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1.
Akshya Vasudev Susana G. Torres-Platas Karin Kerfoot Angela Potes Joseph Therriault Anthony Gifuni Marilyn Segal Karl J. Looper Vasavan Nair Helen Lavretsky Soham Rej 《The American journal of geriatric psychiatry》2019,27(5):536-547
Background
Current pharmacological treatments and psychotherapeutic approaches often have adverse effects or are ineffective in late-life cognitive and mental illnesses. Mind-body interventions offer a holistic approach and are of interest because of potential patient acceptability and scalability.Objective
To synthesize current evidence on mind-body interventions in treating or preventing mental illnesses and cognitive disorders in older adults.Search Strategy
A search was conducted using Ovid MEDLINE, EMBASE, and PsycINFO articles published from 1993 to 2017.Selection Criteria
1) Randomized controlled trials, 2) involving older adults (>60 years old), 3) suffering from mental illness or cognitive decline, 4) comparing mind-body interventions with a control group. Mind-body interventions included: imagery, meditation, prayer, autogenic training, tai chi & variants, and yoga. Control group included: health education, other non-pharmacological interventions, treatment as usual, or no treatment at all.Data Collection and Analysis
Data included number of patients, age, psychiatric diagnoses, type of intervention, frequency andduration, control conditions, outcomes measures and treatment results.Results
3916 articles were reviewed and ten met inclusion criteria. Six were on Tai Chi and four assessed meditation-based therapies. Clinically significant improvement in depressive and anxiety symptoms were reported, as well as improvement insomedomains of cognition and reduced risk of cognitive deterioration.Conclusion
There is increasing evidence that mind-body interventions may potentially be useful in the treatment or prevention of geriatric mental illnesses and cognitive disorders. There are important methodological limitations of the current literature such as small sample sizes, heterogeneous study populations, and varying clinical outcomes. 相似文献2.
Christine E. Gould Brian C. Kok Vanessa K. Ma Julie Loebach Wetherell Keith Sudheimer Sherry A. Beaudreau 《The American journal of geriatric psychiatry》2019,27(5):514-525
Objective
The study's aim was to demonstrate the feasibility and preliminary efficacy of a 4-week video-delivered relaxation program called Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE) for reducing anxiety and increasing activity engagement in older adults with anxiety disorders.Methods
This was an 8-week pilot randomized controlled trial performed as outpatient and self-directed learning at home among 40 community-dwelling adults aged 60years or older who met criteria for an anxiety disorder (generalized anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, or anxiety disorder unspecified). The study looked at the BREATHE intervention compared with a wait list control condition. The primary outcome measure was anxiety symptoms (Geriatric Anxiety Scale). Secondary outcomes included activity engagement (modified Activity Card Sort), depressive symptoms (Patient Health Questionnaire), and somatic symptoms (Somatic Symptom Scale).Results
In linear mixed-effects models, findings indicated a significant reduction in anxiety symptoms. There was no significant effect of group on activity engagement. Results also showed significant reductions in depressive and somatic symptoms associated with the BREATHE intervention compared with wait list.Conclusion
Our findings demonstrate feasibility and preliminary efficacy for this brief video-delivered relaxation intervention and suggest that older adults can benefit from technology-delivered interventions with minimal provider contact. Although activity engagement did not improve, lessons learned suggest that targeted coaching around activity goals may help target this outcome. 相似文献3.
Amanda J.F. Tamman Janitza L. Montalvo-Ortiz Steven M. Southwick John H. Krystal Becca R. Levy Robert H. Pietrzak 《The American journal of geriatric psychiatry》2019,27(5):528-532
Objective
The aim of this study was to identify how a broad range of sociodemographic, military, health, and psychosocial factors relate to accelerated DNA methylation aging (Δage) in a large, contemporary, nationally representative sample of male U.S. veterans.Methods
Data were analyzed from a sample of U.S. male European-American veterans who participated in the National Health and Resilience in Veterans Study (N?=?1,135).Results
Psychosocial factors of lifetime trauma burden, child sexual trauma, and negative beliefs about aging were independently associated with Δage. Three health variables—diabetes, hypertension, and body mass index—emerged as additional correlates of Δage.Conclusion
Results of the study build on prior work demonstrating associations between accelerated DNA methylation aging and traumatic stress, highlighting a role for child sexual abuse in particular. They further underscore the importance of targeting negative beliefs about aging, which are modifiable, in prevention efforts designed to forestall accelerated DNA methylation aging. 相似文献4.
