 13.6%; P=0.122). The combined risk of ischemic cardiovascular deaths was 2.4-fold higher among hp2 carriers (95% confidence interval, 1.28-4.43) after adjustment for major cardiovascular risk factors. CONCLUSIONS Hp2 allele is associated with premature ischemic cardiovascular deaths after first-ever ischemic stroke.
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Affiliation(s)
- Petra Ijäs
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland.
| | - Susanna Melkas
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Jani Saksi
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Antti Jula
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Matti Jauhiainen
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Niku Oksala
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Tarja Pohjasvaara
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Markku Kaste
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Pekka J Karhunen
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Perttu Lindsberg
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
| | - Timo Erkinjuntti
- From the Clinical Neurosciences, Neurology (I.P., S.M., T.P., M.K., P.L., T.E.) and Research Programs Unit, Molecular Neurology, Biomedicum Helsinki (I.P., J.S., P.L.), University of Helsinki, Finland; Department of Neurology, Helsinki University Hospital, Finland (I.P., S.M., T.P., M.K., P.L., T.E.); National Institute for Health and Welfare, Helsinki, Finland (A.J., M.J.); Minerva Foundation Institute for Medical Research, Biomedicum, Helsinki, Finland (M.J.); School of Medicine, University of Tampere, Finland (N.O., P.J.K.); and FimLab Laboratories Ltd (N.O., P.J.K.) and Division of Vascular Surgery, Department of Surgery (N.O.), Tampere University Hospital, Finland
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Jokinen H, Melkas S, Madureira S, Verdelho A, Ferro JM, Fazekas F, Schmidt R, Scheltens P, Barkhof F, Wardlaw JM, Inzitari D, Pantoni L, Erkinjuntti T. Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease. J Neurol Neurosurg Psychiatry 2016; 87:1296-1302. [PMID: 27951523 DOI: 10.1136/jnnp-2016-313914] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/10/2016] [Accepted: 09/20/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cerebral small vessel disease (SVD) is characterised by progressive white matter hyperintensities (WMH), cognitive decline and loss of functional independence. The correspondence between neuroimaging findings and the severity of clinical symptoms has been modest, however, and thus the outcome may be affected by various host factors. We investigated the predictive value of educational and occupational attainments as proxy measures of cognitive reserve on long-term cognitive and functional outcome in patients with different degrees of WMH. METHODS In the Leukoaraiosis and Disability (LADIS) study, 615 older individuals with WMH were evaluated with brain MRI and detailed clinical and neuropsychological assessments at 3-year follow-up. A prolonged follow-up of functional and cognitive status was administered with a structured telephone interview after up to 7 years. RESULTS Higher levels of educational and occupational attainment were strongly related to baseline cognitive scores and predicted a slower rate of decline at 3-year follow-up in measures of processing speed, executive functions and memory independently of WMH volume and other confounders. The deleterious effect of WMH on processing speed and memory was moderated by education and occupation. Education mitigated the relation of WMH volume on 7-year cognitive status. Moreover, higher education and occupational attainments were related to favourable outcome at 7-year follow-up as defined by sustained functional independence and lower mortality. CONCLUSIONS The results support the presumption that cognitive reserve plays a significant role as a buffer against the clinical manifestations of SVD and may in part explain high individual variability in outcome.
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Affiliation(s)
- Hanna Jokinen
- Department of Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Melkas
- Department of Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sofia Madureira
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana Verdelho
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisbon, Portugal
| | - José M Ferro
- Serviço de Neurologia, Centro de Estudos Egas Moniz, Hospital de Santa Maria, Lisbon, Portugal
| | - Franz Fazekas
- Department of Neurology and MRI Institute, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology and MRI Institute, Medical University of Graz, Graz, Austria
| | - Philip Scheltens
- Department of Radiology and Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Neurology, VU University Medical Center, Amsterdam, The Netherlands.,UCL Institutes of Neurology & Healthcare Engineering, London, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy.,Department NEUROFARBA, University of Florence, Florence, Italy
| | | | - Timo Erkinjuntti
- Department of Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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26
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Sachdev PS, Lo JW, Crawford JD, Mellon L, Hickey A, Williams D, Bordet R, Mendyk AM, Gelé P, Deplanque D, Bae HJ, Lim JS, Brodtmann A, Werden E, Cumming T, Köhler S, Verhey FRJ, Dong YH, Tan HH, Chen C, Xin X, Kalaria RN, Allan LM, Akinyemi RO, Ogunniyi A, Klimkowicz-Mrowiec A, Dichgans M, Wollenweber FA, Zietemann V, Hoffmann M, Desmond DW, Linden T, Blomstrand C, Fagerberg B, Skoog I, Godefroy O, Barbay M, Roussel M, Lee BC, Yu KH, Wardlaw J, Makin SJ, Doubal FN, Chappell FM, Srikanth VK, Thrift AG, Donnan GA, Kandiah N, Chander RJ, Lin X, Cordonnier C, Moulin S, Rossi C, Sabayan B, Stott DJ, Jukema JW, Melkas S, Jokinen H, Erkinjuntti T, Mok VCT, Wong A, Lam BYK, Leys D, Hénon H, Bombois S, Lipnicki DM, Kochan NA. STROKOG (stroke and cognition consortium): An international consortium to examine the epidemiology, diagnosis, and treatment of neurocognitive disorders in relation to cerebrovascular disease. Alzheimers Dement (Amst) 2016; 7:11-23. [PMID: 28138511 PMCID: PMC5257024 DOI: 10.1016/j.dadm.2016.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The Stroke and Cognition consortium (STROKOG) aims to facilitate a better understanding of the determinants of vascular contributions to cognitive disorders and help improve the diagnosis and treatment of vascular cognitive disorders (VCD). METHODS Longitudinal studies with ≥75 participants who had suffered or were at risk of stroke or TIA and which evaluated cognitive function were invited to join STROKOG. The consortium will facilitate projects investigating rates and patterns of cognitive decline, risk factors for VCD, and biomarkers of vascular dementia. RESULTS Currently, STROKOG includes 25 (21 published) studies, with 12,092 participants from five continents. The duration of follow-up ranges from 3 months to 21 years. DISCUSSION Although data harmonization will be a key challenge, STROKOG is in a unique position to reuse and combine international cohort data and fully explore patient level characteristics and outcomes. STROKOG could potentially transform our understanding of VCD and have a worldwide impact on promoting better vascular cognitive outcomes.
