Journal articles on the topic 'Cerebrovascular disease – Patients – Longitudinal studies'
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Chong, Joanna Su Xian, Hyemin Jang, Hee Jin Kim, Kwun Kei Ng, Duk L. Na, Jae Hong Lee, Sang Won Seo, and Juan Zhou. "Amyloid and cerebrovascular burden divergently influence brain functional network changes over time." Neurology 93, no. 16 (September 11, 2019): e1514-e1525. http://dx.doi.org/10.1212/wnl.0000000000008315.
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ObjectiveTo examine the effects of baseline Alzheimer disease and cerebrovascular disease markers on longitudinal default mode network (DMN) and executive control network (ECN) functional connectivity (FC) changes in mild cognitive impairment (MCI).MethodsWe studied 30 patients with amnestic MCI (aMCI) and 55 patients with subcortical vascular MCI (svMCI) with baseline Pittsburgh Compound B (PiB)–PET scans and longitudinal MRI scans. Participants were followed up clinically with annual MRI for up to 4 years (aMCI: 26 with 2 timepoints, 4 with 3 timepoints; svMCI: 13 with 2 timepoints, 16 with 3 timepoints, 26 with 4 timepoints).Resultsβ-Amyloid (Aβ) burden was associated with longitudinal DMN FC declines, while cerebrovascular burden was associated with longitudinal ECN FC changes. When patients were divided into PiB+ and PiB− groups, PiB+ patients showed longitudinal DMN FC declines, while patients with svMCI showed longitudinal ECN FC increases. Direct comparisons between the 2 groups without mixed pathology (aMCI PiB+ and svMCI PiB−) recapitulated this divergent pattern: aMCI PiB+ patients showed steeper longitudinal DMN FC declines, while svMCI PiB− patients showed steeper longitudinal ECN FC increases. Finally, using baseline PiB uptake and lacune numbers as continuous variables, baseline PiB uptake showed inverse U-shape associations with longitudinal DMN FC changes in both MCI subtypes, while baseline lacune numbers showed mainly inverse U-shape relationships with longitudinal ECN FC changes in patients with svMCI.ConclusionsOur findings underscore the divergent effects of Aβ and cerebrovascular burden on longitudinal FC changes in the DMN and ECN in the predementia stage, which reflect the underlying pathology and may be used to track early changes in Alzheimer disease and cerebrovascular disease.
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Swanwick, Gregory RJ, Michael Kirby, Robert F. Coen, Conor P. Maguire, Desmond O'Neill, Bernard J. Walsh, Davis Coakley, and Brian A. Lawlor. "Effects of co-existent cerebrovascular disease on rate of progression in Alzheimer's disease." Irish Journal of Psychological Medicine 13, no. 3 (September 1996): 91–94. http://dx.doi.org/10.1017/s0790966700002615.
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AbstractObjective: The aim of this study was to determine whether patients with possible Alzheimer's disease (AD) who do not meet criteria for vascular dementia but who nonetheless have clinical or radiographic evidence of cerebrovascular disease (CVD), differ in presentation or rate of progression from patients with probable AD.Method: Baseline cognitive and functional scores were obtained from 154 patients who had either possible or probable AD. Repeat data after a 12 month interval were obtained on 73 of these patients. Baseline data and rates of progression were compared for probable AD patients and possible AD patients with evidence of co-existent CVD.Results: The diagnostic groups did not differ at baseline with a mean mini-mental state examination (MMSE) score of 18.1. Comparison of the longitudinal data showed a mean annual drop of 4.1 points on the MMSE in both groups.Conclusions: The patients with and without evidence of co-existent CVD did not differ either at baseline or prognostically suggesting that evidence of CVD does not affect the rate of progression in AD. However, further longitudinal studies using neuropathological criteria are warranted to determine whether such data can be interpreted in favour of including possible AD cases in clinical trials of probable AD.
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Lahti, M., J. Tiihonen, H. Wildgust, M. Beary, R. Hodgson, E. Kajantie, C. Osmond, K. Räikkönen, and J. Eriksson. "Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia." Psychological Medicine 42, no. 11 (March 12, 2012): 2275–85. http://dx.doi.org/10.1017/s0033291712000396.
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BackgroundPatients with schizophrenia have excess cardiovascular morbidity and mortality. Previous studies suggest that this may be partly due to inadequate somatic treatment and care, such as non-optimal use of lipid-lowering and antihypertensive pharmacotherapy, but longitudinal studies on such aetiological pathways are scarce.MethodWe investigated the use of lipid-lowering and antihypertensive pharmacotherapy, and the risk of hospitalization for and death from coronary heart disease and stroke among patients with schizophrenia in a birth cohort of 12 939 subjects (Helsinki Birth Cohort Study). This cohort was followed for over 30 adult years by using national databases on cardio- and cerebrovascular hospitalizations and mortality and on reimbursement entitlements and use of drugs for treatment of hypertension, dyslipidaemia, coronary heart disease and diabetes.ResultsIndividuals with schizophrenia had a higher risk of hospitalization for coronary heart disease [hazard ratio (HR) 1.65, 95% confidence interval (CI) 1.03–2.57], and mortality from this disease was markedly higher (HR 2.92, 95% CI 1.70–5.00), particularly among women (p=0.001 for women, p=0.008 for men). Women with schizophrenia had also marginally increased stroke mortality (p=0.06). However, patients with schizophrenia used less lipid-lowering (odds ratio 0.47, 95% CI 0.27–0.80) and antihypertensive drug treatment (HR 0.37, 95% CI 0.22–0.61).ConclusionsIn this longitudinal study, coronary heart disease morbidity was increased and coronary heart disease mortality markedly increased in patients, especially in women with schizophrenia. These patients nevertheless received less antihypertensive and lipid-lowering treatment.
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Burkauskas, J., P. Lang, A. Bunevičius, J. Neverauskas, M. Bučiūtė-Jankauskienė, and N. Mickuvienė. "Cognitive function in patients with coronary artery disease: A literature review." Journal of International Medical Research 46, no. 10 (August 29, 2018): 4019–31. http://dx.doi.org/10.1177/0300060517751452.
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Objective Cognitive function impairment is a well-documented complication of cerebrovascular disease (CBVD). Less is known about what factors affect the deterioration of cognitive function in patients with coronary artery disease (CAD). The aim of this review is to explore recent studies investigating factors associated with cognitive function in patients with CAD. Methods Studies published from 2010 to 2016 were identified through a systematic search of MEDLINE/PubMed and were included if they addressed factors affecting cognitive function in the CAD population. Results Of the 227 publications identified, 32 were selected for the review. Five factors tentatively affecting cognitive function in patients with CAD were identified: coronary artery bypass grafting (CABG) surgery, apolipoprotein E4 (APOE4) genotype, left ventricular ejection fraction (LVEF), medication use, and various hormones and biomarkers. Conclusion New techniques in CABG surgery have proven to alleviate postoperative cognitive decline. Researchers are still debating the effects of APOE4 genotype, LVEF, and the use of cardiovascular medications on cognitive function. Thyroid hormones and biomarkers are associated with cognitive function, but the exact nature of the association is debatable. Longitudinal studies should clarify those associations. In addition, cross-sectional studies addressing other causes of cognitive decline in patients with CAD are warranted.
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Di Perri, Tullio, Maurizio Guerrini, Franco Laghi Pasini, Angela Acciavatti, Daniela Pieragalli, Cinzia Galigani, Pier Leopoldo Capecchi, Alfredo Orrico, Massimo Franchi, and Patrizia Blardi. "Hemorheological Factors in the Pathophysiology of Acute and Chronic Cerebrovascular Disease." Cephalalgia 5, no. 2_suppl (May 1985): 71–77. http://dx.doi.org/10.1177/03331024850050s212.
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The hemorheologic changes in three groups of patients suffering from acute and chronic cerebrovascular diseases were studied. Firstly, a horizontal study on 57 patients with definite stroke and on 49 patients with TIA was made. Plasma viscosity, whole blood filtration rate, fibrinogen concentration and hematocrit were evaluated as markers of the rheological property of blood. Blood samples were drawn within 6 h from the onset of vascular syndrome. The findings were compared with values obtained in 112 as controls. At the same time, washed red cell filtration rate, together with lactoferrin, betaglucuronidase and beta-thromboglobulin plasma level were assayed. In both groups the onset of the vascular storm was associated with a marked increase of plasma fibrinogen and of blood and plasma viscosity and a significant decrease of whole blood filterability. Lactoferrin, betaglucuronidase and beta-thromboglobulin levels were also significantly increased. Following this, a longitudinal study was performed on 27 patients with definite stroke and 32 patients with TIA. The clinical regression of acute stroke was associated with the progressive reduction of rheological abnormalities. Finally, 81 patients with clinical diagnosis of cerebrovascular disease due to previous stroke or repeated TIA were studied together. An increase of blood viscosity, of fibrinogen concentration and of hematocrit and a decrease of blood filtration rate together with higher levels of beta-thromboglobulin were registered. These results confirm the existence of an association between CVD and hemorheological alterations and suggest more in depth research directed towards identifying the significance of these alterations in the pathogenesis of tissue ischemia. They also serve to introduce a rationale for the pharmacological and therapeutical corrections of these syndromes.
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Solmi, M., N. Veronese, B. Beatrice, R. Stella, S. Paolo, G. Davide, E. Collantoni, et al. "Prevalence, incidence and comparative meta-analysis of all-cause and specific-cause cardiovascular disease in patients with serious mental illness." European Psychiatry 41, S1 (April 2017): S319—S320. http://dx.doi.org/10.1016/j.eurpsy.2017.02.238.
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Patients with severe mental illness (SMI) have been described at higher risk of cardiovascular disease (CVD). The aim of this systematic review and meta-analysis was to quantify prevalence, incidence, cross-sectional association and longitudinal increased risk of coronary heart disease (CHD), stroke, transient ischemic attack and cerebrovascular disease (CBVD), heart failure (HF), peripheral vascular disease (PVD), death due to CVD, and any CVD in patients with SMI. We included 92 studies, with a total population of 3,371,461 patients (BD = 241,226, MDD = 476,102, SCZ = 1,721,586, SMI = 932,547) and 113,925,577 controls. Pooled prevalence of any CVD in SMI was 9.9% (95% CI = 7.4–13.3) (33 studies, 360,144 patients). Compared to controls, after adjusting for a median of 7 confounders, SMI was associated with higher risk of CVD in cross-sectional studies, OR:1.53 (95% CI = 1.27–1.83) (11 studies), with CHD OR: 1.51 (95% CI = 1.47–1.55) (5 studies), with CBVD OR: 1.42 (95% CI = 1.21–1.66) (6 studies), and tended to be associated with HF OR: 1.28 (95% CI = 0.99–1.65) (4 studies). Cumulative incidence was 3.6 CVD events in a median follow-up period of 8.4 years (range: 1.76–30). After considering a median of 6 confounders, SMI was associated with higher longitudinal risk of CVD in longitudinal studies HR: 1.78 (95% CI = 1.6, 1.98) (31 studies), of CHD: HR: 1.54 (95% CI 1.30–1.82) (18 studies), of CBVD HR: 1.64 (95% CI 1.26–2.14) (11 studies), of HF HR:2.10 (95% CI 1.64–2.70) (2 studies), of PVD, unadjusted RR: 3.11 (95% CI 2.46–3.91) (3 studies), of death due to CVD, HR 1.85 (95% CI 1.53–2.24) (16 studies). In this meta-analysis, the association between SMI and CVD has been quantified in a world representative sample; we suggest prevention of CVD should be warranted as standard care in SMI.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Gong, Xin, Xiaoli Wang, Tianxing Shi, Jianwei Shi, Wenya Yu, Liang Zhou, Ning Chen, Jiaoling Huang, and Zhaoxin Wang. "Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016–2018." BMJ Open 10, no. 11 (November 2020): e040878. http://dx.doi.org/10.1136/bmjopen-2020-040878.