Arnabh Basu Nidhi Goel Sowmya Puvvada Theresa Jacob 《The American journal of geriatric psychiatry》2019,27(5):564-568
Objective
Hoarding behavior is not limited to obsessive-compulsive disorder (OCD) alone. With the objective of highlighting the association between hoarding behavior and common psychiatric disorders, we explored its occurrence in psychiatric inpatients and co-occurrence with Axis I diagnoses.Methods
In this prospective cohort study, we enrolled adult psychiatric inpatients by simple random sampling at an urban, community-based, academic medical center. Patients were screened for hoarding using the validated Hoarding Rating Scale-Interview, and those meeting criteria for clinically significant hoarding were assessed for Axis I disorders.Results
Clinically significant hoarding was observed in 33% of the 200 acute psychiatry patients admitted to the study. Mood disorders were positively associated with hoarding (p?=?0.033), whereas psychotic spectrum disorders had a weaker association with it (p?=?0.015).Conclusion
This study indicates a need for clinicians to be mindful that hoarding manifests in many forms of mental illness and is not limited to OCD alone. 相似文献5.
Adam Simning Julie Kittel Yeates Conwell 《The American journal of geriatric psychiatry》2019,27(4):381-390
Objective
The aim of this study was to determine whether patients who received rehabilitation services had an increased risk of having late-life depressive or anxiety symptoms within the year following termination of services.Methods
The National Health and Aging Trends Study (NHATS) is a population-based, longitudinal cohort survey of a nationally representative sample of Medicare beneficiaries aged 65years and older. This study involved 5,979 participants from the 2016 NHATS survey. The Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item assessed for clinically significant depressive and anxiety symptoms.Results
The prevalence of depressive and anxiety symptoms was higher in older adults who had received rehabilitation services in the year prior and varied by site: no rehabilitation (depressive and anxiety symptoms): 10.4% and 8.8%; nursing home or inpatient rehabilitation: 38.8% and 23.8%; outpatient rehabilitation: 8.6% and 5.5%; in-home rehabilitation: 35.3% and 20.5%; multiple rehabilitation sites: 20.3% and 14.4%; and any rehabilitation site: 18.4% and 11.8%. In multiple logistic regression analyses, nursing home and inpatient and in-home rehabilitation services, respectively, were associated with an increased risk of having subsequent depressive symptoms (odds ratio: 3.51; 95% confidence interval [CI]: 1.85–6.63; OR: 2.15; 95% CI: 1.08–4.30) but not anxiety symptoms.Conclusion
Older adults who receive rehabilitation services are at risk of having depressive and anxiety symptoms after these services have terminated. As mental illness is associated with considerable morbidity and may affect rehabilitation outcomes, additional efforts to identify and treat depression and anxiety in these older adults may be warranted. 相似文献6.