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Affiliation(s)
- Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia
| | - Jessica W Lo
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - John D Crawford
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Stroke and Geriatric Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Régis Bordet
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Anne-Marie Mendyk
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Patrick Gelé
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Dominique Deplanque
- University of Lille, Inserm, CHU Lille, CIC 1403 - Centre d'investigation clinique, Lille, France
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Amy Brodtmann
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Emilio Werden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Toby Cumming
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Sebastian Köhler
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Yan-Hong Dong
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia; Dementia Collaborative Research Centre, University of New South Wales, Sydney, Australia; Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hui Hui Tan
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Medicine (Neurology Division), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Christopher Chen
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xu Xin
- Memory Ageing and Cognition Center, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Raj N Kalaria
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Allan
- Neurovascular Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Frank A Wollenweber
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Vera Zietemann
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Hoffmann
- Cognitive Neurology and Stroke Programs, University of Central Florida, Orlando VA Medical Center, Orlando, Florida, USA
| | | | - Thomas Linden
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia; Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Christian Blomstrand
- Institute of Neuroscience and Physiology, Centre of Brain Research and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Fagerberg
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory for Cardiovascular and Metabolic Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Olivier Godefroy
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Mélanie Barbay
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Martine Roussel
- Department of Neurology and Laboratory of Functional Neurosciences, University Hospital of Amiens, France
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Stephen J Makin
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Tasmania, Australia
| | - Amanda G Thrift
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia
| | - Geoffrey A Donnan
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Xuling Lin
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Charlotte Cordonnier
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Solene Moulin
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Costanza Rossi
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - David J Stott
- Academic Section of Geriatrics, University of Glasgow, Glasgow, United Kingdom
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Susanna Melkas
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Hanna Jokinen
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Timo Erkinjuntti
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Finland
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Bonnie Y K Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China; Therese Pei Fong Chow Research Centre for Prevention of Dementia, Hong Kong SAR, China
| | - Didier Leys
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Hilde Hénon
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Stéphanie Bombois
- University of Lille, Inserm, CHU Lille, U1171 - Degenerative & Vascular Cognitive Disorders, Lille, France
| | - Darren M Lipnicki
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
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Curtze S, Sibolt G, Melkas S, Mustanoja S, Haapaniemi E, Putaala J, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Symptomatic post-thrombolytic intracerebral hemorrhage is not related to the cause of stroke. Eur J Neurol 2016; 23:1700-1704. [DOI: 10.1111/ene.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. Curtze
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - G. Sibolt
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - S. Melkas
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - S. Mustanoja
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - E. Haapaniemi
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - J. Putaala
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - T. Sairanen
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - M. Tiainen
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - T. Tatlisumak
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
- Institute of Neuroscience and Physiology; Salhgrenska Academy at University of Gothenburg; Gothenburg
- Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - D. Strbian
- Clinical Neurosciences; Neurology; University of Helsinki; Helsinki
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
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28
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Curtze S, Putaala J, Sibolt G, Melkas S, Mustanoja S, Haapaniemi E, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Cerebral white matter lesions and post-thrombolytic remote parenchymal hemorrhage. Ann Neurol 2016; 80:593-9. [DOI: 10.1002/ana.24760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/07/2016] [Accepted: 08/09/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Sami Curtze
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Jukka Putaala
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Gerli Sibolt
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Susanna Melkas
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Satu Mustanoja
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Elena Haapaniemi
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Tiina Sairanen
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Marjaana Tiainen
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
| | - Turgut Tatlisumak
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
- Institute of Neuroscience and Physiology; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
- Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Daniel Strbian
- Division of Neurology, Department of Clinical Neurosciences; University of Helsinki; Helsinki Finland
- Department of Neurology; Helsinki University Hospital; Helsinki Finland
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29
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Waltimo T, Haapaniemi E, Surakka IL, Melkas S, Sairanen T, Sibolt G, Tatlisumak T, Strbian D. Post-thrombolytic blood pressure and symptomatic intracerebral hemorrhage. Eur J Neurol 2016; 23:1757-1762. [DOI: 10.1111/ene.13118] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- T. Waltimo
- Department of Neurology; Helsinki University Central Hospital; Helsinki
| | - E. Haapaniemi
- Department of Neurology; Helsinki University Central Hospital; Helsinki
| | - I. L. Surakka
- Institute for Molecular Medicine Finland; University of Helsinki; Helsinki Finland
| | - S. Melkas
- Department of Neurology; Helsinki University Central Hospital; Helsinki
| | - T. Sairanen
- Department of Neurology; Helsinki University Central Hospital; Helsinki
| | - G. Sibolt
- Department of Neurology; Helsinki University Central Hospital; Helsinki
| | - T. Tatlisumak
- Institute for Molecular Medicine Finland; University of Helsinki; Helsinki Finland
| | - D. Strbian
- Department of Neurology; Helsinki University Central Hospital; Helsinki
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Curtze S, Sibolt G, Melkas S, Mustanoja S, Haapaniemi E, Putaala J, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Abstract WP70: Cause of Stroke is not Associated With the Risk of Symptomatic Post-thrombolytic Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
The risk of intracranial hemorrhage following intravenous thrombolysis (IVT) is increased by various factors including the underlying vessel conditions and the mechanisms of vessel occlusion, the location of the occlusion, and the extent of ischemic changes with subsequent blood-brain-barrier disruption. We hypothesized that the stroke etiology is associated with the risk of symptomatic intracerebral hemorrhage (sICH).