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ObjectivesThis study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed.SettingWe extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre.ParticipantsOur data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong.ResultsWe found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits—a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age.ConclusionsDifferent from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.
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Sánchez Muñoz-Torrero, Juan F., Guillermo Escudero-Sánchez, Julián F. Calderón-García, Sergio Rico-Martín, Nicolás Roberto Robles, M. Asunción Bacaicoa, José N. Alcalá-Pedrajas, Guadalupe Gil-Fernández, and Manuel Monreal. "Systolic Blood Pressure and Outcomes in Stable Outpatients with Recent Symptomatic Artery Disease: A Population-Based Longitudinal Study." International Journal of Environmental Research and Public Health 18, no. 17 (September 4, 2021): 9348. http://dx.doi.org/10.3390/ijerph18179348.
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Objectives: The most appropriate targets for systolic blood pressure (SBP) levels to reduce cardiovascular morbidity and mortality in patients with symptomatic artery disease remain controversial. We compared the rate of subsequent ischemic events or death according to mean SBP levels during follow-up. Design: Prospective cohort study. FRENA is an ongoing registry of stable outpatients with symptomatic coronary (CAD), cerebrovascular (CVD) or peripheral artery disease (PAD). Setting: 24 Spanish hospitals. Participants: 4789 stable outpatients with vascular disease. Results: As of June 2017, 4789 patients had been enrolled in different Spanish centres. Of these, 1722 (36%) had CAD, 1383 (29%) CVD and 1684 (35%) PAD. Over a mean follow-up of 18 months, 136 patients suffered subsequent myocardial infarction, 125 had ischemic stroke, 74 underwent limb amputation, and 260 died. On multivariable analysis, CVD patients with mean SBP levels 130–140 mm Hg had a lower risk of mortality than those with levels <130 mm Hg (hazard ratio (HR): 0.39; 95% CI: 0.20–0.77), as did those with levels >140 mm Hg (HR: 0.46; 95% CI: 0.26–0.84). PAD patients with mean SBP levels >140 mm Hg had a lower risk for subsequent ischemic events (HR: 0.57; 95% CI: 0.39–0.83) and those with levels 130–140 mm Hg (HR: 0.47; 95% CI: 0.29–0.78) or >140 mm Hg (HR: 0.32; 95% CI: 0.21–0.50) had a lower risk of mortality. We found no differences in patients with CAD. Conclusions: In this real-world cohort of symptomatic arterial disease patients, most of whom are not eligible for clinical trials, the risk of subsequent events and death varies according to the levels of SBP and the location of previous events. Especially among patients with large artery atherosclerosis, PAD or CVD, SBP <130 mm Hg may result in increased mortality. Due to potential factors in this issue, Prospective, well designed studies are warranted to confirm these observational data.
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Wang, Chung-Yuan, Hong-Hsi Hsien, Kuo-Wei Hung, Hsiu-Fen Lin, Hung-Yi Chiou, Shu-Chuan Jennifer Yeh, Yu-Jo Yeh, and Hon-Yi Shi. "Multidiscipline Stroke Post-Acute Care Transfer System: Propensity-Score-Based Comparison of Functional Status." Journal of Clinical Medicine 8, no. 8 (August 16, 2019): 1233. http://dx.doi.org/10.3390/jcm8081233.
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Few studies have investigated the characteristics of stroke inpatients after post-acute care (PAC) rehabilitation, and few studies have applied propensity score matching (PSM) in a natural experimental design to examine the longitudinal impacts of a medical referral system on functional status. This study coupled a natural experimental design with PSM to assess the impact of a medical referral system in stroke patients and to examine the longitudinal effects of the system on functional status. The intervention was a hospital-based, function oriented, 12-week to 1-year rehabilitative PAC intervention for patients with cerebrovascular diseases. The average duration of PAC in the intra-hospital transfer group (31.52 days) was significantly shorter than that in the inter-hospital transfer group (37.1 days) (p < 0.001). The intra-hospital transfer group also had better functional outcomes. The training effect was larger in patients with moderate disability (Modified Rankin Scale, MRS = 3) and moderately severe disability (MRS = 4) compared to patients with slight disability (MRS = 2). Intensive post-stroke rehabilitative care delivered by per-diem payment is effective in terms of improving functional status. To construct a vertically integrated medical system, strengthening the qualified local hospitals with PAC wards, accelerating the inter-hospital transfer, and offering sufficient intensive rehabilitative PAC days are the most essential requirements.
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Yeh, Wen-Shuo, Shih-Cheng Yang, Chih-Ming Liang, Yu-Chi Li, Wei-Chen Tai, Chen-Hsiang Lee, Yao-Hsu Yang, et al. "The Role of Non-Selective β-Blockers in Compensated Cirrhotic Patients without Major Complications." Medicina 56, no. 1 (December 30, 2019): 14. http://dx.doi.org/10.3390/medicina56010014.
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Background and Objectives: Non-selective β-blockers (NSBB) could prevent decompensation and hepatocellular carcinoma (HCC) in cirrhotic patients with clinically significant portal hypertension (CSPH), but remained uncertain for compensated cirrhotic patients without major complications. We aimed to compare the clinical outcomes between propranolol users and non-users of a CC group without major complications. Material and Methods: We conducted this population-based cohort study by using the Taiwanese Longitudinal Health Insurance Database 2000. Propranolol users (classified as cumulative defined daily dose (cDDD)) and non-PPL users were matched with a 1:1 propensity score in both cohorts. Results: This study comprised 6896 propranolol users and 6896 non-propranolol users. There was no significant impact on the development of spontaneous bacterial peritonitis between the two groups (aHR: 1.24, 95% confidence interval (CI): 0.88~1.75; p = 0.2111). Male gender, aged condition, and non-liver related diseases (peripheral vascular disease, cerebrovascular disease, dementia, pulmonary disease, and renal disease) were the independent risk factors of mortality. PPL users had significantly lower incidence of HCC development than non-users (aHR: 0.81, p = 0.0580; aHR: 0.80, p = 0.1588; and aHR: 0.49, p < 0.0001 in the groups of 1–28, 29–90, and >90 cDDD, respectively). Conclusion: The current study suggested that high cumulative doses of propranolol could decrease the risk of hepatocellular carcinoma among compensated cirrhotic patients without major complications. Further large-scale prospective studies are still required to confirm the findings in this study. Results: It remained uncertain whether non-selective β-blockers (NSBB) could prevent decompensation and hepatocellular carcinoma (HCC) in compensatory cirrhotic patients without major complications. This study aimed to compare the clinical outcomes between propranolol users and non-users of the CC group without major complications.
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Son, Youn-Jung, Chanhee Park, and Mi Won. "Impact of Physical Activity and Sleep Duration on Depressive Symptoms in Hypertensive Patients: Results from a Nationally Representative Korean Sample." International Journal of Environmental Research and Public Health 15, no. 12 (November 22, 2018): 2611. http://dx.doi.org/10.3390/ijerph15122611.
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Depressive symptoms among individuals with hypertension may increase the risk of cardio-cerebrovascular disease, disease burden, and mortality. However, few studies have examined the relationships among physical activity, sleep duration, and depressive symptoms. Thus, this cross-sectional study examined the associations of physical activity and sleep duration with depressive symptoms in individuals with hypertension. We analyzed data collected as part of the 2014 Korea National Health and Nutrition Examination Survey, which included 846 patients with hypertension aged 19 or older. The prevalence rate of depressive symptoms was around 11.2%. A logistic regression analysis showed that moderate to vigorous physical activity (odds ratio (OR) = 4.42; 95% confidence interval (CI) = 2.19–8.89) and short (OR = 2.18; 95% CI = 1.11–4.28) and long sleep duration (OR = 4.09; 95% CI = 1.83–9.13) increased the risk of depressive symptoms after adjusting for confounding factors. Additionally, older age and low educational levels were associated with depressive symptoms. Our findings highlight that physical activity and sleep duration should be key components of lifestyle modification among hypertensive patients with depressive symptoms. Further investigation might benefit from validating these findings using a longitudinal design and examining the mediating effects of physical activity and/or sleep duration on the relationship between individual characteristics and depressive symptoms.
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Tarng, Hong I., Lynne Taylor, and Barbara A. Konkle. "Von Willebrand Factor Levels Do Not Increase with Age in Patients with Type 1 Von Willebrand Disease." Blood 104, no. 11 (November 16, 2004): 4028. http://dx.doi.org/10.1182/blood.v104.11.4028.4028.
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Abstract A number of inherited and acquired factors modulate von Willebrand factor antigen (VWF:Ag) levels, including blood type, race, activity and stress level, thyroid hormone status, and, in women, time in menstrual cycle. In reported studies a positive correlation between VWF:Ag and/or factor VIII levels and age has been demonstrated, with an increase of 5 – 6 IU/dL per decade (Conlan MG et al, 1993; Kamphuisen PW et al, 1998). Those studies have primarily assessed VWF and factor VIII as risk factors for ischemic heart disease, cerebrovascular disease, and venous thromboembolism. None of the subjects had von Willebrand disease (VWD). Their VWF:Ag levels were in the higher normal or elevated range. The purpose of this study was to determine whether there is a relationship between age and VWF:Ag level in patients with Type 1 VWD. We collected the data from 36 patients who were diagnosed with type 1 VWD and followed at the Penn Comprehensive Hemophilia and Thrombosis Program up to a period of 13 years (See Table 1 below). For each patient, date of birth, VWF:Ag levels with corresponding test dates were collected by reviewing the medical histories and the lab results. Test results obtained during pregnancy, DDAVP testing, or during prophylaxis or therapy for bleeding control were excluded. One year was set as the observation period, so the adjacent VWF:Ag levels that were tested less than one year were excluded from the dataset. When two test results were available on a patient within a one-year period, the lower test result was used. To investigate whether there was a relationship between VWF:Ag levels and age, cross-sectional analyses (across each visit) and longitudinal analyses were performed using scatter plots, Spearman and Pearson correlations, and regression analysis. No significant increase in VWF:Ag levels with age was demonstrated. The fact that we did not find an increase in VWF:Ag levels over time in our patients could be due to the relatively small number of patients studied or could reflect a subtype of VWD, due to our selection criteria. Only patients with abnormal values were included. Some patients have a prior diagnosis of VWD and bleeding symptoms, but have normal values when tested. Since these patients are adults, this may be due, at least in part, to an age-related increase. Type 1 VWD may occur secondary to decreased VWF synthesis and/or clearance. It is possible that age-related effects on VWF levels will differ depending on the underlying factor(s) resulting in a lower VWF level. Further studies correlating a patient’s values longitudinally with the underlying pathophysiology of their disease would aid in our understanding of their bleeding risks over time. Patient # Age at Last Visit, range (mean) Females (%) Race % (Cauc/AA/Other) VWF:Ag mean 36 17–70 (34) 89 78/19/3 49%
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AJEGANOVA, SOFIA, ULF de FAIRE, TOMAS JOGESTRAND, JOHAN FROSTEGÅRD, and INGIÄLD HAFSTRÖM. "Carotid Atherosclerosis, Disease Measures, Oxidized Low-density Lipoproteins, and Atheroprotective Natural Antibodies for Cardiovascular Disease in Early Rheumatoid Arthritis — An Inception Cohort Study." Journal of Rheumatology 39, no. 6 (May 15, 2012): 1146–54. http://dx.doi.org/10.3899/jrheum.111334.