Dominique A. Cadilhac Monique F. Kilkenny Natasha A. Lannin Helen M. Dewey Christopher R. Levi Kelvin Hill Brenda Grabsch Rohan Grimley David Blacker Amanda G. Thrift Sandy Middleton Craig S. Anderson Geoffrey A. Donnan 《Journal of stroke and cerebrovascular diseases》2019,28(5):1302-1310
Background
The quality of care and outcomes for people who experience stroke whilst in hospital for another condition has not been previously studied in Australia.Aims
To explore differences in long-term outcomes among patients with in-hospital events treated in stroke units (SUs) compared to those managed in other hospital wards.Methods
Forty-five hospitals participating in the Australian Stroke Clinical Registry between January 2010 and December 2014 contributed data. Survival of all patients with in-hospital stroke to 180 days after stroke and health-related quality of life, using EQ-5D-3L among 73% eligible, were compared using multilevel, multivariable regression models. Models were adjusted for age, sex, index of relative socioeconomic disadvantage, ability to walk, stroke type, transfer from another hospital, and history of stroke.Results
Among 20,786 stroke events, 1182 (5.1%) occurred in-hospital (median age 77 years, 49% male). Patients with in-hospital stroke treated in SUs died less often within 30 days (Hazard Ratio 0.56; 95% CI 0.39-0.81) than those not admitted to SUs. Survivors reported similar health-related quality of life between 90 and 180 days compared to those treated in other wards (coefficient?=?0.01, 95% CI –0.06-0.09, P?=?.78). Patients managed in SUs more often received recommended management (e.g. swallowing screening).Conclusion
The benefits of SU care may extend to patients experiencing in-hospital stroke. Validation, including accounting for potential residual confounding factors, is required. 相似文献7.
Objective
No studies have estimated the difference in suicidal ideation, plans, and attempts for lesbian, gay, or bisexual (LGB) adults aged 50+ compared with heterosexuals using nationally representative data.Methods
We used 2015–2017 National Survey on Drug Use and Health data to estimate the prevalence of self-reported suicidal ideation, plans, and attempts for LGB adults 50+ compared with heterosexuals in the preceding 12 months.Results
Over 185,000 LGB adults aged 50+ in the United States were estimated to have had suicidal ideation in the preceding year. After adjusting for sex and race/ethnicity, LGB individuals aged 50+ had a 4.5 percentage point higher prevalence of suicidal ideation compared with heterosexuals (prevalence difference [PD]: 0.045; 95% confidence interval [CI]: 0.022, 0.067). Of those with suicidal ideation, LGB individuals aged 50+ had a 17.2 percentage point higher prevalence of suicide plans compared with heterosexuals (PD: 0.172; 95% CI: 0.011, 0.332).Conclusion
LGB adults in middle and older age have higher suicidal ideation and plans than heterosexual peers. 相似文献8.
9.
Xiaofan Guo Zhao Li Ying Zhou Shasha Yu Hongmei Yang Liqiang Zheng Yamin Liu Yingxian Sun 《Journal of stroke and cerebrovascular diseases》2019,28(4):1062-1069
Background
Stroke burden is extremely high in Chinese hypertensive population. Novel biomarkers for cardiovascular diseases can be detected by metabolomic profiling of human fluids. We aim to find a panel of distinctive plasma metabolites for predicting incident ischemic stroke in hypertensive patients.Methods
This is a nested case-control study from a prospective cohort design. Baseline plasma samples were collected from 66 newly developed ischemic stroke cases and 66 matched controls. Untargeted metabolomics was performed by ultra-high performance liquid chromatography-tandem mass spectrometry, and data were analyzed by multivariate and univariate statistics.Results
Plasma metabolite profiles clearly differed between hypertensive patients with incident ischemic stroke and without. A total of 12 metabolites were screened and identified as potential biomarkers. The altered metabolic pathways included retinol metabolism, sphingolipid metabolism, glycerophospholipid metabolism, lysine degradation, tyrosine metabolism, and tryptophan metabolism. For prediction of hypertensive ischemic stroke, the panel of specific metabolomics-based biomarkers provided area under the curve of 0.848 (95% confidence interval: 0.783-0.913).Conclusions
Our study identified a metabolic signature of incident ischemic stroke in hypertension. Differences in small-molecule metabolites hold translational value in prediction and provide insights into potential new mechanisms of this condition. 相似文献10.