Methods:
A consecutive cohort of 2485 IVT-treated patients at the Helsinki University Central Hospital was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. A sICH was classified according to the European Cooperative Acute Stroke Study II criteria. The associations of sICH with nominal, ordinal, and continuous variables were analyzed in a univariate binary regression model and adjusted in multivariate binary regression models.
Results:
In univariate analyses cardioembolism (OR 1.14; 95% CI 0.79-1.64) and large-artery atherosclerosis (OR 1.30; 95% CI 0.85-2.00) were not associated with sICH, and small-vessel occlusion was associated with a lower risk of sICH (OR 0.18; 95% CI 0.06-0.57). When adjusted for previously identified factors associated with sICH (see Table), none of the TOAST categories was associated with a higher or lower risk of sICH compared with the the rest of the causes.
Conclusions:
The risk of sICH in IVT-treated patients is not significantly associated with the cause of stroke.
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Affiliation(s)
- Sami Curtze
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | - Gerli Sibolt
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | - Susanna Melkas
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | - Satu Mustanoja
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | | | - Jukka Putaala
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | - Tiina Sairanen
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
| | | | | | - Daniel Strbian
- Neurology, Helsinki Central Univ Hosp, Helsinki, Finland
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Ijas P, Melkas S, Saksi J, Jula A, Jauhiainen M, Pohjasvaara T, Kaste M, Karhunen PJ, Lindsberg P, Erkinjuntti T. Abstract TP158: Haptoglobin Hp2 Variant Associates With an Increased Risk of Ischemic Cardiovascular Death After First-ever Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tp158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Haptoglobin (Hb) is an acute phase plasma protein which binds free hemoglobin and protects tissues from heme-iron induced oxidative damage. Hp gene exists in two variant alleles, Hp1 and Hp2 giving rise to three protein isoforms, hp1-1, hp1-2 and hp2-2, which differ in their efficiency to limit oxidative stress. Previously, Hp variants have been associated with the risk of ischemic stroke subtypes, Hp1 variant with lacunar stroke and Hp2 with large-artery atherosclerotic stroke.
Hypothesis:
Our aim was to scrutinize previous associations to stroke subtypes and, further, to test association of Hp variants with the extent of white matter lesions (WML) and incidence of cardiovascular death after first-ever ischemic stroke.
Methods:
Hp was genotyped by PCR and gel electrophoresis in Helsinki Stroke Aging Memory Study (SAM, n=378 with DNA) and Cardiovascular diseases -subcohort of Health 2000 Survey (n=1426), who served as population controls.
Results:
Hp genotype frequencies were 15.6% (Hp1-1), 44.2% (Hp1-2) and 40.2% (Hp2-2), within Hardy-Weinberg equilibrium and equal to those described in other Caucasian populations. There were no significant differences in Hp genotypes between stroke subtypes classified according to TOAST within SAM or compared to population controls. Hp alleles did not associate with the extent of WML. In follow-up, the carriers of Hp2 allele (Hp1-2 and Hp2-2) had substantially higher rate of cardiac deaths (24.5% vs 8.5%, P=0.006) and a trend towards more fatal strokes (23.5% vs 13.6%, P=0.122). The combined risk of ischemic cardiovascular death was 2.4-fold increased in Hp2 carriers (95%CI 1.28-4.43) even after adjustment for major cardiovascular risk factors (age, gender, hypertension, diabetes, atrial fibrillation, smoking, high LDL cholesterol).
Conclusions:
Hp2 allele is associated with increased risk of ischemic cardiovascular death after first-ever ischemic stroke. This may result from the impaired capacity of Hp2-containing protein isoforms to alleviate oxidative stress in the vasculopathic arterial tree.
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Affiliation(s)
- Petra Ijas
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Susanna Melkas
- Dept of Clinical Neurosciences, Univ of Helsinki, Helsinki, Finland
| | - Jani Saksi
- Rsch Programs Unit, Molecular Neurology, Univ of Helsinki, Helsinki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
| | | | | | - Markku Kaste
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Pekka J Karhunen
- Sch of Medicine, Forensic Medicine, Univ of Tampere, Tampere, Finland
| | - Perttu Lindsberg
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Timo Erkinjuntti
- Dept of Clinical Neurosciences, Univ of Helsinki, Helsinki, Finland
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Melkas S, Curtze S, Sibolt G, Oksala NK, Putaala J, Soinne L, Pohjasvaara T, Kaste M, Karhunen P, Erkinjuntti T. Abstract TMP119: High Homocysteine Level is not Associated With White Matter Changes, Dementia nor Mortality After Ischemic Stroke. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.tmp119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Association between high homocysteine level and cerebral small-vessel disease has been implicated in cross-sectional studies, but results from longitudinal studies have been less clear. The aim of this study was to investigate whether homocysteine level at 3-months poststroke relates to the occurrence of white matter changes (WMC), the surrogate of cerebral small-vessel disease. We also investigated whether it relates to the prognosis after ischemic stroke regarding the risk of dementia at 3-months and mortality in long-term follow-up.