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Objective.Although an enhanced risk of cardiovascular disease (CVD) in persons with rheumatoid arthritis (RA) is well established, the mechanisms behind it remain unclear. We studied whether carotid atherosclerosis, RA disease measures, or potential cardiovascular biomarkers influenced the incidence of CVD in an RA inception cohort.Methods.RA disease measures and CVD biomarkers were assessed at 0, 3, 12, 24, and 60 months after disease onset, and carotid ultrasonography after 5 years. The study outcome was incident CVD events — acute myocardial infarction, angina pectoris, congestive heart failure, or ischemic cerebrovascular event. Survival analysis and Cox and longitudinal regressions were used for statistical analyses.Results.A total of 105 patients, without CVD events prior to RA onset, experienced 17 CVD events, an incidence rate of 1.35 events per 100 person-years (95% CI 0.71–2.0). The rate of CVD events did not differ with regard to measures of carotid intima-media thickness, but it was higher for patients with bilateral carotid plaques than for those without (p = 0.012). Improvement in Disease Activity Score for 28 joints, visual analog scale for pain, and Stanford Health Assessment Questionnaire score over the first year, as well as usage of methotrexate (MTX), was associated, independent of age, with reduction of risk of CVD event [hazard ratios 0.68 (95% CI 0.5–0.97), 0.97 (95% CI 0.95–0.99), 0.35 (95% CI 0.15–0.82), and 0.34 (95% CI 0.12–0.91), respectively]. In longitudinal analyses, increasing oxidized low-density lipoprotein (oxLDL) and probability for low antiphosphorylcholine antibodies (anti-PC) were observed in those who experienced a subsequent CVD event.Conclusion.Bilateral carotid plaques were associated with poor CVD-free survival. Early reductions of inflammation, pain, and disability as well as MTX usage were associated with better CVD outcome. Elevated oxLDL and low IgM anti-PC levels may link chronic inflammation in RA to enhanced risk of CVD events.
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Baldwin, DS. "Depression and panic: Comorbidity." European Psychiatry 13, S2 (1998): 65s—70s. http://dx.doi.org/10.1016/s0924-9338(98)80016-3.
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SummaryPanic disorder is a common condition. Epidemiological studies throughout the world consistently indicate that the lifetime prevalence of panic disorder (with or without agoraphobia) is between 1.5% and 3.5%. Panic disorder shows substantial comorbidity with other forms of mental illness. Major depressive disorder occurs in 50 to 65% of individuals with panic disorder and there is considerable cross-sectional and longitudinal comorbidity with recurrent brief depression and dysthymia. Phobic anxiety disorders, most notably social phobia and generalised anxiety disorder, commonly occur with panic disorder, especially in individuals with more severe agoraphobia. Approximately 35 to 50% of individuals with panic disorder in community settings also have agoraphobia. Panic disorder also shows significant comorbidity with physical illness. Compared with individuals without or with some other psychiatric diagnosis, patients with panic disorder have an increased risk of suffering from multiple medically unexplained symptoms and are associated with high use of medical services and increased mortality from both cardiovascular and cerebrovascular disease.
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Liu, Natalie, Jen Birstler, Manasa Venkatesh, Lawrence Hanrahan, Guanhua Chen, and Luke Funk. "Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study." Journal of Medical Internet Research 23, no. 8 (August 9, 2021): e24017. http://dx.doi.org/10.2196/24017.
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Background Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Methods US adults aged 18-75 years who had ≥3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index. Results We included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2). Conclusions The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised.
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Boo, Yebeen Ysabelle, Otto-Emil Jutila, Meghan A. Cupp, Logan Manikam, and Sung-Il Cho. "The identification of established modifiable mid-life risk factors for cardiovascular disease which contribute to cognitive decline: Korean Longitudinal Study of Aging (KLoSA)." Aging Clinical and Experimental Research 33, no. 9 (February 4, 2021): 2573–86. http://dx.doi.org/10.1007/s40520-020-01783-x.
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Abstract Introduction We explored how different chronic diseases, risk factors, and protective factors highly associated with cardiovascular diseases (CVD) are associated with dementia or Mild Cognitive Impairment (MCI) in Korean elders, with a focus on those that manifest in mid-life. Methods A CVD-free cohort (n = 4289) from the Korean Longitudinal Study of Aging was selected to perform Cox mixed-effects proportional hazard regressions. Eighteen control variables with strong associations to CVD were chosen as explanatory variables, and Mini-Mental State Examination (MMSE) score cut-off for dementia and MCI were used as outcome variables. Results The statistically significant (P < 0.05) adverse factors that contribute in developing dementia were age (aHR 1.07, 1.05–1.09), Centre for Epidemiological Studies Depression Scale (CESD-10) (aHR 1.17, 1.12–1.23), diagnosis with cerebrovascular disease (aHR 3.73, 1.81–7.66), living with diabetes (aHR 2.30, 1.22–4.35), and living with high blood pressure (HBP) (aHR 2.05, 1.09–3.87). In contrast, the statistically significant protective factors against developing dementia were current alcohol consumption (aHR 0.67, 0.46–0.99), higher educational attainment (aHR 0.36, 0.26–0.56), and regular exercise (aHR 0.37, 0.26–0.51). The factors with a statistically significant adverse association with progression to MCI were age (aHR 1.02, 1.01–1.03) and CESD-10 (aHR 1.17, 1.14–1.19). In contrast, the statistically significant protective factors against developing MCI were BMI (aHR 0.96, 0.94–0.98), higher educational attainment (aHR 0.33, 0.26–0.43), and regular exercise (aHR 0.83, 0.74–0.92). Conclusion In lieu of the protective factor of MCI and dementia, implementing regular exercise routine well before mid-life and cognitive decline is significant, with adjustments made for those suffering from health conditions, so they can continue exercising despite their morbidity. Further attention in diabetes care and management is needed for patients who already show decline in cognitive ability as it is likely that their MCI impacts their ability to manage their existing chronic conditions, which may adversely affect their cognitive ability furthermore.
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Wekker, V., L. van Dammen, A. Koning, K. Y. Heida, R. C. Painter, J. Limpens, J. S. E. Laven, J. E. Roeters van Lennep, T. J. Roseboom, and A. Hoek. "Long-term cardiometabolic disease risk in women with PCOS: a systematic review and meta-analysis." Human Reproduction Update 26, no. 6 (September 30, 2020): 942–60. http://dx.doi.org/10.1093/humupd/dmaa029.
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Abstract BACKGROUND Polycystic ovary syndrome (PCOS) is associated with cardiometabolic disease, but recent systematic reviews and meta-analyses of longitudinal studies that quantify these associations are lacking. OBJECTIVE AND RATIONALE Is PCOS a risk factor for cardiometabolic disease? SEARCH METHODS We searched from inception to September 2019 in MEDLINE and EMBASE using controlled terms (e.g. MESH) and text words for PCOS and cardiometabolic outcomes, including cardiovascular disease (CVD), stroke, myocardial infarction, hypertension (HT), type 2 diabetes (T2D), metabolic syndrome and dyslipidaemia. Cohort studies and case–control studies comparing the prevalence of T2D, HT, fatal or non-fatal CVD and/or lipid concentrations of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) between women with and without PCOS of ≥18 years of age were eligible for this systematic review and meta-analysis. Studies were eligible regardless of the degree to which they adjusted for confounders including obesity. Articles had to be written in English, German or Dutch. Intervention studies, animal studies, conference abstracts, studies with a follow-up duration less than 3 years and studies with less than 10 PCOS cases were excluded. Study selection, quality assessment (Newcastle–Ottawa Scale) and data extraction were performed by two independent researchers. OUTCOMES Of the 5971 identified records, 23 cohort studies were included in the current systematic review. Women with PCOS had increased risks of HT (risk ratio (RR): 1.75, 95% CI 1.42 to 2.15), T2D (RR: 3.00, 95% CI 2.56 to 3.51), a higher serum concentration of TC (mean difference (MD): 7.14 95% CI 1.58 to 12.70 mg/dl), a lower serum concentration of HDL-C (MD: −2.45 95% CI −4.51 to −0.38 mg/dl) and increased risks of non-fatal cerebrovascular disease events (RR: 1.41, 95% CI 1.02 to 1.94) compared to women without PCOS. No differences were found for LDL-C (MD: 3.32 95% CI −4.11 to 10.75 mg/dl), TG (MD 18.53 95% CI −0.58 to 37.64 mg/dl) or coronary disease events (RR: 1.78, 95% CI 0.99 to 3.23). No meta-analyses could be performed for fatal CVD events due to the paucity of mortality data. WIDER IMPLICATIONS Women with PCOS are at increased risk of cardiometabolic disease. This review quantifies this risk, which is important for clinicians to inform patients and to take into account in the cardiovascular risk assessment of women with PCOS. Future clinical trials are needed to assess the ability of cardiometabolic screening and management in women with PCOS to reduce future CVD morbidity.
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Döme, Péter, Péter Kunovszki, Péter Takács, László Fehér, Tamás Balázs, Károly Dede, Siobhán Mulhern-Haughey, Sébastien Barbreau, and Zoltán Rihmer. "Clinical characteristics of treatment-resistant depression in adults in Hungary: Real-world evidence from a 7-year-long retrospective data analysis." PLOS ONE 16, no. 1 (January 20, 2021): e0245510. http://dx.doi.org/10.1371/journal.pone.0245510.
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Purpose Treatment-resistant depression (TRD) is associated with a poor quality of life and high economic burden. This observational retrospective epidemiological study aimed to estimate the proportion of patients with TRD within a cohort of patients with major depressive disorder (MDD) in Hungary and examine the mortality and comorbidities of patients with and without TRD. Patients and methods This study included patients with MDD who experienced onset of a new depressive episode between 01 January 2009 and 31 August 2015, using data from a nationwide, longitudinal database. Results Overall, 99,531 patients were included in the MDD cohort, of which 8,268 (8.3%) also met the criteria for TRD. The overall survival of non-TRD patients was longer than in TRD patients; the risk of mortality for TRD patients was significantly higher than of non-TRD patients (HR [CI] 1.381 [1.212–1.571]; p<0.001). Patients with TRD had a significantly higher probability of having “Neurotic, stress-related and somatoform disordersˮ, autoimmune conditions, cardio- or cerebrovascular diseases, thyroid gland diseases and self-harming behaviour not resulting in death than non-TRD patients (for all comparisons, p values were less than 0.005). Discussion To our best knowledge, this is the first study to assess the frequency of TRD in Hungary. In a cohort of Hungarian MDD patients, we have found that the proportion of TRD (~8.3%) is comparable to those reported in previous studies with similar methodology from other countries. The majority of our other main findings (e.g. more frequent self-harming behaviour, increased risk of “Neurotic, stress-related and somatoform disordersˮ and higher overall mortality in TRD subjects) are also in line with previous results from other countries. Taking the substantial proportion of patients with TRD into consideration, a more comprehensive and targeted treatment strategy would be required for these individuals.
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Peterson, Ingrid, Ntobeko Ntusi, Kondwani Jambo, Christine Kelly, Jacqueline Huwa, Louise Afran, Joseph Kamtchum Tatuene, et al. "Evaluating the reactivation of herpesviruses and inflammation as cardiovascular and cerebrovascular risk factors in antiretroviral therapy initiators in an African HIV-infected population (RHICCA): a protocol for a longitudinal cohort study." BMJ Open 9, no. 9 (September 2019): e025576. http://dx.doi.org/10.1136/bmjopen-2018-025576.
