Prestroke dementia in patients with atrial fibrillation

Background and purpose

Prestroke dementia is frequentbut usually not identified.Non–valvular atrial fibrillation(NVAF) is independently associatedwith an increased risk for dementia.However, the frequencyand determinants of prestroke dementiain patients with NVAF havenever been evaluated.

Objective

The aim of this study was to determinethe frequency of prestrokedementia and associated factors inpatients with a previously knownNVAF.

Methods

This is an ancillarystudy of Stroke in Atrial FibrillationEnsemble II (SAFE II), an observationalstudy conducted in patientswith a previously knownNVAF, consecutively admitted foran acute stroke in French and Italiancenters. Prestroke dementiawas evaluated by the IQCODE inpatients with a reliable informant.Patients were considered as dementedbefore stroke when theirIQCODE score was ≥ 104.

Results

of204 patients, 39 (19.1%; 95% confidenceinterval [CI]: 13.7%–24.5%)patients met criteria for prestrokedementia. The only variable independentlyassociated with prestrokedementia was increasing age(adjusted odds ratio for 1 year increasein age: 1.10; 95 % CI:1.04–1.17), and there was a nonsignificanttendency for previousischemic stroke or TIA and arterialhypertension.

Conclusion

One fifthof stroke patients with a previouslyknown NVAF were already dementedbefore stroke. The maindeterminant of prestroke dementiais increasing age. A large cohort isnecessary to identify other determinants.

     

Prestroke Sarcopenia and Stroke Severity in Elderly Patients with Acute Stroke

Objective: The association between prestroke sarcopenia and stroke severity has not been evaluated previously. The purpose of this study was to determine whether prestroke sarcopenia is associated with stroke severity in elderly patients with acute stroke. Methods: We assessed prestroke sarcopenia of elderly patients with acute stroke by using a questionnaire for sarcopenia (SARC-F). Patients were divided into groups according to their SARC-F score: SARC-F score less than 4 (nonsarcopenia) and SARC-F score ≥4 (prestroke sarcopenia). Stroke severity was assessed according to the National Institute of Health Stroke Scale. Logistic regression was used to derive crude and adjusted odds ratio for the presence of prestroke sarcopenia and stroke severity. Results: Among the 183 patients enrolled (age, median [interquartile range]: 75 [11] years; 103 men), the prevalence of prestroke sarcopenia was 15% (n = 27). Crude odds ratio for the presence of prestroke sarcopenia and moderate-to-severe stroke (National Institute of Health Stroke Scale score > 5) was 4.00 (95% confidence interval, 1.68-9.53; P = .002). After adjusting for confounding variables (age, sex, and stroke risk factors), the presence of prestroke sarcopenia remained an independent predictor of severe stroke, with an odds ratio of 3.54 (95% confidence interval, 1.32-9.49; P= .01). Conclusions: Prestroke sarcopenia can predict moderate to severe stroke in elderly patients with acute stroke.     

中风前抗轴突生长抑制因子DNA免疫促进脑缺血后神经再生

目的为了澄清中风前抗轴突生长抑制因子DNA免疫对局部脑缺血神经再生的促进作用。方法经腓肠肌注射抗轴突生长抑制因子DNA疫苗免疫动物，每周一次，共6W；血清中检测出相关抗体后，采用永久性阻断大脑中动脉的方法制备左侧局部脑缺血模型，通过立体定向脑内注射生物素化葡聚糖胺（BDA）追踪皮质红核束的新生轴索。结果中风前接受抗轴突生长抑制因子DNA免疫，局部脑缺血后皮质红核束的代偿性新生轴索明显增多。结论中风前抗轴突生长抑制因子DNA免疫可提高永久性局部脑缺血后的神经再生。     

Prestroke Conditions of Acute Ischemic Stroke Patients are Associated with Functional Outcome after Mechanical Thrombectomy