Methods:
A total of 321 consecutive acute ischemic stroke patients aged 55 to 85 were included in the study and followed up to 12 years. Plasma homocysteine level and occurrence of WMC in MRI were measured 3 months poststroke and dementia according to DSM-III was evaluated at the same time.
Findings:
The median homocysteine level was 13.50 μmol/l (interquartile range [IQR] 10.60-18.50 μmol/l). Total of 81 patients (25.2%) had homocysteine level above 18.50 μmol/l. In logistic regression analysis, homocysteine level above 18.50 μmol/l was not associated with severe WMC nor with dementia at 3 months poststroke. In Kaplan-Meier analysis, homocysteine level above 18.50 μmol/l was not associated with survival in 12-year follow-up. For further analysis, the group was divided in quartiles according to homocysteine level. The quartiles did not differ in occurrence of severe WMC at baseline, in the risk of dementia at 3 months, nor in the risk of mortality in 12-year follow-up.
Interpretation:
In our poststroke cohort homocysteine level is not associated with WMC. Further, it does not relate to impaired prognosis manifested as dementia at 3 months or mortality in 12-year follow-up.
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Affiliation(s)
| | - Sami Curtze
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Gerli Sibolt
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Niku K Oksala
- Div of Vascular Surgery, Dept of Surgery, Tampere Univ Hosp, Tampere, Finland
| | - Jukka Putaala
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Lauri Soinne
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | | | - Markku Kaste
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
| | - Pekka Karhunen
- Dept of Forensic Medicine, Sch of Medicine,, Tampere Univ Hosp, Tampere Univ, Tampere, Finland
| | - Timo Erkinjuntti
- Dept of Neurology, Helsinki Univ Central Hosp, Helsinki, Finland
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Sibolt G, Curtze S, Melkas S, Pohjasvaara T, Kaste M, Karhunen PJ, Oksala NKJ, Erkinjuntti T. Severe cerebral white matter lesions in ischemic stroke patients are associated with less time spent at home and early institutionalization. Int J Stroke 2015; 10:1192-6. [PMID: 26487377 DOI: 10.1111/ijs.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/24/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Cerebral white matter lesions are one imaging surrogate for cerebral small vessel disease. These white matter lesions are associated with increased morbidity and mortality in both the general population and ischemic stroke patients. AIMS To investigate whether severe white matter lesions in a cohort of ischemic stroke patients are associated with fewer days spent at home and earlier permanent institutionalization. METHODS We included 391 consecutive patients aged 55-85 years with ischemic stroke admitted to the Helsinki University Central Hospital (the Stroke Aging Memory cohort) with a 21-year follow-up. Hospitalization and nursing home admissions were reviewed from national registers.white matter lesions were rated using magnetic resonance imaging performed three-months poststroke, dichotomized as none-to-moderate and severe. Kaplan-Meier plots log-rank and binary logistic regression (odds ratio) and Cox multivariable proportional hazards model were used to study the association of white matter lesions with days spent at home and the time of permanent institutionalization. Hazards and odds ratio with their 95% confidence intervals are reported. RESULTS Severe white matter lesions were associated with fewer days spent at home, and more frequent, and earlier permanent institutionalization (1487 vs. 2354 days; log-rank P < 0·001).After adjusting for significant covariates from univariable analyses, severe white matter lesions were associated with fewer days spent at home (odds ratio 1·62; confidence interval 1·16-2·25), permanent institutionalization within five-years (odds ratio 2·29; confidence interval 1·23-4·29), and increased hazards ratio of permanent institutionalization during 21 years of follow-up (1·64; confidence interval 1·119-2·26). CONCLUSIONS After ischemic stroke, patients with severe white matter lesions spend fewer days at home and become permanently institutionalized earlier, especially within the first five-years.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Susanna Melkas
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Tarja Pohjasvaara
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Markku Kaste
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka J Karhunen
- School of Medicine, University of Tampere, Tampere, Finland.,FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland
| | - Niku K J Oksala
- School of Medicine, University of Tampere, Tampere, Finland.,FimLab Laboratories Ltd, Tampere University Hospital Region, Tampere, Finland.,Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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Maestrini I, Strbian D, Gautier S, Haapaniemi E, Moulin S, Sairanen T, Dequatre-Ponchelle N, Sibolt G, Cordonnier C, Melkas S, Leys D, Tatlisumak T, Bordet R. Higher neutrophil counts before thrombolysis for cerebral ischemia predict worse outcomes. Neurology 2015; 85:1408-16. [PMID: 26362283 DOI: 10.1212/wnl.0000000000002029] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/11/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether higher neutrophil counts before IV recombinant tissue plasminogen activator (rtPA) administration in ischemic stroke (IS) patients are associated with symptomatic intracerebral hemorrhages (sICH) and worse outcomes at 3 months. METHODS Blood samples for leukocyte, neutrophil, and lymphocyte counts were drawn before IV rtPA administration in IS patients included in the cohorts of Lille and Helsinki. The primary endpoint was sICH (European Cooperative Acute Stroke-II definition). Secondary endpoints were death and excellent (modified Rankin Scale [mRS] score 0-1 or equal to prestroke mRS) and good (mRS score 0-2 or equal to prestroke mRS) outcomes at 3 months. RESULTS We included 846 patients (median age 71 years; 50.8% men). The neutrophil count and neutrophil to lymphocyte ratio (NLR) were independently associated with the 4 endpoints: sICH (adjusted odds ratio [adjOR] for an increase of 1,000 neutrophils = 1.21 and adjOR 1.11, respectively), death (adjOR 1.16 and adjOR 1.08), and excellent (adjOR 0.87 and adjOR 0.85) and good (adjOR 0.86 and adjOR 0.91) outcomes. The total leukocyte count was not associated with any of the 4 endpoints. The best discriminating factor for sICH was NLR ≥4.80 (sensitivity 66.7%, specificity 71.3%, likelihood ratio 2.32). Patients with NLR ≥4.80 had a 3.71-fold increased risk for sICH (95% confidence interval adjOR: 1.97-6.98) compared to patients with NLR <4.80. CONCLUSIONS Higher neutrophil counts and NLR are independently associated with sICH and worse outcome at 3 months. The identification of mediators of this effect could provide new targets for neuroprotection in patients treated by rtPA.