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IntroductionIn Sub-Saharan Africa, the rising rates of cerebrovascular and cardiovascular diseases (CBD/CVD) are intersecting with an ageing HIV-infected population. The widespread use of antiretroviral therapy (ART) may confer an additive risk and may not completely suppress the risk associated with HIV infection. High-quality prospective studies are needed to determine if HIV-infected patients in Africa are at increased risk of CBD/CVD and to identify factors associated with this risk. This study will test the hypothesis that immune activation and dysfunction, driven by HIV and reactivation of latent herpesvirus infections, lead to increased CBD/CVD risk in Malawian adults aged ≥35 years.Methods and analysisWe will conduct a single-centre, 36-month, prospective cohort study in 800 HIV-infected patients initiating ART and 190 HIV-uninfected controls in Blantyre, Malawi. Patients and controls will be recruited from government ART clinics and the community, respectively, and will be frequency-matched by 5-year age band and sex. At baseline and follow-up visits, we will measure carotid intima-media thickness and pulse wave velocity as surrogate markers of vasculopathy, and will be used to estimate CBD/CVD risk. Our primary exposures of interest are cytomegalovirus and varicella zoster reactivation, changes in HIV plasma viral load, and markers of systemic inflammation and endothelial function. Multivariable regression models will be developed to assess the study’s primary hypothesis. The occurrence of clinical CBD/CVD will be assessed as secondary study endpoints.Ethics and disseminationThe University of Malawi College of Medicine and Liverpool School of Tropical Medicine research ethics committees approved this work. Our goal is to understand the pathogenesis of CBD/CVD among HIV cohorts on ART, in Sub-Saharan Africa, and provide data to inform future interventional clinical trials. This study runs between May 2017 and August 2020. Results of the main trial will be submitted for publication in a peer-reviewed journal.Trial registration numberISRCTN42862937.
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Makani, Julie, Elineema Meda, Stella Rwezaula, Thomas Williams, Swee Lay Thein, and Kevin Marsh. "Clinical and Laboratory Features of Homozygous Sickle Cell Patients in Tanzania; Malaria, Infections and Cerebral Blood Flow Velocity." Blood 106, no. 11 (November 16, 2005): 3778. http://dx.doi.org/10.1182/blood.v106.11.3778.3778.
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Abstract Background: Significant advances have been made in the management of patients with sickle cell disease (SCD), with resultant increase in survival, most notably in the USA where 1,000 children are born with SCD every year. In contrast, in Africa, where it is estimated that 450,000 children are born with SCD every year, there has been little change in the management and minimal reduction in mortality. There is no reason to doubt that similar interventions and consequent improvements in survival can be achieved in Africa. However, the lack of resources mean that it is vital that proposed interventions are based on a clear definition of the problem. Aims: The study attempts to define causes of morbidity and mortality in SCD in Tanzania focusing on three major areas where it is important to establish clear answers. The aims of the study are to determine the role of Plasmodium falciparum infection in precipitating crises in SCD patients, to describe the major bacterial pathogens associated with admission in SCD patients and to establish the association of increased cerebral blood flow velocities (CBFv) and cerebrovascular accidents (CVA) in SCD patients in East Africa. Study design: This is an ongoing hospital based, prospective, descriptive cohort study in Muhimbili national hospital, Dar-es-salaam, Tanzania. Patients are seen in outpatient clinic every three months, if there is any acute event requiring hospital attendance and when admitted to the hospital. Results: From march 2004, there have been 3,650 visits during which clinical and laboratory data has been collected on 885 (male 51.4%) patients, all homozygous for HbS on cellulose acetate electrophoresis. The mean age of the patients is 10 ± 7.2 years, (range 9 months-54 yrs), with 22.7% being under the age of 5 years and 8.28% above 20 years. The frequency of major clinical events, including fits (5.2%), stroke (1.9%) is reported. The prevalence of malaria parasitaemia in outpatients and during admission was 2.9% and 7.7% respectively. 227 patients have been admitted during this period, presenting with pain (44%), anemia (17%) and fever (15%). Transcranial Doppler ultrasonography was done in 400 patients; with 25% having a time averaged maximal mean velocity of 150 cms/second or more, suggesting stenosis. Conclusion: This study is the initial step in describing the causes of morbidity in patients with SCD disease in Tanzania, and will form the basis of longitudinal studies that will attempt to guide interventional strategies, target research and provide insight into natural history of SCD in East Africa.
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Rivera-Rodriguez, Claudia, Gary Cheung, and Sarah Cullum. "Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study." JMIR Research Protocols 10, no. 1 (January 6, 2021): e20225. http://dx.doi.org/10.2196/20225.
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Background Dementia describes a cluster of symptoms that includes memory loss; difficulties with thinking, problem solving, or language; and functional impairment. Dementia can be caused by a number of neurodegenerative diseases, such as Alzheimer disease and cerebrovascular disease. Currently in New Zealand, most of the systematically collected and detailed information on dementia is obtained through a suite of International Residential Assessment Instrument (interRAI) assessments, including the home care, contact assessment, and long-term care facility versions. These versions of interRAI are standardized comprehensive geriatric assessments. Patients are referred to have an interRAI assessment by the Needs Assessment and Service Coordination (NASC) services after a series of screening processes. Previous estimates of the prevalence and costs of dementia in New Zealand have been based on international studies with different populations and health and social care systems. This new local knowledge will have implications for estimating the demographic distribution and socioeconomic impact of dementia in New Zealand. Objective This study investigates the prevalence of dementia, risk factors for dementia, and drivers of the informal cost of dementia among people registered in the NASC database in New Zealand. Methods This study aims to analyze secondary data routinely collected by the NASC and interRAI (home care and contact assessment versions) databases between July 1, 2014, and July 1, 2019, in New Zealand. The databases will be linked to produce an integrated data set, which will be used to (1) investigate the sociodemographic and clinical risk factors associated with dementia and other neurological conditions, (2) estimate the prevalence of dementia using weighting methods for complex samples, and (3) identify the cost of informal care per client (in number of hours of care provided by unpaid carers) and the drivers of such costs. We will use design-based survey methods for the estimation of prevalence and generalized estimating equations for regression models and correlated and longitudinal data. Results The results will provide much needed statistics regarding dementia prevalence and risk factors and the cost of informal care for people living with dementia in New Zealand. Potential health inequities for different ethnic groups will be highlighted, which can then be used by decision makers to inform the development of policy and practice. Conclusions As of November 2020, there were no dementia prevalence studies or studies on informal care costs of dementia using national data from New Zealand. All existing studies have used data from other populations with substantially different demographic distributions. This study will give insight into the actual prevalence, risk factors, and informal care costs of dementia for the population with support needs in New Zealand. It will provide valuable information to improve health outcomes and better inform policy and planning. International Registered Report Identifier (IRRID) DERR1-10.2196/20225
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Rotta, Newra Tellechea, Alexandre Rodrigues da Silva, Flora Luciana Figueira da Silva, Lygia Ohlweiler, Eraldo Belarmino Jr, Valéria Raimundo Fonteles, Josiane Ranzan, Orlando Javier Ramos Rodriguez, and Régis Osório Martins. "Cerebrovascular disease in pediatric patients." Arquivos de Neuro-Psiquiatria 60, no. 4 (December 2002): 959–63. http://dx.doi.org/10.1590/s0004-282x2002000600013.
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Although rare in childhood, stroke may have a serious impact when it happens in this stage of life. Also, it may be the first sign of a systemic disease. We report 12 cases of patients with stroke treated in the Neuropediatrics Unit of Hospital de Clínicas de Porto Alegre (HCPA) from March 1997 to March 2000. All patients, from term infants to 12-year-old children hospitalized in the Pediatrics Unit of HCPA, had clinical suspicion of stroke, which was later confirmed by radiological studies. Patient follow up ranged from 1 to 6 years (mean = 3.4 years). Presenting symptoms were hemiparesis in 9 patients, seizures in 7, deviation of labial commissure in 3, and loss of consciousness in 1. The increase in the number of cases of childhood stroke identified and later confirmed by noninvasive methods had helped in the determination of different ethiologies of stroke: the most frequent being hematologic, cardiac and genetic diseases. However, our study included 6 newborns with stroke whose ethiology was not identified. Seven children with seizures received phenobarbital. Six term infants had neonatal seizures secondary to stroke and restricted to the first 72 hours of life.
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Lehmann, E. D., K. D. Hopkins, R. L. Jones, A. G. Rudd, and R. G. Gosling. "Aortic Distensibility in Patients with Cerebrovascular Disease." Clinical Science 89, no. 3 (September 1, 1995): 247–53. http://dx.doi.org/10.1042/cs0890247.
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1. Non-invasive aortic compliance measurements have been used previously to assess the distensibility of the aorta in several pathological conditions associated with increased cardiovascular risk. We set out to establish whether aortic compliance is abnormal in patients with stroke. 2. Pulse wave velocity measurements of thoracoabdominal aortic compliance were made in 20 stroke patients and 25 age- and sex-matched hospitalized, non-stroke control subjects putatively free of cardiovascular disease. Since compliance varies with non-chronic changes in blood pressure, a blood pressure corrected index of aortic distensibility, Cp, was calculated. 3. Aortic compliance was significantly reduced in patients with stroke compared with non-stroke control subjects (0.46 ± 0.27 versus 0.86 ± 0.34%/10 mmHg, P < 0.0002), corresponding with higher values for pulse wave velocity. Stroke patients also had significantly higher systolic and diastolic blood pressures (P < 0.02 and P < 0.002 respectively) and total cholesterol levels (P < 0.004) than the control subjects. Calculation of Cp did not alter the observation of stiffer aortas in the stroke cohort (P < 0.0007). 4. In both stroke patient and control cohorts, as expected, inverse trends were observed between aortic compliance and blood pressure. Also as expected, in the control group Cp values did not show a relationship with blood pressure (r = 0.02, P = 0.092, not significant). However, in the stroke cohort a marked dependence of Cp on blood pressure was observed (r = −0.48, P = 0.03). 5. Transoesophageal echocardiographic studies have recently identified advanced atherosclerosis in the ascending aorta as a possible source of cerebral emboli and an independent risk factor for ischaemic stroke. Our observations of significantly stiffer thoracoabdominal aortas in patients with stroke lead us to hypothesize that a totally non-invasive assessment of aortic compliance may potentially prove a useful surrogate marker of such atherosclerotic risk. 6. Blood pressure-corrected indices of arterial elastic properties based on normotensive models are widely applied in the literature. Our observation that these indices exhibit a considerable blood pressure dependence leads us to urge caution in the use of such corrections, especially in hypertensive patients.
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Doumas, Michael, Konstantinos Tziomalos, and Vasilios G. Athyros. "LETTER TO THE EDITOR Pay-for-performance Versus a Budget-Restrictive System for the Management of Dyslipidemia. Should this Approach also be Applied in Hypertension?" Open Hypertension Journal 5, no. 1 (November 14, 2013): 32–34. http://dx.doi.org/10.2174/1876526201305010032.