Karolina Skagen Siri Opsahl Hetlevik Mahtab Zamani Vibke Lilleby Mona Skjelland 《Journal of stroke and cerebrovascular diseases》2019,28(5):1295-1301
Background
This study investigated preclinical atherosclerosis in patients with juvenile mixed connective tissue disease (JMCTD), which is a chronic inflammatory disease with a varied phenotype. Mixed connective tissue disease (MCTD) has well known associations with other autoimmune diseases known to have increased risk of cardiovascular disease. However, the cardiovascular risk for patients with the juvenile form remains unclear.Materials and methods
Forty-nine patients with JMCTD and 45 age-and sex-matched controls took part in this study. They underwent blood tests, clinical examination, and ultrasound measurement of the carotid arteries.Results
We found that patients had significantly higher average carotid intima-media thickness (IMT) as compared to controls (mean 0.57 ± 0.09 versus 0.53 ± 0.06, P?=?.03). IMT also increased with both increasing disease duration (years from diagnosis), and severity as assessed by the physicians global assessment score, after adjustment for age.Conclusions
This is the first study to demonstrate increased preclinical atherosclerosis in juvenile MCTD. Our findings suggest that the atherosclerotic burden in this patient group, which was independent of traditional cardiovascular risk factors, might be secondary to the underlying connective tissue disease. 相似文献11.
Danielle S. Jackson Samprit Banerjee Jo Anne Sirey Cristina Pollari Nili Solomonov Richard Novitch Alexandra Chalfin Yiyuan Wu George S. Alexopoulos 《The American journal of geriatric psychiatry》2019,27(5):502-511
Objective
Clinically significant depression occurs in approximately 40% of chronic obstructive pulmonary disease (COPD) patients, and both illnesses severely impair quality of life. This study tests the hypothesis that problem-solving integrated with a treatment adherence intervention, the Problem Solving-Adherence (PSA), is superior to a personalized treatment adherence intervention, the Personalized Intervention for Depressed Patients with COPD (PID-C), alone in improving quality of life in depressed COPD patients.Methods
After screening 633 admissions for acute rehabilitation, we studied quality of life in 87 participants with major depression (by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and severe COPD randomly assigned to 14 sessions of PID-C or PSA over 26 weeks. Quality of life was assessed using the Word Health Organization Quality of Life-BREF at baseline and weeks 10, 14, and 26.Results
The hypothesis was not supported. Exploratory latent class growth modeling identified two quality of life trajectories. In 80.5% of participants, quality of life remained unchanged and improved in the remaining 19.5% during the first 14 weeks. Patients with a stable quality trajectory had higher qualityof life at baseline and a stronger sense of personal agency.Conclusion
Maintaining quality of life is a favorable outcome in depressed patients with COPD whose course is one of deterioration. These findings highlight the usefulness of PID-C, an easy to learn, personalized adherence enhancement intervention that, after further testing, may be integrated into the rehabilitation and care of depressed COPD patients. 相似文献12.
Elizabeth K. Vernon Bryce Cooley William Rozum Gail B. Rattinger Stephanie Behrens Joshua Matyi Elizabeth Fauth Constantine G. Lyketsos JoAnn T. Tschanz 《The American journal of geriatric psychiatry》2019,27(4):349-359
Objective
Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs.Methods
Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002–2012).Results
In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed ?0.32 points per year for the psychosis cluster, ?0.11 points per year for agitation/aggression, and ?0.67 overall for the affective cluster.Conclusion
Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention. 相似文献13.