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Affiliation(s)
- Ilaria Maestrini
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Daniel Strbian
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Sophie Gautier
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Elena Haapaniemi
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Solène Moulin
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Tiina Sairanen
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Nelly Dequatre-Ponchelle
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Gerli Sibolt
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Charlotte Cordonnier
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Susanna Melkas
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Didier Leys
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland.
| | - Turgut Tatlisumak
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
| | - Régis Bordet
- From the Departments of Neurology (I.M., S.G., S. Moulin, N.D.-P., C.C., D.L., R.B.) and Pharmacology (S. Moulin, N.D.-P., C.C., D.L.), INSERM U 1171, University of Lille, UDSL; CHU Lille (S.G., R.B.), France; "Sapienza" University of Rome (I.M.), Italy; and the Department of Neurology (D.S., E.H., T.S., G.S., S. Melkas, T.T.), Helsinki University Central Hospital, Finland
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Curtze S, Haapaniemi E, Melkas S, Mustanoja S, Putaala J, Sairanen T, Sibolt G, Tiainen M, Tatlisumak T, Strbian D. White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage. Stroke 2015; 46:2149-55. [PMID: 26111888 DOI: 10.1161/strokeaha.115.009318] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/04/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral white matter lesions (WMLs), a surrogate for small-vessel disease, are common in patients with stroke and may be related to an increased intracranial bleeding risk after intravenous thrombolysis in acute ischemic stroke. We aimed to investigate the risk of symptomatic intracerebral hemorrhage (sICH) in the presence of WMLs in a large cohort of ischemic stroke patients treated with intravenous thrombolysis. METHODS We included 2485 consecutive patients treated with intravenous thrombolysis at the Helsinki University Central Hospital. WMLs were scored according to 4 previously published computed tomography visual rating scales from all baseline head scans. A sICH was classified according to the European Cooperative Acute Stroke Study II criteria. The associations of sICH with nominal, ordinal, and continuous variables were analyzed in a univariate binary regression model and adjusted in multivariate binary regression models. RESULTS In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables or dichotomized at different cutoff points) were associated with increased risk of sICH. In binary analyses, WML doubled the bleeding risk: the odds ratios of all 4 visual rating scales ranged from 2.22 (95% confidence interval, 1.49-3.30) to 2.70 (1.87-3.90) in univariable and from 2.00 (1.26-3.16) to 2.62 (1.71-4.02) in multivariable analyses. The multivariable-adjusted odds ratio for the association of high load of WMLs with remote parenchymal hemorrhage was 4.11 (2.38-7.10). CONCLUSIONS WMLs visible on computed tomography are associated with a more than doubled risk of sICH in patients treated with intravenous thrombolysis for acute ischemic stroke.
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Affiliation(s)
- Sami Curtze
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
| | - Elena Haapaniemi
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Susanna Melkas
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Satu Mustanoja
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Jukka Putaala
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Tiina Sairanen
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Gerli Sibolt
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Marjaana Tiainen
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Turgut Tatlisumak
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Daniel Strbian
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Department of Neurological Sciences, University of Helsinki, Helsinki, Finland (S.C., E.H., S. Melkas, S. Mustanoja, J.P., T.S., G.S., M.T., T.T., D.S.); Institute of Neuroscience and Physiology, Salhgrenska Academy at University of Gothenburg, Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
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Jokinen H, Melkas S, Ylikoski R, Pohjasvaara T, Kaste M, Erkinjuntti T, Hietanen M. Post-stroke cognitive impairment is common even after successful clinical recovery. Eur J Neurol 2015; 22:1288-94. [DOI: 10.1111/ene.12743] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- H. Jokinen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - S. Melkas
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - R. Ylikoski
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Pohjasvaara
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Kaste
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - T. Erkinjuntti
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - M. Hietanen
- Clinical Neurosciences, Neurology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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Aarnio K, Joensuu H, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, Putaala J. Cancer in Young Adults With Ischemic Stroke. Stroke 2015; 46:1601-6. [DOI: 10.1161/strokeaha.115.008694] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/25/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Karoliina Aarnio
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Heikki Joensuu
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Elena Haapaniemi
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Susanna Melkas
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Markku Kaste
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Turgut Tatlisumak
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
| | - Jukka Putaala
- From the Clinical Neurosciences, Department of Neurology, University of Helsinki and Helsinki University Central Hospital, Finland (K.A., E.H., S.M., M.K., T.T., J.P.); Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland (H.J.); and Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.)