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The results of the Dyslipidemia International Study (DYSIS) were reported yesterday in the European Society of Cardiology (ESC) congress held at Amsterdam, Netherlands [1]. DYSIS compared low density lipoprotein cholesterol (LDL-C) target achievement in two West European Countries, UK, with an incentive-driven reimbursement system and Germany, with a budget-restrictive healthcare system. Overall, 80% of UK patients achieved the LDL-C target of <100 mg/dL (mean levels 82 mg/dL), compared with just 42% of patients in Germany (mean levels 111 mg/dL), despite the higher use of ezetimibe in the German population than in the UK population (11 vs. 3%). Dyslipidemic patients in the UK were more likely to be treated with potent statins whereas German doctors were more concerned with insurance restrictions than UK physicians [1]. Thus, it seems that lipid targets are more likely to be achieved in clinical practice in pay-for-performance than in budget-restrictive systems, like in Germany [1]. The UK healthcare system makes physicians participate in a clinical audit, and these results are used to assess the quality of care provided. There are no specific quality-improvement strategies in Germany. Interestingly, the German reimbursement for atorvastatin changed in recent years, and many patients were subsequently switched to the less potent simvastatin [1]. A total of 85% of German patients were treated with simvastatin (average dose 27 mg/d) compared with just 66% of UK patients (average simvastatin dose 37 mg/d), while nearly 25% of UK patients were treated with atorvastatin (average dose 34 mg/d) vs. just 4% of Germans who received this higher-potency statin [1]. These despite the fact that the German population had a higher baseline incidence of cerebrovascular disease, peripheral arterial disease and diabetes mellitus; more secondary prevention patients that should achieve even lower LDL-C targets. Since 2005 there is abundant data suggesting a close relation of LDL-C levels with cardiovascular disease (CVD) events, even between two groups on active statin treatment [2]. The Treating to New Targets study showed a significant 22% further reduction in CVD events achieved with 80 mg/d of atorvastatin (mean LDL-C level 77 mg/dL) compared with 10 mg/d of atorvastatin (mean LDL-C level 100 mg/dL) in high risk patients [2]. This was confirmed in the Pravastatin or Atorvastatin Evaluation and Infection (PROVE-IT) Thrombolysis In Myocardial Infarction (PROVE IT)-TIMI- 22 study in patients with acute coronary syndromes [3]. This was also verified in March 2013 (in the ACC Congress) by the results of the Ibaraki Cardiovascular Assessment Study (ICAS) in CVD patients with initially low LDL-C [4]. These findings suggest that if you save money today from prescribing a cheaper (and less potent) statin you will pay tomorrow twice as much in costs from CVD fatal and non-fatal events. This was confirmed in The Health Improvement Network (THIN) registry [5,6]. Switching from atorvastatin to simvastatin was significantly associated with increased risk for all CVD events [hazards ratio (HR) 1.30, 95% confidence interval (CI) 1.02-1.64], major CVD events (HR 1.43, 95% CI 1.10-1.87), and stroke (HR 2.14, 95% CI 1.21-3.81). Interestingly, these increased risks were partly attributed to differences in lipid levels and partly to the pleitropic effects of statins [5, 6]. Arterial hypertension (AH) is a major risk factor for CVD, accounting globally for 51% of stroke and 45% of ischemic heart disease deaths [7]. The important question is whether treatment results are similar in antihypertensive treatment as in hypolipidaemic treatment if the pay-forperformance approach is used. In UK, the inclusion of renalspecific indicators in a primary care pay for performance (P4P) system has promoted identification and better management of risk factors related to chronic kidney disease (CKD) since April 2006 [8]. The P4P framework, also known as the Quality and Outcomes Framework (QOF), aims at control of CVD risk factors; one of its key targets is AH. It is clear that AH is a major risk factor for CKD, and consequently CVD [8]. Thus, achieving better blood pressure (BP) control is likely to have a positive impact on both CKD and CVD [9]. BP control was improved since the introduction of P4P and this improvement has been sustained [9]. This was associated with a significant increase in the use of antihypertensive medication, resulting in increased prescription cost (€25/month) [9]. Longer-term follow-up will establish whether or not this translates into improved outcomes in terms of progression of CKD and CVD events [9]. But why to restrict this policy only in hypertensive patients with CKD? AH is a prevalent CVD risk factor with rather disappointing control results. A recent systematic review evaluated data regarding AH control from 35 countries [10]. AH control was achieved in about third of treated patients. In particular, AH control rates were higher in women than in men (36.8% versus 31.9%), and in developed countries compared to developing countries (33.3% versus 29.6% for men, and 38.4 versus 34.0% for women, respectively) [10]. However, when the awareness and treatment of hypertension were taken into account, the true hypertension control rates were substantially lower (16.9% for women versus 10.5% for men) and rather similar in developed and developing countries (17.3% versus 16.2% for men, and 10.8% versus 9.8% for women, respectively) [10]. These incredibly disappointing AH control rates were verified in the Copenhagen City Heart Study, a prospective longitudinal study. During the 25-year follow up period AH control increased from 21% to 26% [11]. Once again however, when control rates were adjusted for AH awareness and treatment, the true AH control rates were improved but remained unacceptably low (4.7% vs. 1.4%). It is therefore of no surprise that 7.6 million premature deaths (about 13.5% of the global total) are attributed to high BP [12]. A study evaluated an intensive protocol-based strategy for achieving BP control in family practice in the Centre for Studies in Primary Care, Queen's University, Kingston, Ontario [13]. There was an improvement between baseline and 12-month follow-up. BP control was significantly better for the intervention group as assessed with both systolic and diastolic mean BP on 24-hour ambulatory BP monitoring [13]. This suggests that an intensive, protocol-based approach to achieve BP control in hypertensive patients in family practice is effective and works even when there is flexibility built into the algorithm to allow family physicians to use their judgment in individual patients [13]. Moreover, data from the REACH Registry, Austrian Chapter, determined the extent of lost therapeutic benefit (LTB) in hypertensive patients, and investigated the relationship between the presence of LTB and clinical outcomes [14]. Presence of heart failure, previous myocardial infarction and being male decreased the likelihood of LTB, while presence of diabetes, age > 65 and ankle brachial index < 0.90 increased the risk of LTB. Patients with LTB in the age category 55-64 had higher incidence of vascular events compared to those with non-LTB [14]. The pay-for-performance system was introduced in the new General Medical Services contract in the United Kingdom since April 2004, and general practitioners are awarded for the achievement of various clinical targets, including hypertension control [15]. Some reports questioned the effectiveness of the pay-for-performance system on blood pressure control [16,17], however several lines of evidence point towards a beneficial effect of the P4P system on blood pressure management. A large longitudinal survey in over 8,500 general practices in England demonstrated that both blood pressure monitoring and blood pressure control have improved substantially after the implementation of the P4P system [18]. In particular, a mean increased of 6% to 8% in blood pressure control rates was observed in hypertensive patients with or without coronary artery disease, cerebrovascular disease, and diabetes [18]. Another recent study evaluated the effects of pay-for-performance system in Wandswort, London at 2007 [19]. This interrupted time series study showed that both systolic and diastolic blood pressure were constantly decreasing after the implementation of the pay-for-performance system, for a mean reduction of 5.8 mmHg for systolic and 2.9 mmHg for diastolic between 2003 and 2007 [19]. More importantly, robust epidemiological data confirm the improvements in hypertension control rates in England. The results of the 2006 Health Survey in England revealed that hypertension control rates increased from 22% at 2003 to 28% at 2006, especially in women (from 23% to 32%) [20]. Although several factors might have contributed to this improvement in control rates, it seems very likely that the pay-for-performance system might have exerted beneficial effects. The pay-for-performance system might also affect the inequalities in primary care delivery. The quality of health services is usually compromised in deprived areas. It has been shown that the financial incentives of the pay-forperformance system have substantially reduced the inequalities in clinical care delivery due to area deprivation, narrowing the gap between the least deprived and the most deprived areas from 4.0% to 0.8% [21]. Similar beneficial effects of the pay-for-performance system might also apply for the ethnic disparities in hypertension management. Although some older studies reported the persistence of ethnic disparities in the management of hypertension [22], more recent studies demonstrate attenuation of ethnic disparities in blood pressure control [19]. In contrast, the removal of financial incentives carries the risk of worsening performance levels. Indeed, a study from the Kaiser Permanente Insurance System in Northern California reveals that when financial incentives for some conditions were removed from some facilities, the level of performance for the detection and control of these conditions declined significantly by about 3% per year [23], while the reattachment of financial incentives was associated with significant improvements. To conclude, it appears that pay-for-performance, especially based on treatment protocols, may substantially increase BP control with considerable clinical benefits and in a cost-effective way.
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Khasanova, D. R., T. V. Danilova, and Z. K. Latypova. "Epilepsy in patients with ischemic brain disease." Kazan medical journal 94, no. 2 (April 15, 2013): 235–39. http://dx.doi.org/10.17816/kmj1595.
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Epilepsy is one of the most actual social problems in modern neurology and psychiatry. According to the results of the domestic and foreign studies, the risk of developing epilepsy increases with age. The increased rate of nervous system vascular and degenerative diseases as well as brain tumors and head injuries in elderly patients is one of the reasons for it. The review is devoted to the development of epilepsy in adults having an active cerebrovascular disease. Epilepsy is the disease with multiple causative factors. Among the etiological factors of epilepsy development in adults, the predominant place belongs to vascular diseases. The article presents the epidemiological aspects of the problem, the questions of pathophysiology, the variability of epileptic syndromes developing as a result of ischemic brain disease. It describes the characteristics of epileptic process as a result of a vascular lesion. The role of the cerebrovascular reactivity in brain vascular diseases development is described. A place of different research methods (such as electroencephalography, transcranial and extracranial duplex ultrasonography scanning of the major brain vessels, different modes of magnetic resonance imaging, functional magnetic resonance imaging and magnetic resonance spectroscopy) in identifying risk factors for seizures in patients with cerebrovascular pathology is reported. Possible exogenous and endogenous precipitants (cerebral atherosclerotic vascular disease, hypertension, cerebrovascular deregulation, increased convulsive predisposition, the external epileptic triggers, etc.) are described.
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Xia, Ying, Nawaf Yassi, Parnesh Raniga, Pierrick Bourgeat, Patricia Desmond, James Doecke, David Ames, et al. "Comorbidity of Cerebrovascular and Alzheimer’s Disease in Aging." Journal of Alzheimer's Disease 78, no. 1 (October 27, 2020): 321–34. http://dx.doi.org/10.3233/jad-200419.
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Background: Cerebrovascular disease often coexists with Alzheimer’s disease (AD). While both diseases share common risk factors, their interrelationship remains unclear. Increasing the understanding of how cerebrovascular changes interact with AD is essential to develop therapeutic strategies and refine biomarkers for early diagnosis. Objective: We investigate the prevalence and risk factors for the comorbidity of amyloid-β (Aβ) and cerebrovascular disease in the Australian Imaging, Biomarkers and Lifestyle Study of Ageing, and further examine their cross-sectional association. Methods: A total of 598 participants (422 cognitively normal, 89 with mild cognitive impairment, 87 with AD) underwent positron emission tomography and structural magnetic resonance imaging for assessment of Aβ deposition and cerebrovascular disease. Individuals were categorized based on the comorbidity status of Aβ and cerebrovascular disease (V) as Aβ–V–, Aβ–V+, Aβ+V–, or Aβ+V+. Results: Advancing age was associated with greater likelihood of cerebrovascular disease, high Aβ load and their comorbidity. Apolipoprotein E ɛ4 carriage was only associated with Aβ positivity. Greater total and regional WMH burden were observed in participants with AD. However, no association were observed between Aβ and WMH measures after stratification by clinical classification, suggesting that the observed association between AD and cerebrovascular disease was driven by the common risk factor of age. Conclusion: Our observations demonstrate common comorbid condition of Aβ and cerebrovascular disease in later life. While our study did not demonstrate a convincing cross-sectional association between Aβ and WMH burden, future longitudinal studies are required to further confirm this.
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Bracco, L., D. Campani, E. Baratti, A. Lippi, D. Inzitari, G. Pracucci, and L. Amaducci. "Relation between MRI features and dementia in cerebrovascular disease patients with leukoaraiosis: A longitudinal study." Journal of the Neurological Sciences 120, no. 2 (December 1993): 131–36. http://dx.doi.org/10.1016/0022-510x(93)90263-x.
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Wahlberg, Thomas B., Margareta Blombäck, and Ingela Övermark. "Blood Coagulation Studies in 45 Patients with Ischemic Cerebrovascular Disease and 44 Patients with Venous Thromboembolic Disease." Acta Medica Scandinavica 207, no. 1-6 (April 24, 2009): 385–90. http://dx.doi.org/10.1111/j.0954-6820.1980.tb09743.x.
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Janelidze, Shorena, Niklas Mattsson, Erik Stomrud, Olof Lindberg, Sebastian Palmqvist, Henrik Zetterberg, Kaj Blennow, and Oskar Hansson. "CSF biomarkers of neuroinflammation and cerebrovascular dysfunction in early Alzheimer disease." Neurology 91, no. 9 (July 27, 2018): e867-e877. http://dx.doi.org/10.1212/wnl.0000000000006082.