Kui Kai Lau Anderson Chun On Tsang Kay Cheong Teo Hoi Lam Li Lawrence KW Chu Justin Chung Hin Li Morgan KC Chan Vanessa Hang Lam Wan Edward S Hui Henry Ka Fung Mak 《Journal of stroke and cerebrovascular diseases》2019,28(5):1274-1280
Background
Recent studies in Caucasians with transient ischaemic attack or ischaemic stroke have demonstrated significant age-specific associations between cerebral small vessel disease (SVD) burden on magnetic resonance imaging and renal impairment. We aimed to validate these findings in a large cohort of Chinese with ischaemic stroke.Methods
In 959 Chinese with ischaemic stroke who received a brain magnetic resonance imaging at the University of Hong Kong, we determined the age-specific associations of renal impairment (glomerular filtration rate < 60 mL/min/1.73 m2) with neuroimaging markers of SVD as well as with the SVD score.Results
Although renal impairment was associated with the SVD score in univariate analysis in all patients (odds ratio 1.61, 95% confidence interval 1.24-2.09, P < .0001), these associations were attenuated after adjusting for age and sex (P?=?.38). Similar findings were noted in patients with ischaemic stroke due to SVD and non-SVD subtypes. However, in 222 of 959 patients aged <60, renal impairment was independently associated with an increasing microbleed (adjusted odds ratio 6.82, 2.26-20.59), subcortical (4.97, 1.62-15.24) periventricular white matter hyperintensity (3.96, 1.08-14.51) and global SVD burden (3.41, 1.16-10.04; all P < .05) even after adjusting for age, sex, and vascular risk factors. Nevertheless, there were no associations between renal impairment and individual neuroimaging markers of SVD nor with the SVD score in patients aged ≥60 after adjusting for age and sex (all P > .05).Conclusions
In Chinese with ischaemic stroke, renal impairment was independently associated with microbleed, white matter hyperintensity and global SVD burden in individuals aged <60, but not in those aged ≥60, suggesting that there may be shared susceptibilities to premature systemic disease. 相似文献14.
Carolyn W. Zhu Hillel T. Grossman Mary Sano 《The American journal of geriatric psychiatry》2019,27(4):395-405
Objective
Apathy is common in Alzheimer disease (AD) and has a far-reaching impact on patients’ clinical course and management needs. However, it is unclear if apathy is an integral component of AD or a manifestation of depression in cognitive decline. This study aims to examine interrelationships between apathy, depression, and function.Methods
This was a cross-sectional study of well-characterized AD patients in the National Alzheimer's Coordinating Center Uniform Data Set with a Clinical Dementia Rating (CDR) between 0.5 and 2. Participants’ function was measured using the Functional Assessment Questionnaire. Apathy and depression were measured using clinician judgment and informant-reported Neuropsychiatric Inventory–Questionnaire. Dementia severity was categorized by CDR.Results
Sample included 7,679 participants (55.7% men) with a mean (standard deviation) age of 74.9 (9.7) years; 3,197 (41.6%) had apathy based on clinician judgment. Among those with apathy, approximately half had no depression. Presence of apathy was associated with 21%, 10%, and 3% worsening in function compared with those without apathy in CDR 0.5, 1, and 2 groups, respectively. Depression was not independently associated with functional status. Results revealed no interaction between apathy and depression.Conclusion
Apathy, but not depression, was significantly associated with worse function, with the strongest effects in mild dementia. Results emphasize the need for separate assessments of apathy and depression in the evaluation and treatment of patients with dementia. Understanding their independent effects on function will help identify patients who may benefit from more targeted management strategies. 相似文献15.
Rebecca S.Y. Teng Benjamin Y.Q. Tan Samuel Miny Nicholas L. Syn Andrew F.W. Ho Nicholas J.H. Ngiam Leonard L.L. Yeo Andrew M. Choong Vijay K. Sharma 《Journal of stroke and cerebrovascular diseases》2019,28(4):906-919
Background
Blood pressure (BP) is an important determinant of functional outcome in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA). Current guidelines recommend a BP target of 185/110 mmHg before IV-tPA bolus and maintaining it at less than 180/105 mmHg for the first 24 hours. However, the effect of blood pressure on various outcome measures after systemic thrombolysis remains unclear.Methods
Following a systematic search of Medline and EMBASE, all observational studies reporting effect of pretreatment BP on 90-day functional outcome as measured by the modified Rankin Scale (mRS) and/ or incidence of symptomatic intracranial hemorrhage (sICH) in AIS patients receiving thrombolytic therapy were included.Results
Of 2181 studies screened, 26 studies, involving 38,937 subjects, met inclusion criteria. Higher prethrombolysis systolic BP was significantly-associated with poorer 90-day functional outcome (Mean difference 3.87 mmHg; 95% confidence interval [CI] 1.18-6.56) and increased incidence of sICH (Mean difference 5.31; 95% CI 2.22-8.40). When studies were stratified by different cut-offs for functional outcome (mRS 0-1 versus 0-2) and definitions of sICH used (Randomized controlled trials or SITS-MOST), there was no significant difference in mean difference between the subgroups.Conclusions
Our data showed that higher prethrombolysis SBP was associated with poorer outcomes in thrombolysed acute ischemic stroke patients. This may suggest that more aggressive lowering of BP below the current recommendations prior to thrombolysis could be beneficial. The effect of early BP trends after tPA infusion could not be evaluated due to limited available data. Ongoing randomized clinical trials, like ENCHANTED, may provide further insights into the current guidelines and optimal BP levels. 相似文献16.