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Curtze S, Melkas S, Sibolt G, Haapaniemi E, Mustanoja S, Putaala J, Sairanen T, Tiainen M, Tatlisumak T, Strbian D. Cerebral computed tomography-graded white matter lesions are associated with worse outcome after thrombolysis in patients with stroke. Stroke 2015; 46:1554-60. [PMID: 25899244 DOI: 10.1161/strokeaha.115.008941] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Compared with other stroke causes, small-vessel disease is associated with better 3-month outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis. Another question is the impact of coexisting cerebral white matter lesions (WMLs; a surrogate marker of small-vessel disease) on outcome, which was addressed in the current study. METHODS We analyzed 2485 consecutive intravenous thrombolysis-treated patients at the Helsinki University Central Hospital, 2001 to 2014. WMLs were scored according to 4 previously published computed tomographic visual rating scales from all baseline head scans. The inter-rater agreement was calculated. The primary outcome measure was shift analysis, and the secondary examined all possible binary cutoffs in the modified Rankin Scale at 3 months. The associations of modified Rankin Scale with nominal, ordinal, and continuous variables were analyzed in univariate and adjusted in multivariate binary and ordinal regression (shift analysis) models. RESULTS In univariate and multivariate regression analyses, all 4 tested visual WML rating scales (as continuous variables, or dichotomized at different cutoff points) were associated with worse outcome at all binary levels and in shift analyses of the modified Rankin Scale. After adjusting for confounders, the statistically strongest association in shift analyses remained for the Blennow scale dichotomized at >3 points, reflecting at least moderate WMLs (odds ratio, 1.90; 95% confidence interval, 1.48-2.44). CONCLUSIONS WMLs on admission computed tomographic scan are independently associated with worse outcome in intravenous thrombolysis-treated patients with stroke.
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Affiliation(s)
- Sami Curtze
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.
| | - Susanna Melkas
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Gerli Sibolt
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Elena Haapaniemi
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Satu Mustanoja
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Jukka Putaala
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Tiina Sairanen
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Daniel Strbian
- From the Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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Melkas S, Harno H, Pälvimäki E, Siironen J. [Postpartum cerebral sinus thrombosis leading to death of a young woman]. Duodecim 2015; 131:680-683. [PMID: 26233987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Of all cerebral sinus thromboses, 5 to 20% occur in connection with pregnancy or childbirth, or during the puerperium. The risk is highest during the first month following delivery. Approximately half of the women developing sinus thrombosis possess several concomitant risk factors predisposing to venous thrombosis, and about a fifth of them have a trombophilic disorder. We describe a postpartum cerebral sinus thrombosis leading with the associated complications to the patient's death. The patient was afterwards shown to possess the most common factor predisposing to venous thrombosis, the factor V Leiden mutation.
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Aarnio K, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, Putaala J. Long-Term Mortality After First-Ever and Recurrent Stroke in Young Adults. Stroke 2014; 45:2670-6. [DOI: 10.1161/strokeaha.114.005648] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Karoliina Aarnio
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Elena Haapaniemi
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Susanna Melkas
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Markku Kaste
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Putaala
- From the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Melkas S, Jokinen H, Hietanen M, Erkinjuntti T. Poststroke cognitive impairment and dementia: prevalence, diagnosis, and treatment. Degener Neurol Neuromuscul Dis 2014; 4:21-27. [PMID: 32669898 PMCID: PMC7337160 DOI: 10.2147/dnnd.s37353] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 11/26/2013] [Indexed: 12/21/2022] Open
Abstract
Three aspects of poststroke cognitive impairment and dementia are discussed in this review: prevalence; diagnosis; and treatment. The aim is to increase awareness of poststroke cognitive impairment in order to further stimulate strategies to recognize the condition and to prevent its progression. Approximately two-thirds of all middle-aged and elderly stroke patients develop cognitive impairment, and one in three develops dementia. The standard reference for diagnosis is a detailed neuropsychological examination. Short screening tests have been used for both clinical and research purposes, but their sensitivity is limited and there is no consensus as to which test is the most appropriate. The treatment of poststroke cognitive impairment and dementia is based on effective treatment of vascular risk factors, including lifestyle modification when needed.
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Affiliation(s)
- Susanna Melkas
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Hanna Jokinen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Marja Hietanen
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
| | - Timo Erkinjuntti
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland
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Sibolt G, Curtze S, Melkas S, Pohjasvaara T, Kaste M, Karhunen PJ, Oksala NKJ, Vataja R, Erkinjuntti T. Post-stroke depression and depression-executive dysfunction syndrome are associated with recurrence of ischaemic stroke. Cerebrovasc Dis 2013; 36:336-43. [PMID: 24193249 DOI: 10.1159/000355145] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/16/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence. METHODS We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ(2), Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia). RESULTS The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke. CONCLUSIONS Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Sibolt G, Curtze S, Melkas S, Putaala J, Pohjasvaara T, Kaste M, Karhunen PJ, Oksala NKJ, Erkinjuntti T. Poststroke dementia is associated with recurrent ischaemic stroke. J Neurol Neurosurg Psychiatry 2013; 84:722-6. [PMID: 23418214 DOI: 10.1136/jnnp-2012-304084] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up. METHODS We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and PSD on survival free of recurrent stroke were estimated using Kaplan-Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models. RESULTS In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p<0.001). This finding was replicated in patients with first-ever stroke (6.89 years, 5.85 to 7.93 vs 9.68 years, 9.12 to 10.24; p<0.001). In Cox univariate analysis, PSD was associated with increased risk for recurrent stroke both in the entire cohort (HR 2.02; 95% CI 1.47 to 2.77) and in those with first-ever stroke (2.40; 1.68 to 3.42). After adjustment for the significant covariates of age, atrial fibrillation, peripheral arterial disease and hypertension, PSD was associated with increased risk for recurrent stroke both in the entire cohort (1.84; 1.34 to 2.54) and in those with first-ever stroke (2.16; 1.51 to 3.10). CONCLUSIONS Poststroke dementia predicts recurrence of ischaemic stroke in long-term follow-up and should be considered when estimating prognosis.