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ObjectiveTo measure CSF levels of biomarkers reflecting microglia and astrocytes activation, neuroinflammation, and cerebrovascular changes and study their associations with the core biomarkers of Alzheimer disease (AD) pathology (β-amyloid [Aβ] and tau), structural imaging correlates, and clinical disease progression over time.MethodsThe study included cognitively unimpaired elderly (n = 508), patients with mild cognitive impairment (MCI, n = 256), and patients with AD dementia (n = 57) from the longitudinal Swedish BioFINDER cohort. CSF samples were analyzed for YKL-40, interleukin (IL)–6, IL-7, IL-8, IL-15, IP-10, monocyte chemoattractant protein 1, intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1), placental growth factor, and fms-related tyrosine kinase 1 (Flt-1). MRI data were available from 677 study participants. Longitudinal clinical assessments were conducted in control individuals and patients with MCI (mean follow-up 3 years, range 1–6 years).ResultsCSF levels of YKL-40, ICAM-1, VCAM-1, IL-15, and Flt-1 were increased during the preclinical, prodromal, and dementia stages of AD. High levels of these biomarkers were associated with increased CSF levels of total tau, with the associations, especially for YKL-40, being stronger in Aβ-positive individuals. The results were similar for associations between phosphorylated tau and YKL-40, ICAM-1, and VCAM-1. High levels of the biomarkers were also associated with cortical thinning (primarily in the precuneus and superior parietal regions) and with subsequent cognitive deterioration in patients without dementia as measured with Mini-Mental State Examination (YKL-40) and Clinical Dementia Rating Sum of Boxes (YKL-40, ICAM-1, VCAM-1 and IL-15). Finally, higher levels of CSF YKL-40, ICAM-1, and Flt-1 increased risk of development of AD dementia in patients without dementia.ConclusionsNeuroinflammation and cerebrovascular dysfunction are early events occurring already at presymptomatic stages of AD and contribute to disease progression.
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Kolmos, Mia, Rikke Steen Krawcyk, and Christina Kruuse. "Effect of high-intensity training on endothelial function in patients with cardiovascular and cerebrovascular disease: A systematic review." SAGE Open Medicine 4 (January 1, 2016): 205031211668225. http://dx.doi.org/10.1177/2050312116682253.
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Objectives: Exercise improves endothelial dysfunction, the key manifestation of cardiovascular and cerebrovascular disease, and is recommended in both cardiovascular and cerebrovascular rehabilitation. Disagreement remains, however, on the role of intensity of exercise. The purpose of this review was to gather current knowledge on the effects of high-intensity training versus moderate-intensity continuous exercise on endothelial function in cardiovascular and cerebrovascular patients. Methods: A systematic review was performed in PubMed database, Embase and Cochrane libraries and on PEDro using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were restricted to cardiovascular and cerebrovascular patients, and healthy subjects as general reference. Interventions comprised of high-intensity training alone, high-intensity training compared to moderate-intensity continuous exercise, or no training, with endothelial function as outcome measure. Endothelial function was measured either physiologically by flow-mediated dilatation and/or by systemic biomarkers. Data were analyzed descriptively due to non-comparability for a meta-analysis to be performed. Results: A total of 20 studies were included in the review. Although there was great heterogenecity in design, population and exercise protocols, all studies found high-intensity training to be safe. High-intensity training was equal to moderate-intensity continuous exercise through improvement in endothelial function in 15 of the 20 selected studies, as measured by flow-mediated dilatation, nitric oxide bioavailability and circulating biomarkers. Only a few studies examined high-intensity training in cerebrovascular patients, none with endothelial function as outcome. Conclusion: High-intensity training is promising as a time-efficient exercise strategy in cardiovascular rehabilitation, but data on endothelial effects in cerebrovascular rehabilitation are warranted. Agreement on a more uniform exercise protocol is essential to further investigate the optimal exercise mode for cerebrovascular rehabilitation.
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Su, Nan, Yonghwan Kim, and Youngin Won. "Association of Primary Hypertension and Risk of Cerebrovascular Diseases with Overweight and Physical Activity in Korean Women: A Longitudinal Study." Healthcare 9, no. 9 (August 24, 2021): 1093. http://dx.doi.org/10.3390/healthcare9091093.
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Cerebrovascular diseases include stroke, intracranial stenosis, aneurysms, and vascular malformations; primary hypertension is typically associated with cerebrovascular disease. The incidence of these diseases is higher in men than in women, and low physical activity and obesity are known to increase the risk of cerebrovascular disease. This study aimed to longitudinally analyze the adjusted relative risk (ARR) of primary hypertension and cerebrovascular diseases, in relation to body mass index (BMI) and physical activity (PA), in Korean women. The study retrieved the data of 1,464,377 adult Korean women (aged 50–79 years), who participated in the national health screening program from 2002 to 2003. The participants had no history of primary hypertension or cerebrovascular diseases, and were followed up by the International Statistical Classification of Diseases and Related Health Problems (ICD) until 2013. The participants were divided into the following groups: normal weight (18.5–24.9), overweight (25.0–29.9), and obese (≥30.0) kg/m2, based on the World Health Organization (WHO) classification. The frequency of PA (days) was determined using a physical activity questionnaire, and defined as low (0–2), medium (3–4), and high (5–7) days. The RR was calculated using Cox regression. Three models were created based on the adjusted variables. The ARR for hypertension was 0.933 (95% CI; 0.920–0.955, p < 0.001) in obese patients with medium PA. Primary hypertension was lower (ARR: 0.943; 95% CI; 0.928–0.961, p < 0.001) in overweight participants with medium PA, than in those with low PA. The incidence of cerebrovascular disease was lower in overweight individuals with medium PA (ARR: 0.945, 95% CI; 0.925–0.976, p < 0.001), than in those with low PA. The risk of cerebrovascular disease was reduced in normal-weight participants with medium PA (ARR: 0.889; 95% CI: 0.854–0.919; p < 0.001), than in those with high PA (ARR 0.913; 95% CI; 0.889–0.953, p < 0.001). In the obese group, there was no significant difference in the risk of cerebrovascular disease, based on the frequency of PA. In conclusion, the relative risk of primary hypertension in women was lower with moderate activity than with low activity, in the normal-weight and overweight groups. The relative risk of cerebrovascular disease was lower in the participants with moderate and high activity than in those with low activity, even at normal weight. In obese individuals, moderate and high activity reduced cerebrovascular disease compared to low activity. Therefore, regardless of obesity, PA may contribute to the prevention of primary hypertension and cerebrovascular disease in adult women.
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Uzuner, N., S. Ozkan, and N. Cinar. "Cerebrovascular reactivity in multiple sclerosis patients." Multiple Sclerosis Journal 13, no. 6 (February 9, 2007): 737–41. http://dx.doi.org/10.1177/1352458506074645.
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A close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature has long been recognised. Some studies have suggested that vascular endothelial cell activation might be an early event in the evolution of MS, and demyelisation may have an ischemic basis in this condition. Hypoxia caused by breath holding (BH) results in autoregulatory vasodilatation, and an increase in CBF to the cortex. The increased CBF can be evaluated by transcranial Doppler (TCD), and can provide information about the vascular integrity. In this study, we aimed to examine the vascular integrity and assess the vasomotor reactivity of MS patients in response to BH in different activation phases of the disease by means of TCD. We studied 12 patients with clinically diagnosed relapsing remitting (RR) MS, according to the Poser criteria. The initial TCD examination was performed in the first two days of an acute exacerbation of disease and prior to any treatment. The second test was performed just after iv methylprednisolone (IVMP) treatment, and the third examination occurred one month later, when the patient was in the remission phase. A group of 11 healthy subjects was also examined by TCD as control. Blood flow velocities were recorded during 30 seconds of normal breathing and 15 seconds BH. Vasomotor reactivity was calculated as a ratio of difference of cerebral flow velocities during BH. There were no significant vasomotor reactivity differences between the controls (55.7%) and the patients during attacks (46.5%), as well as after treatment (48.3%) and during attack free periods (50.9%). There were also no significant changes amongst the patients groups throughout the study. In this study, in different disease activity stages, we observed non-significant cerebrovascular vasomotor reactivity difference between the RRMS patients and the healthy controls, although it was slightly lower in the MS patients. This observation suggests that cerebrovascular reactivity is normal in different disease activity levels. Multiple Sclerosis 2007; 13: 737-741. http://msj.sagepub.com
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Remes, Tiina, Maria Suo-Palosaari, Niina Ritari, Riina Puosi, Päivi Koskenkorva, Anna Sutela, Sanna-Maria Toiviainen-Salo, et al. "QOL-12. CLINICAL SIGNIFICANCE OF RADIATION-INDUCED CEREBROVASULAR DISEASE IN CHILDHOOD BRAIN TUMOR SURVIVORS." Neuro-Oncology 22, Supplement_3 (December 1, 2020): iii433. http://dx.doi.org/10.1093/neuonc/noaa222.675.
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Abstract BACKGROUND Childhood brain tumor survivors have a high risk of early cerebrovascular disease, but currently its clinical significance is unknown. METHODS In a nation-wide study, we investigated 68 childhood brain tumor survivors treated with radiotherapy by using magnetic resonance imaging (MRI) and neuropsychological examination after median follow-up time of 20.6 years (range 5.0 – 33.1 years) since radiotherapy. Associations between imaging markers of cerebrovascular disease, white matter hyperintensities and the results of neuropsychological examination were investigated. RESULTS Majority (65 %) of the survivors was diagnosed with cerebrovascular disease at median age of 27.1 years (range16.2 – 43.8 years). The presence of imaging markers of cerebrovascular disease or white matter hyperintensities was associated with poorer performance in verbal (VIQ) and performance (PIQ) intelligent quotient, working and semantic memory, executive functions, visuospatial ability, and immediate and general auditive memory (P < 0.05). Survivors with microbleeds performed worse in PIQ, processing speed, executive functions, and visuospatial ability (P <0.05). Lacunar infarcts were associated with difficulties in visuospatial ability (P <0.05). Survivors with white matter hyperintensities in MRI had higher impairment of working and semantic memory, visuospatial ability, and general auditive memory (P < 0.05). Cerebrovascular and small-vessel disease burden associated with poorer neurocognitive performance. CONCLUSION The imaging markers of cerebrovascular disease and white matter hyperintensities were related to poorer cognitive performance in radiation-treated long-term survivors of childhood brain tumor. Longitudinal studies are urgently needed to investigate how cerebrovascular disease and related cognitive impairment progress in the survivors.
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Buyru, Nur, Julide Altinisik, Goksel Somay, and Turgut Ulutin. "Factor V Leiden Mutation in Cerebrovascular Disease." Clinical and Applied Thrombosis/Hemostasis 11, no. 3 (July 2005): 339–42. http://dx.doi.org/10.1177/107602960501100314.
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Several studies indicate a high prevalence of factor V Leiden mutation as the most frequent coagulation defect found in patients with venous thrombosis. The relationship between this mutation and cerebrovascular disease has not been established in adults. In this investigation, we studied 29 patients with ischemic stroke and 20 with intracerebral hemorrhage, all of whom were compared with 20 controls. A region of the factor V gene containing the Leiden mutation site was amplified with polymerase chain reaction and the presence of mutation was determined with restriction enzyme digestion. We found no evidence of an association between factor V Leiden mutation and ischemic stroke or intracerebral hemorrhage. There was no evidence of association in subgroup the analysis by age, smoking status, myocardial infarction, hypertension, diabetes mellitus, or coronary disease. Factor V Leiden mutation doesn’t seem to be associated with a risk of cerebrovascular disease.
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Chang, Chia-Ming, Tzu-Yuan Stessa Chao, Yi-Ting Huang, Yi-Fang Tu, Tzu-Ching Sung, Jung-Der Wang, and Hsin-I. Shih. "Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot." International Journal of Environmental Research and Public Health 18, no. 14 (July 11, 2021): 7400. http://dx.doi.org/10.3390/ijerph18147400.
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Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case–cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45–75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20–2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12–2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24–3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28–8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.