Winnie Qian Tom A. Schweizer Nathan W. Churchill Colleen Millikin Zahinoor Ismail Eric E. Smith Lisa M. Lix David G. Munoz Joseph J. Barfett Tarek K. Rajji Corinne E. Fischer 《The American journal of geriatric psychiatry》2019,27(5):490-498
Objective
Delusions affect approximately a third of Alzheimer disease (AD) patients and are associated with poor outcomes. Previous studies investigating the neuroanatomic correlates of delusions have yet to reach a consensus, with findings of reduced volume across all lobes, particularly in frontal regions. The current study examined the gray matter (GM) differences associated with delusions in AD.Methods
Using voxel-based morphometry, we assessed GM in 23 AD patients who developed delusions (AD+D) and 36 comparable AD patients who did not (AD-D) at baseline and follow-up. Analysis of variance was used to identify consistent differences between AD+D and AD-D patients across time points (main effect of group), consistent changes from baseline to follow-up (main effect of time), and differential changes between AD+D and AD-D over time (interaction of group and time). All data were obtained from the National Alzheimer's Coordinating Center database.Results
The AD+D group had consistently lower frontal GM volume, although both groups showed decreased GM in frontotemporal brain regions over time. An interaction was observed between delusions and longitudinal change, with AD+D patients having significantly elevated GM in predominantly temporal areas at baseline assessment, becoming significantly lower than the AD-D group at follow-up.Conclusion
These findings suggest that, there are specific volumetric markers that distinguish patients with delusions from those without, before, and after the onset of delusions. Specifically, the decline of GM in temporal areas that had elevated levels prior to the onset of delusions may be involved in the manifestation of delusions. 相似文献17.
Background
Intracerebral hemorrhage (ICH) is a subtype of stroke with high disability and mortality. Dexmedetomidine (Dex) has been shown to provide neuroprotection in several neurological diseases. The aim of present study was to investigate the effects of Dex on ICH-induced neurological deficits and brain injury and the underlying mechanisms.Methods
ICH mouse model was established by intracerebral injection of autologous blood, followed by Dex or vehicle treatment. Neurological function, brain water content, neuronal activity, and oxidative parameters were determined. The protein expressions of peroxisome proliferator-activated receptor gamma coactivator 1-α (PGC-1α), uncoupling protein 2, and manganese-dependent superoxide dismutase were examined by western blotting.Results
Dex administration significantly inhibited ICH-induced the memory impairment, dyskinesia, brain edema, and neuron loss. In addition, ICH-induced the increase in brain oxidative stress level was markedly attenuated after Dex treatment, as evidenced by increased glutathione peroxidase and superoxide dismutase levels and reduced malondialdehyde and nitric oxide levels. Compared with vehicle-treated ICH mice, Dex-treated ICH mice showed significantly decreased intracellular reactive oxygen species (ROS) and mitochondrial ROS (mROS) production in brain, but had no effects on the increased nicotinamide-adenine dinucleotide phosphate oxidase activity. However, stimulation of mROS abrogated the inhibitory effects of Dex on neurological deficits and oxidative stress. The decrease in production of adenosine triphosphate and the expressions of PGC-1α, uncoupling protein 2, and manganese-dependent superoxide dismutase induced by ICH was restored by Dex treatment.Conclusions
Our results reveal that Dex improves ICH-induced neurological deficits and brain injury by inhibiting PGC-1α pathway inactivation and mitochondrial dysfunction-derived oxidative stress. 相似文献18.