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Affiliation(s)
- Gerli Sibolt
- Department of Neurology, Helsinki University Central Hospital, P.O. Box 340 (Haartmaninkatu 4), , Helsinki 00029 HUS, Finland.
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Ojala-Oksala J, Jokinen H, Kopsi V, Lehtonen K, Luukkonen L, Paukkunen A, Seeck L, Melkas S, Pohjasvaara T, Karhunen P, Hietanen M, Erkinjuntti T, Oksala N. Educational history is an independent predictor of cognitive deficits and long-term survival in postacute patients with mild to moderate ischemic stroke. Stroke 2012; 43:2931-5. [PMID: 22935400 DOI: 10.1161/strokeaha.112.667618] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke cognitive decline and white matter lesions (WML) are related to poor poststroke survival. Whether cognitive reserve as reflected by educational history associates with cognitive decline, recurrent strokes, and poststroke mortality independent of WML is not known. METHODS A total of 486 consecutive acute mild/moderate ischemic stroke patients subjected to comprehensive neuropsychological assessment (n=409) and magnetic resonance imaging (n=395) 3 months poststroke were included in the study and followed-up for up to 12 years. Odds ratios (OR) for logistic and hazard ratios for Cox regression analyses are reported (OR and hazard ratio≤1 indicates a beneficial effect). RESULTS Long educational history (per tertile) was associated with lower frequency of executive dysfunction in models adjusted for age, sex, marital status, and stroke severity (OR, 0.75; P<0.05) but not when adding WML as a covariate. In contrast, educational history was independently associated with less memory impairment (OR, 0.67; P<0.01), aphasia (OR, 0.69; P<0.05), visuospatial and constructive deficits (OR, 0.70; P<0.05), Mini-Mental State Examination score<25 (OR, 0.53; P<0.0001), and dementia (OR, 0.66; P<0.01). In Cox regression analysis, educational history was not associated with recurrent strokes, but it associated independently with favorable poststroke survival (hazard ratio, 0.86; P<0.05). CONCLUSIONS Long educational history associates with less poststroke cognitive deficits, dementia, and favorable long-term survival independent of age, gender, marital status, stroke severity, and WML in patients with mild/moderate ischemic stroke. This supports the hypothesis that educational history as a proxy indicator of cognitive reserve protects against deficits induced by acute stroke.
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Affiliation(s)
- Johanna Ojala-Oksala
- School of Medicine, University of Tampere and Tampere University Hospital, Department of Surgery, Tampere, Finland
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Melkas S, Laurila JV, Vataja R, Oksala N, Jokinen H, Pohjasvaara T, Leppävuori A, Kaste M, Karhunen PJ, Erkinjuntti T. Post-stroke delirium in relation to dementia and long-term mortality. Int J Geriatr Psychiatry 2012; 27:401-8. [PMID: 21560162 DOI: 10.1002/gps.2733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/22/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account. METHODS The study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria. FINDINGS Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival. INTERPRETATION In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.
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Affiliation(s)
- Susanna Melkas
- Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.
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Melkas S, Sibolt G, Oksala N, Putaala J, Pohjasvaara T, Kaste M, Karhunen P, Erkinjuntti T. Extensive White Matter Changes Predict Stroke Recurrence up to 5 Years after a First-Ever Ischemic Stroke. Cerebrovasc Dis 2012; 34:191-8. [DOI: 10.1159/000341404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/25/2012] [Indexed: 11/19/2022] Open
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Melkas S, Putaala J, Oksala NKJ, Pohjasvaara T, Oksala A, Kaste M, Karhunen PJ, Erkinjuntti T. Small-vessel disease relates to poor poststroke survival in a 12-year follow-up. Neurology 2011; 76:734-9. [PMID: 21339501 DOI: 10.1212/wnl.0b013e31820db666] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to compare ultra-long-term poststroke survival in small-vessel disease (SVD) vs non-SVD subtype of stroke. METHODS We followed patients hospitalized with acute ischemic stroke (age 55-85) for 12 years. The diagnosis of SVD was based on the criteria of Trial of Org 10172 in Acute Stroke Treatment. A detailed medical history regarding the relevant risk factors was obtained. Stroke severity was assessed with the modified Rankin Scale (mRS) at 3 months. Influence of the SVD subtype of stroke was analyzed using Kaplan-Meier log-rank analysis with endpoint all-cause death, and Cox regression proportional hazards model was constructed for multivariate analysis. The association between SVD and causes of death (cardiac, brain-related, all other) was analyzed using Kaplan-Meier log-rank analysis. RESULTS Of the 486 patients, stroke etiology was SVD in 63 patients (13.0%). Median survival was 4.3 years for SVD and 7.9 years for non-SVD (p ≤ 0.001). In the stepwise Cox regression analysis adjusted for relevant confounders, independent predictors of death were SVD (hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.06-2.41), advanced age (HR 1.07, 95% CI 1.05-1.09), stroke severity (mRS 3-5 vs 1-2; HR 2.02, 95% CI 1.58-2.58), smoking (HR 1.44, 95% CI 1.10-1.88), and cardiac failure (HR 1.53, 95% CI 1.14-2.06). SVD was associated with cardiac cause of death (p = 0.021). CONCLUSIONS In this well-characterized ischemic stroke cohort of patients aged 55-85 years with a 12-year follow-up, acute index stroke attributable to SVD was associated with poorer long-term survival and higher risk for cardiac death than other stroke subtypes.