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Qiu, Chengxuan, and Laura Fratiglioni. "Epidemiology of Cerebrovascular Disease Related Cognitive Decline." International Psychogeriatrics 15, S1 (July 2003): 105–10. http://dx.doi.org/10.1017/s1041610203009049.
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Cognitive decline is a central component of the dementia process. Population-based prospective studies have confirmed the existence of age-related cognitive decline, although its conceptual basis and nosological status remain controversial. Healthy old people show decline with aging in global cognition and memory function in particular. Preclinical and clinical dementia patients exhibit deficits across multiple cognitive domains, with the largest and most consistent deficits in memory function. Cerebrovascluar disease may lead to cognitive decline and promote the clinical expression of dementia directly or by interaction with APOE η4. Early treatment and prevention of cerebrovascular disease may be the major measures for preventing and postponing the progression of the vascular disease related cognitive decline.
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Smeeing, Diederik P. J., Jeroen Hendrikse, Esben T. Petersen, Manus J. Donahue, and Jill B. de Vis. "Arterial Spin Labeling and Blood Oxygen Level-Dependent MRI Cerebrovascular Reactivity in Cerebrovascular Disease: A Systematic Review and Meta-Analysis." Cerebrovascular Diseases 42, no. 3-4 (2016): 288–307. http://dx.doi.org/10.1159/000446081.
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Background: The cerebrovascular reactivity (CVR) results of blood oxygen level-dependent (BOLD) and arterial spin labeling (ASL) MRI studies performed in patients with cerebrovascular disease (steno-occlusive vascular disease or stroke) were systematically reviewed. Summary: Thirty-one articles were included. Twenty-three (74.2%) studies used BOLD MRI to evaluate the CVR, 4 (12.9%) studies used ASL MRI and 4 (12.9%) studies used both BOLD and ASL MRI. Thirteen studies (3 significant) found a lower BOLD CVR, 2 studies found a similar CVR and 3 studies found a higher CVR in the ipsilateral compared to the contralateral hemisphere. Nine (5 significant) out of 10 studies found a lower BOLD CVR in the ipsilateral hemispheres of patients compared to controls. Six studies (2 significant) found a lower ASL CVR in the ipsilateral compared to the contralateral hemispheres. Three out of 5 studies found a significant lower ASL CVR in the ipsilateral hemispheres of patients compared to controls. Key Messages: This review brings support for a reduced BOLD and ASL CVR in the ipsilateral hemisphere of patients with cerebrovascular disease. We suggest that future studies will be performed in a uniform way so reference values can be established and could be used to guide treatment decisions in patients with cerebrovascular disease.
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Sullivan, Humbert G., Theodore B. Kingsbury, Mary E. Morgan, Ronnie D. Jeffcoat, Jerry D. Allison, Jamie J. Goode, and Dennis E. McDonnell. "The rCBF response to Diamox in normal subjects and cerebrovascular disease patients." Journal of Neurosurgery 67, no. 4 (October 1987): 525–34. http://dx.doi.org/10.3171/jns.1987.67.4.0525.
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✓ Age-related norms for the regional cerebral blood flow (rCBF) response to Diamox (acetazolamide) were based on studies of 55 normal subjects at rest and on studies of 33 of these 55 normal subjects following an intravenous injection of Diamox (22 mg/kg). After the Diamox injection, rCBF increased at all locations measured in all subjects. On average, rCBF increased 1.7 times. The following were found for rCBF in both resting and Diamox-treated subjects: 1) rCBF decreased significantly with increasing age; 2) slope and intercept for the regression of rCBF on age were largest for frontal detectors, intermediate for parietal detectors, and smallest for occipital detectors; 3) rCBF hyperfrontality was most noticeable in younger subjects; 4) in subjects of any age, 95% confidence intervals for rCBF were relatively large (expected value ± 30%) and lower 95% confidence intervals for Diamox rCBF tended to overlap the upper 95% confidence intervals for resting rCBF; and 5) side-to-side percentage difference in rCBF did not have a significant regression on age and tended to be less than 10% to 20%. Diamox did not have an important effect on blood pressure, pulse rate, or respiratory rate. The normative data for the rCBF response to Diamox was used in evaluating 20 patients with cerebrovascular disease. Forty percent of these patients, all of whom exhibited angiographic evidence of potentially hemodynamically significant lesions, had normal rCBF at rest and after Diamox injection. Twenty percent had normal resting flows with abnormal Diamox-activated flows. Asymmetry in rCBF was the most sensitive indicator of a potential abnormality in cerebral perfusion. Thirty percent of the abnormal studies showed only significant asymmetry. It is suggested that rCBF studies at rest and after Diamox treatment, with age-related norms, may be useful in the management of patients with cerebrovascular disease.
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Charidimou, Andreas, Deborah Blacker, and Anand Viswanathan. "Context is everything: From cardiovascular disease to cerebral microbleeds." International Journal of Stroke 13, no. 1 (September 14, 2017): 6–10. http://dx.doi.org/10.1177/1747493017730907.
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Increasingly, our approach to cerebrovascular disease has become blurred by evidence published in literature often without careful consideration of what this evidence implies for specific patients at hand. In this essay, we analyze key contextual issues in cerebrovascular small vessel disease, in an attempt to highlight the symbolic gap that exists between research and clinical practice, a recurring theme in medicine. We highlight the importance of considering context when using data from epidemiologic, neuroimaging, and biomarker studies in determining relevance to the patient at hand. We argue, that while biomarkers and neuroimaging may eventually serve to help to identify individuals with specific cerebrovascular diseases, we must always continue to understand patients in a specific clinical context. These reflections are particularly relevant when considering cerebral microbleeds—a key marker of cerebrovascular small vessel disease whose detection often raises thorny clinical dilemmas.
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Locāne, Sintija, Elīna Pūcīte, Evija Miglāne, Andrejs Millers, Arina Novasa, Renija Ieviņa, and Tatjana Muravska. "Antiplatelet Resistance in Patients with Atherosclerosis." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 73, no. 4 (August 1, 2019): 373–78. http://dx.doi.org/10.2478/prolas-2019-0058.
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Abstract Variable platelet response to aspirin and clopidogrel is a well-known phenomenon in patients with coronary artery disease and ischemic cerebral stroke. The objective of the present study was to evaluate the frequency and possible risk factors of antiplatelet resistance in patients with cerebrovascular and cardiovascular diseases. The VerifyNow system was used to evaluate adenosine-5-diphosphate and platelet P2YI2 receptor function in patients with cerebrovascular and cardiovascular disease, who received dual antiplatelet therapy. Aspirin resistance was defined as aspirin reaction units (ARU) ≥ 550. Clopidogrel resistance was defined as Platelet Reaction Units (PRU) > 230. In the group of cerebrovascular diseases there were 13.2% (n = 27) patients with aspirin and 24.5% (n = 50) with clopidogrel resistance. However, in the cardiovascular group there were 20% (n = 9) aspirin and 11.1% (n = 5) clopidogrel resistant patients. In the cerebrovascular group, aspirin resistant patients had a lower triglyceride level (p = 0.001, r = 0.26) than aspirin sensitive patients. Clopidogrel resistant patients had a significantly higher level of glycated haemoglobin (HbA1C) (p = 0.016, r = 023), triglycerides (p = 0.033, r = 0.16) and lower level of high-density lipoproteins (p = 0.027, r = 0.16) than clopidogrel sensitive patients. In the cardiovascular group, patients who were resistant to aspirin had a significantly higher high-density lipoprotein level (p = 0.038, r = 0.31). No other factors differed significantly between the aspirin or clopidogrel resistant and sensitive patients in the cardiovascular group. Aspirin resistance was more common in patients with cardiovascular disease, and clopidogrel resistance in patients with cerebrovascular disease, although the difference was not significant. Our findings indicate that diabetes mellitus and an elevated level of lipoproteins could be risk factors for aspirin or clopidogrel resistance in patients with cerebrovascular diseases. Further studies should be conducted using larger patient cohorts with balanced groups of patients to investigate clinical aspects of antiplatelet resistance.
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Tran, Nhu N., Jodie K. Votava-Smith, John C. Wood, Ashok Panigrahy, Choo Phei Wee, Matthew Borzage, S. Ram Kumar, et al. "Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls." PLOS ONE 16, no. 5 (May 10, 2021): e0251255. http://dx.doi.org/10.1371/journal.pone.0251255.
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Objective Infants with Congenital Heart Disease (CHD) are at risk for developmental delays, though the mechanisms of brain injury that impair development are unknown. Potential causes could include cerebral hypoxia and cerebrovascular instability. We hypothesized that we would detect significantly reduced cerebral oxygen saturation and greater cerebrovascular instability in CHD infants compared to the healthy controls. Methods We performed a secondary analysis on a sample of 43 term infants (28 CHD, 15 healthy controls) that assessed prospectively in temporal cross-section before or at 12 days of age. CHD infants were assessed prior to open-heart surgery. Cerebral oxygen saturation levels were estimated using Near-Infrared Spectroscopy, and cerebrovascular stability was assessed with the response of cerebral oxygen saturation after a postural change (supine to sitting). Results Cerebral oxygen saturation was 9 points lower in CHD than control infants in both postures (β = -9.3; 95%CI = -17.68, -1.00; p = 0.028), even after controlling for differences in peripheral oxygen saturation. Cerebrovascular stability was significantly impaired in CHD compared to healthy infants (β = -2.4; 95%CI = -4.12, -.61; p = 0.008), and in CHD infants with single ventricle compared with biventricular defects (β = -1.5; 95%CI = -2.95, -0.05; p = 0.04). Conclusion CHD infants had cerebral hypoxia and decreased cerebral oxygen saturation values following a postural change, suggesting cerebrovascular instability. Future longitudinal studies should assess the associations of cerebral hypoxia and cerebrovascular instability with long-term neurodevelopmental outcomes in CHD infants.
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Chou, Ping-Song, Yi-Hui Kao, Meng-Ni Wu, Mei-Chuan Chou, Chun-Hung Chen, Ruey-Tay Lin, and Yuan-Han Yang. "Effect of the Interaction Between Hypertension and Cerebral White Matter Changes on the Progression of Alzheimer Disease." Current Alzheimer Research 15, no. 14 (November 2, 2018): 1354–60. http://dx.doi.org/10.2174/1567205015666181002141013.
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Background: Cerebrovascular pathologies and hypertension could play a vital role in Alzheimer disease (AD) progression. However, whether cerebrovascular pathologies and hypertension accelerate the AD progression through an independent or interaction effect is unknown. Objective: To investigate the effect of the interactions of cerebrovascular pathologies and hypertension on AD progression. Method: A retrospective longitudinal study was conducted to compare AD courses in patients with different severities of cerebral White Matter Changes (WMCs) in relation to hypertension. Annual comprehensive psychometrics were performed. WMCs were rated using a rating scale for Age-related WMCs (ARWMC). Results: In total, 278 patients with sporadic AD were enrolled in this study. The mean age of the patients was 76.6 ± 7.4 years, and 166 patients had hypertension. Among AD patients with hypertension, those with deterioration in clinical dementia rating-sum of box (CDR-SB) and CDR had significantly severe baseline ARWMC scales in total (CDR-SB: 5.8 vs. 3.6, adjusted P = 0.04; CDR: 6.4 vs. 4.4, adjusted P = 0.04) and frontal area (CDR-SB: 2.4 vs. 1.2, adjusted P = 0.01; CDR: 2.4 vs. 1.7, adjusted P < 0.01) compared with those with no deterioration in psychometrics after adjustment for confounders. By contrast, among AD patients without hypertension, no significant differences in ARWMC scales were observed between patients with and without deterioration. Conclusion: The effect of cerebrovascular pathologies on AD progression between those with and without hypertension might differ. An interaction but not independent effect of hypertension and WMCs on the progression of AD is possible.