Background and AimMechanical thrombectomy was demonstrated to be useful for acute ischemic stroke. However, whether it is beneficial for patients with poor prestroke conditions, such as older adults and those with low activity of daily living, is unclear.MethodsA total of 134 patients who underwent mechanical thrombectomy in our hospital between April 2015 and January 2019 were retrospectively evaluated. Good outcome was defined as modified Rankin scale score of 0-2 at 90 days after stroke onset. Several factors were analyzed to assess their effects on clinical outcomes.ResultsAt 90 days after stroke onset, 37.3% (50 of 134) of patients had a good outcome. Prestroke modified Rankin scale score was independently associated with a good outcome (odds ratio .39, 95% confidence interval .22-.67, P < .001). In patients with prestroke modified Rankin scale score 0-1, 55.4% (46 of 83) had a good outcome, and no significant difference in prognosis was found between patients aged less than 80 years and those aged greater than or equal to 80 years (P = .64). More than half the patients with prestroke modified Rankin scale score greater than or equal to 2 were graded as modified Rankin scale score 5-6 at 90 days regardless of age, which was significantly higher than those with prestroke modified Rankin scale score 0-1 (P < .001).ConclusionsPatients with prestroke modified Rankin scale score 0-1 are expected to have a good prognosis after mechanical thrombectomy even if aged greater than or equal to 80 years. Patients with prestroke modified Rankin scale score greater than or equal to 2 might have an extremely poor prognosis, and we should be more careful in selecting candidates for mechanical thrombectomy.     

The dementia of dementia praecox

A group of 18 long-stay patients with a diagnosis of schizophrenia were compared with a group of 10 age-matched subjects who had been institutionalized by reason of physical disease, on performance on tests of intellectual function; and with a group of agematched healthy subjects, both on tests of intellectual function, and radiographically, using the technique of computerized axial tomography (EMI scan) of the brain. By comparison with the normal controls the patients with schizophrenia had increased cerebral ventricular size (assessed as cross-sectional area) and, by comparison with both control groups, showed substantial impairments on intellectual testing. The differences in ventricular area between patients and controls remained significant (P < 0.01) after four patients who had been leucotomized had been excluded. Within the non-leucotomized patient group ventricular area was unrelated to previous neuroleptic medication, ECT or insulin coma therapy, but there was a significant relationship between ventricular area and intellectual impairment (P < 0.01). Intellectual impairment, as assessed by the Withers & Hinton test battery, the Inglis paired associate learning test, and the digits-backward test, was greater (P < 0.05) in patients with negative features (affective flattening, retardation, poverty of speech) than in those without such features. Premorbid occupational histories suggested that nearly all of these patients had at one time functioned at an adequate intellectual level. The findings suggest that within the group of patients with schizophrenia there is a subgroup whose illnesses have hitherto been considered typically schizophrenic, who have severe intellectual impairment associated with evidence of structural brain disease. The size of this subgroup and the significance of the cerebral changes remain to be determined.     

Determinants Influencing the Prestroke Health Behaviors and Cardiovascular Disease Risk of Stroke Patients: A Cross-Sectional Study

Background: Knowledge about stroke and stroke prevention may provide motivation to lead a healthy lifestyle to prevent stroke. The goal of this study is to quantify the knowledge of stroke and stroke prevention of patients with a recent stroke and its association with health behaviors and cardiovascular disease risk. Methods: We conducted a prospective cross-sectional study utilizing consecutive stroke admissions at 2 hospitals in Vancouver, Canada. We included patients within 48-72 hours of admission. Stroke knowledge was measured prior to any hospital education. The Health-Promoting Lifestyle Profile II (HPLP II), a 52-item self-report scale was used to quantify health behavior for the week prior to the stroke. The cardiovascular risk score was calculated. Hierarchical multiple regression was used to assess the determinants of HPLP II and cardiovascular disease risk. Results: We enrolled patients with primarily mild stroke (n = 100). The mean age of participants was 66.6 ± 13.6 years and 60% were male. The participants had poor knowledge of stroke symptoms and risk factors. In the first regression analysis, the final model explained 27% of the variance in health behavior (F (6, 93) = 5.69, p = <0.001) with only age and knowledge of risk factors as statistically significant variables. In the second regression analysis, the final model explained 15% of the variance in cardiovascular disease risk (F (7, 84) = 2.163, p = 0.046) with only physical activity remaining as a statistically significant variable. Conclusion: The findings would inform the development of novel programs to improve the knowledge and health behavior for prevention of stroke.     

Primary alcoholic dementia and alcohol-related dementia

Clinicopathological issues regarding so‐called ‘alcoholic dementia’ remain under debate. Although clinical observation favors the diagnosis of primary alcohol dementia, caused by direct alcohol neurotoxicity, further confirmation from neuropathological and biochemical perspectives is warranted. Repeat episodes of subclinical Wernicke–Korsakoff’s syndrome may partially account for the chronic state of primary alcoholic dementia, thus supporting the notion that primary alcoholic dementia exists in continuum with chronic and subclinical types of Wernicke–Korsakoff’s syndrome. Diagnostic criteria for alcohol related dementia, as detailed by Oslin et al., represent a purer form of alcoholic dementia and are useful for the scientific discussion of this condition.