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Affiliation(s)
- S Melkas
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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Oksala NKJ, Jokinen H, Melkas S, Oksala A, Pohjasvaara T, Hietanen M, Vataja R, Kaste M, Karhunen PJ, Erkinjuntti T. Cognitive impairment predicts poststroke death in long-term follow-up. J Neurol Neurosurg Psychiatry 2009; 80:1230-5. [PMID: 19620138 DOI: 10.1136/jnnp.2009.174573] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Poststroke global cognitive decline and dementia have been related to poor long-term survival. Whether deficits in specific cognitive domains are associated with long-term survival in patients with ischaemic stroke is not known in detail. METHODS Patients with acute stroke subjected to comprehensive neuropsychological evaluation were included in the study (n = 409) and followed up for up to 12 years. RESULTS In Kaplan-Meier analysis, impairments in following cognitive domains predicted poor poststroke survival (estimated years): executive functions (48.2%) (5.8 vs 10.1 years, p<0.0001), memory (59.9%) (6.8 vs 9.3 years, p = 0.009), language (28.9%) (5.3 vs 8.6 years, p = 0.004) and visuospatial/constructional abilities (55.2%) (5.6 vs 10.1 years, p<0.0001). Low Mini Mental Status Examination (MMSE) <or=25 (30.5%) (4.4 vs 9.3 years, p<0.0001), low education (<6 years) (31.8%) (6.4 vs 8.2 years, p = 0.003) and poor modified Rankin score (39.9%) (3.9 vs 9.7 years, p<0.0001) were also related to poor survival. In Cox regression proportional hazards analyses including age, sex and years of education as covariates, deficits in executive functions (hazard ratio (HR) 1.59, p<0.0001), memory (HR 1.31, p = 0.042), language (HR 1.33, p = 0.036) and visuospatial/constructional abilities (HR 1.82, p<0.0001) were significant predictors of poor poststroke survival. Of these, executive functions (HR 1.33, p = 0.040) as well as visuospatial/constructional abilities (HR 1.53, p = 0.004) remained as significant predictors after addition of MMSE<or=25 and poor modified Rankin score as covariates. Furthermore, cognitive impairment no dementia (CIND) was also an independent predictor of poor poststroke survival (HR 1.63, p = 0.0123). CONCLUSIONS In patients with ischaemic stroke, cognitive impairment, particularly in executive functions, and visuospatial/constructional abilities relate to poor survival.
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Affiliation(s)
- N K J Oksala
- Department of Surgery and Forensic Medicine, Medical School, University of Tampere and Tampere University Hospital, 33014 University of Tampere, Finland.
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Melkas S, Oksala NKJ, Jokinen H, Pohjasvaara T, Vataja R, Oksala A, Kaste M, Karhunen PJ, Erkinjuntti T. Poststroke dementia predicts poor survival in long-term follow-up: influence of prestroke cognitive decline and previous stroke. J Neurol Neurosurg Psychiatry 2009; 80:865-70. [PMID: 19240049 DOI: 10.1136/jnnp.2008.166603] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aim of this study was to investigate the influence of poststroke dementia on long-term survival after acute stroke and also to assess the possible influence of prestroke cognitive decline and previous stroke on this relationship. METHODS A total of 451 consecutive patients with acute ischaemic stroke admitted to hospital were included in the study and followed up for 12 years. Dementia was diagnosed 3 months after stroke in 115 patients (25.5%). RESULTS In Kaplan-Meier analysis, poststroke dementia predicted poor long-term survival (5.1 years vs 8.8 years in patients who did not have poststroke dementia; p<0.001). Prestroke cognitive decline had a negative influence on survival in patients with poststroke dementia (3.8 years vs 5.8 years; p<0.001); however, previous stroke did not affect survival in these patients (p = 0.676). In stepwise Cox regression proportional hazards analysis adjusted for significant covariates, poststroke dementia (hazard ratio (HR) 1.53; p = 0.003), advanced age (HR 1.07; p<0.001), severity of stroke (HR 1.91; p<0.001), smoking (HR 1.35; p = 0.035), cardiac failure (HR 1.61; p = 0.003) and atrial fibrillation (HR 1.89; p = 0.035) were all independent predictors of poor long-term survival. Poststroke dementia (HR 2.33; p<0.001), advanced age (HR 1.07; p<0.001) and poor Rankin score (HR 2.15; p = 0.001) were associated with death from brain-related causes, including infarction, haemorrhage and dementia. CONCLUSIONS Long-term follow-up of our large well-defined poststroke cohort indicated that in patients with acute stroke, dementia is a significant predictor of poor long-term survival and death from brain-associated causes. Prestroke cognitive decline seems to have an additional negative influence on survival, but previous stroke does not seem to affect survival.
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Affiliation(s)
- S Melkas
- Department of Neurology, Helsinki University Central Hospital, POB 300, 00029 HUS, Finland.
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Melkas S, Svartengren K, Nordqvist E, Carlstedt-Duke B, Svartengren M. [High exposure to respiratory tract irritants when identifying tsunami victims. 7 out of 10 forensic team members from Stockholm suffered of respiratory problems]. Lakartidningen 2008; 105:1296-1299. [PMID: 18561532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Susanna Melkas
- Arbets- och miljömedicin, Stockholms läns landsting, Karolinska institutet, Stockholm
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