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Brommels, Mats, Reijo Tilvis, and Lauri Autio. "Cerebrovascular Disease: Declining Incidence but Increasing Hospital Utilisation." Scandinavian Journal of Social Medicine 15, no. 3 (September 1987): 153–57. http://dx.doi.org/10.1177/140349488701500306.
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A total of 20680 patients hospitalised in Helsinki during 1970–1980 due to cerebrovascular diseases were found when screening the Finnish National Hospital Discharge Register. The material was categorised according to three-digit ICD-8 diagnosis codes and age, and was analysed for case-fatality, length of stay and discharge status. By identifying all new cases an assessment of the incidence development during the study period was also possible. A fall in the overall age-standardised incidence of cerebrovascular disease was demonstrated, in accordance with disease register studies. The main reason was decline in incidence of haemorrhagic stoke (ICD-8 no. 431) and less well defined types of stroke (436–438). Ischaemic stroke (433), on the other hand, did not decrease in frequency. The diagnostic shift, occurring parallell with a growing mean age of patients, lead to decreasing acute mortality, increasing institutionalisation rates and longer stays in hospital, thus resulting in growing figures of hospital utilisation in spite of the declining incidence.
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Antonenko, L. M., N. V. Vakhnina, and D. O. Gromova. "Cognitive impairment, dizziness, and unsteadiness in hypertensive patients." Neurology, Neuropsychiatry, Psychosomatics 12, no. 5 (October 25, 2020): 92–97. http://dx.doi.org/10.14412/2074-2711-2020-5-92-97.
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Hypertension is a widespread disease related to modifiable vascular risk factors for stroke and chronic cerebrovascular diseases. The pathogenetic basis of brain damage in hypertension is cerebral microangiopathy that leads to vascular cognitive impairment (CI), instability, and falls. Microcirculatory changes in the presence of hypertension at the initial stages of cerebrovascular disease occur without visible clinical manifestations of brain damage. Pathogenetically justified treatment used at an early stage of the disease makes it possible to achieve good results in the prevention of vascular brain damage. An important aspect of selecting effective therapy is the competent diagnosis of the causes of dizziness and instability, which can be caused not only by brain damage, but also by peripheral vestibular system diseases. Early diagnosis of vascular CI, selection of adequate therapy, and prevention of their further progression are of great importance. The studies performed have shown the high efficacy of vinpocetine (Cavinton®) that has a multifactorial mechanism of action in the treatment and prevention of CI, dizziness, and instability caused by cerebrovascular disease.
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Kravchenko, M. A., O. S. Andreeva, E. V. Gnedovskaya, A. O. Chechetkin, Yu Ya Varakin, E. V. Oshchepkova, and M. A. Piradov. "Hypertensive crisis as cerebrovascular disease risk factor." Systemic Hypertension 15, no. 2 (June 15, 2018): 60–64. http://dx.doi.org/10.26442/2075-082x_2018.2.60-64.
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Objective. To assess main epidemiological indicators for hypertensive crises (HC) in the population of productive age and to study possible correlations of crisis associated arterial hypertension (AH) with clinical and instrumental phenomenon of chronic cerebrovascular diseases. Materials and methods. Data of several studies presented: cross-sectional studies of 726 people aged 35-64 and 415 people aged 40-59. Observational cohort study of 109 patients aged 57.4±5.8 with uncomplicated AH. For the detection of HC in anamnesis, there were used special criteria which widens standard HC definition for additional account of light and mild severity cases. Results. Overall AH prevalence was 45% (95% CI 41-51), in men - 48% (40.2-55.9), in women - 45% (38.4-51.6). History of HC in anamnesis was 11.8% (95% CI 9-15.2), in men 8.8% (5.4-14) and in women - 13.8% (10-18.7). Proportion of HC associated AH defined at the level of 25-30% of all AH cases. The most prevalence of HC associated AH was found in people with “high normal” (130-139/85-89) arterial pressure - 37%. Prevalence of the complaints on headaches, dizziness, poor memory and lower intellectual productivity was higher in people with HC. Chronic cerebrovascular disease was found 2-fold frequently in HC associated AH. But in generally analysis of possible correlations of HC with clinical and instrumental phenomenon of chronic cerebrovascular diseases didn’t revealed any statistically significant differences. Conclusion. HC burden for healthcare system is serious, because it is important risk factor for cerebrovascular diseases and associated with significant lowering of the quality of life. Prevalence of the HC cases with light and mild severity is underestimated. Despite that the study of the most prevalent forms of HC (rare, light and mild severity) didn’t find any associations with morphological or persistent clinical pathology, functional phenomenon were found statistically significant frequently.
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Woods, Robyn L., John J. McNeil, and Anne Murray. "ASPREE SUB-STUDIES." Innovation in Aging 3, Supplement_1 (November 2019): S634. http://dx.doi.org/10.1093/geroni/igz038.2361.
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Abstract To maximize opportunities provided by a large-scale clinical trial, we established sub-studies during the ASPREE trial to investigate specific areas of interest to the health of older persons. A biobank now stores multiple aliquots of blood, urine or saliva collected from >15,000 healthy ASPREE participants across the US and Australia, most at baseline (pre-randomization) and/or after 3 years post- randomization. Other sub-studies included ALSOP (ASPREE Longitudinal Study of Older Persons; sets of questionnaires administered every 2 years focused on medical or social issues) and neuroimaging projects with brain MRI and retinal vascular imaging to investigate anatomical changes linked with cognitive or cerebrovascular outcomes. Further sub-studies addressed the impact of aspirin on cerebral microhemorrhages, age-related macular degeneration, age-related hearing loss, severe sepsis, and falls and fractures. Biomarker analyses underway include plasma androgens in older women and DNA sequencing of the cohort to investigate contributions of genomics to aging health and disease.
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Diener, Hans-Christoph, Tobias Kurth, and Dagny Holle. "Practical implications of the migraine cardio- and cerebrovascular association: Unmet needs of patients." Cephalalgia 35, no. 2 (October 16, 2014): 140–45. http://dx.doi.org/10.1177/0333102414554662.
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Background Numerous studies have described a relationship between migraine and stroke, and there is emerging evidence that migraine is also associated with cardiovascular disease. The combination of migraine and both cerebrovascular and cardiovascular disease has implications for therapy. Methods We conducted a review of the modifications in medical therapy in patients with comorbid migraine and cardio- and cerebrovascular disorders based on publications from the last 15 years. Results Some drugs are contraindicated to treat migraine attacks (ergots, triptans) or for migraine prevention in patients after transient ischemic attack (TIA)/ischemic stroke. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are contraindicated in patients with cerebral bleeding. Some drugs for the treatment of acute migraine attacks are contraindicated in patients with symptomatic coronary heart disease. Conclusions Given the large number of patients with comorbid migraine and cardiovascular as well as cerebrovascular disease, there is an unmet need to treat these patients.
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Roldan, Carlos A., Wilmer L. Sibbitt, Ernest R. Greene, Clifford R. Qualls, and Rex E. Jung. "Libman-Sacks endocarditis and associated cerebrovascular disease: The role of medical therapy." PLOS ONE 16, no. 2 (February 16, 2021): e0247052. http://dx.doi.org/10.1371/journal.pone.0247052.
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Background Libman-Sacks endocarditis in patients with systemic lupus erythematosus (SLE) is commonly complicated with embolic cerebrovascular disease (CVD) or valve dysfunction for which high-risk valve surgery is frequently performed. However, the role of medical therapy alone for Libman-Sacks endocarditis and associated acute CVD remains undefined. Objective To determine in this cross-sectional and longitudinal study if conventional anti-inflammatory and anti-thrombotic therapy may be an effective therapy in SLE patients with Libman-Sacks endocarditis and associated acute CVD. Methods and materials 17 SLE patients with Libman-Sacks endocarditis detected by two-and-three-dimensional transesophageal echocardiography (TEE) and complicated with acute CVD [stroke/TIA, focal brain injury on MRI, or cognitive dysfunction] were treated with conventional anti-inflammatory and anti-thrombotic therapy for a median of 6 months and then underwent repeat TEE, transcranial Doppler, brain MRI, and neurocognitive testing for re-assessment of Libman-Sacks endocarditis and CVD. Results Valve vegetations decreased in number, diameter, and area (all p ≤0.01); associated valve regurgitation significantly improved (p = 0.04), and valve thickening did not progress (p = 0.56). In 13 (76%) patients, valve vegetations or valve regurgitation resolved or improved in number and size or by ≥1 degree, respectively, as compared to 4 (24%) patients in whom vegetations or valve regurgitation persisted unchanged or increased in size or by ≥1 degree (p = 0.03). Also, cerebromicroembolism, lobar and global gray and white matter cerebral perfusion, ischemic brain lesion load, and neurocognitive dysfunction resolved or significantly improved (all p ≤0.04). Conclusion These preliminary data suggest that combined conventional anti-inflammatory and antithrombotic therapy may be an effective treatment for Libman-Sacks endocarditis and its associated CVD and may obviate the need for high-risk valve surgery.
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Ringleb, Peter, Robert Stingele, and Werner Hacke. "Thrombolysis in Acute Cerebrovascular Disease: Indications and Limitations." Thrombosis and Haemostasis 82, no. 08 (1999): 983–86. http://dx.doi.org/10.1055/s-0037-1615942.
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IntroductionLarge-scale trials have shown that thrombolytic therapy reduces mortality and preserves left ventricular function in patients with acute myocardial infarction (AMI). As most ischemic strokes are thromboembolic in origin,1 there appears to be a rationale for the use of thrombolytic agents in the management of ischemic stroke.Thrombolytic agents differ in their mechanisms of action, but in general, they act by promoting the conversion of plasminogen into plasmin, resulting in fibrin degradation and clot dissolution. Streptokinase and recombinant tissue plasminogen activator (rt-PA) are the agents that have been the most widely investigated in stroke studies. Ancrod, the active agent in the venom of the Malayan pit viper, is primarily considered an anticoagulant, although it does stimulate endogenous t-PA release from the vascular endothelium and may enhance local thrombolysis. Urokinase is used in local, intra-arterial thrombolysis but has not been subjected to large clinical trials since computed tomography (CT) diagnosis became widely available.
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Brickman, Adam M., Giuseppe Tosto, Jose Gutierrez, Howard Andrews, Yian Gu, Atul Narkhede, Batool Rizvi, et al. "An MRI measure of degenerative and cerebrovascular pathology in Alzheimer disease." Neurology 91, no. 15 (September 14, 2018): e1402-e1412. http://dx.doi.org/10.1212/wnl.0000000000006310.
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ObjectiveTo develop, replicate, and validate an MRI-based quantitative measure of both cerebrovascular and neurodegeneration in Alzheimer disease (AD) for clinical and potentially research purposes.MethodsWe used data from a cross-sectional and longitudinal community-based study of Medicare-eligible residents in northern Manhattan followed every 18–24 months (n = 1,175, mean age 78 years). White matter hyperintensities, infarcts, hippocampal volumes, and cortical thicknesses were quantified from MRI and combined to generate an MRI measure associated with episodic memory. The combined MRI measure was replicated and validated using autopsy data, clinical diagnoses, and CSF biomarkers and amyloid PET from the Alzheimer's Disease Neuroimaging Initiative.ResultsThe quantitative MRI measure was developed in a group of community participants (n = 690) and replicated in a similar second group (n = 485). Compared with healthy controls, the quantitative MRI measure was lower in patients with mild cognitive impairment and lower still in those with clinically diagnosed AD. The quantitative MRI measure correlated with neurofibrillary tangles, neuronal loss, atrophy, and infarcts at postmortem in an autopsy subset and was also associated with PET amyloid imaging and CSF levels of total tau, phosphorylated tau, and β-amyloid 42. The MRI measure predicted conversion to MCI and clinical AD among healthy controls.ConclusionWe developed, replicated, and validated an MRI measure of cerebrovascular and neurodegenerative pathologies that are associated with clinical and neuropathologic diagnosis of AD and related to established biomarkers.