Liying Xing Shuang Liu Yuanmeng Tian Han Yan Li Jing Kangjing Chen Fei Yan Yingqiu Li Jianfeng Lv Yingxian Sun 《Journal of stroke and cerebrovascular diseases》2019,28(5):1400-1408
Background
Limited data are available on the impact of fasting plasma glucose (FPG) on outcomes in nondiabetic acute ischemic stroke patients.Methods
The prospective, multi-center, and observational study was performed at 8 hospitals in the Liaoning Province between 2015-2016, sought to elucidate the relationship between FPG and the 6-month functional outcomes in nondiabetic acute ischemic stroke patients. The primary effect measure was the adjusted odds ratio for a shift in the direction of unfavorable outcome on the modified Rankin Scale (mRS) score at 6 months, estimated with an ordinal logistic regression, and adjusted for common prognostic factors. Finally, we employed a restricted cubic spline function of linear model to characterize concentration-response (C-R) relationships between FPG and outcomes.Results
A total of 1260 consecutive patients were enrolled, 48.9% of patients had FPG levels >6.1mmol/L. A total of 282 (22.4%) patients achieved an unfavorable neurologic outcome. Patients achieving an unfavorable neurologic outcome had significantly higher levels of FPG than those achieving a favorable neurologic outcome (6.47mmol/L versus 7.02 mmol/L). FPG was significantly related to an unfavorable neurologic outcome in nondiabetic acute ischemic stroke patients. The C-R curve showed a nonlinear relation between FPG and 6-month mRS with the nadir at 5.9mmol/L. Moreover, the likelihood of unfavorable outcome increased by 8.5% for each 1mmol/L increase in FPG.Conclusions
Early identification and prompt hyperglycemia management should be considered to improve the functional outcomes during the early poststroke stage. 相似文献19.
Shoko Hara Masaaki Hori Ryo Ueda Shihori Hayashi Motoki Inaji Yoji Tanaka Taketoshi Maehara Kenji Ishii Shigeki Aoki Tadashi Nariai 《Journal of stroke and cerebrovascular diseases》2019,28(4):1113-1125
Background and Purpose
Chronic ischemia may induce brain microstructural damage and lead to neurocognitive dysfunction in patients with Moyamoya disease (MMD). We applied neurite orientation dispersion and density imaging (NODDI) and 15O-gas positron emission tomography (PET) to elucidate the specific ischemic brain microstructural damage of MMD in the cortex and the white matter.Materials and Methods
Thirty-one patients (16-63years old, 9 males) and 20 age- and sex-matched normal controls were enrolled in this study. NODDI evaluates quantitative parameters reflecting neurite and axonal density, network complexity and the interstitial fluid in all participants. Of 31 patients, 12 newly diagnosed patients were evaluated with PET, also. We evaluated correlations between the microstructural parameters of NODDI and the hemodynamic and metabolic parameters of PET, the relationship between NODDI and clinical severity of each hemisphere (Normal, Asymtpomatic, Symptomatic, and Infarcted) as well as neurocognitive performance.Results
All NODDI parameters significantly correlated with PET parameters (absolute r?=?0.46-0.83, P ≤ .048) and clinical severity (P < .001), suggesting that neurite and axonal density and network complexity decreased, and the interstitial fluid increased, as the ischemic burden became severe. NODDI parameters reflecting neurite and axonal density and network complexity significantly correlated with neurocognitive profiles (r?=?0.36-0.64, P ≤ .048), but the interstitial fluid component did not.Conclusions
Chronic ischemia in patients with MMD may induce decreased neurite and axonal density, simplified network complexity, and may lead to neurocognitive dysfunction. The increased interstitial fluid accompanying hemodynamic impairment may not be identical to the decreased neurite density and might be driven by another mechanism. 相似文献20.
Mark A. Oldham Keith A. Hawkins I-Hsin Lin Yanhong Deng Qing Hao Leslie M. Scoutt David D. Yuh Hochang B. Lee 《The American journal of geriatric psychiatry》2019,27(5):476-486