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Cerebrovascular Risk Factors (cerebrovascular + risk_factor)
Selected AbstractsEffects of physiological aging and cerebrovascular risk factors on the hemodynamic response to brain activation: a functional transcranial Doppler studyEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2007K. Gröschel The influence of the vascular system on the coupling of cerebral blood flow (CBF) to focal brain activation during aging is incompletely understood. Using functional transcranial Doppler sonography and a hypercapnic challenge as a marker of intact cerebral vasoreactivity, we determined CBF velocity (CBFV) changes in response to a language and arithmetic task in a group of 43 healthy young subjects (mean age 32 ± 8.6 years), 18 healthy old subjects (mean age 64 ± 9.8 years) and 29 old subjects with risk factors for an atherosclerosis (mean age 69 ± 8.4 years). Despite a similar performance during the cognitive tasks the CBFV changes were significantly lower in the group of old subjects with vascular risk factors compared with the healthy young and old subjects. Similarly, the CBFV changes during hypercapnia were significantly lower in the group of old subjects with vascular risk factors compared with the healthy young and old subjects. In contrast, both cognitive tasks and hypercapnia produced comparable CBFV changes in the group of healthy young and old subjects. These results suggest that the hemodynamic response to neuronal activation is unaffected by aging alone, whereas the presence of cardiovascular risk factors significantly diminishes the capability of cerebral vessels to react to vasodilating stimuli. [source] Clinical utility of computed tomography in the assessment of dementia: a memory clinic studyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2004Kelly A. Condefer Abstract Objective To define the influence of computed tomography (CT) on clinical decision-making in the outpatient evaluation of dementia. Design A case series in which two physicians reviewed standardised data extracted from clinical records, first blind to CT results, and then with CT results. Clinical decisions made with and without the input of CT were compared. The study was based in an outpatient referral centre for the assessment of memory disorders and dementia. The study involved 146 participants who were diagnosed with dementia after their first clinic visit, had Mini Mental State Examination scores >12, were aged >65 years, and had no history of neurologic disease. Results CT impacted on diagnosis in an average of 12% (±2), and on treatment plan in 11% (±2) of cases. Physicians predicted a priori which cases CT may influence with an average sensitivity of 28% (±2), and specificity of 78.5% (±1.5). There was no statistically significant relationship between diagnostically uncertain cases and helpful CT scans [average ,2,=,1.121 (±1.116), p,=,ns]. Blind to CT physicians appropriately identified cerebrovascular disease with an average sensitivity of 63% (±3), and specificity of 93.5% (±3.5). Conclusions In the outpatient setting, CT may be expected to impact on diagnosis and treatment of dementia in 10% to 15% of cases. Memory clinic physicians recognise and treat cerebrovascular risk factors with reasonable sensitivity and specificity without the input of CT. Copyright © 2004 John Wiley & Sons, Ltd. [source] Characteristics and Predictors of Aortic Plaques in Patients with Transient Ischemic Attacks and StrokesJOURNAL OF NEUROIMAGING, Issue 1 2004Abutaher M. Yahia MD ABSTRACT Objective. To identify the prevalence and characteristics of aortic atherosclerotic plaque disease and its association with cerebrovascular risk factors in patients with cerebral ischemic events. Background. Aortic atheroma is associated with ischemic stroke. Its characteristics, including morphology and distribution among different stroke subtypes, are not well described. Method. From July 2000 to August 2001, all patients evaluated by transesophageal echocardiography (TEE) with diagnoses of transient ischemic attacks (TIAs) and strokes were prospectively studied. Demographics, including age, gender, ethnicity, cerebrovascular risk factors, and stroke subtypes, were collected. Results. Thoracic aortic atheromas (TAAs) were present in 141 of 237 patients (59%) (mean age = 59 ± 14, 119 [50%] male). Mild plaque (<2mm) was present in 13 of 237 (5%), moderate plaque (2,4 mm) in 49 (21%), severe plaque (,4 mm) in 79 (33%), and complex plaque in 64 (27%). Patients' ages (odds ratio [OR] = 1.05, confidence interval [CI] 1.03,1.08, P < .001), coronary artery disease (OR = 2.2, CI 1.02,4.8, P < .042), and patent foramen ovale (PFO) (OR = 0.39, CI 0.22,0.70, P < .002) were associated with the severity and complexity of aortic plaque. In multivariate analysis, age (OR = 1.06, CI 1.03,1.08, P < .001) and the presence of PFO (OR = 0.35, CI 0.18,0.65, P < .001) continued to be significant to the severity and complexity of aortic atheroma. Gender, history of stroke, hypertension, diabetes mellitus, hyperlipidemia, and history of smoking were not associated with TAA. Conclusion. One third of TAA plaques are severe and complex in nature and more frequently present in the descending aorta and the arch of the aorta than in the ascending aorta. TEE should be considered for the early detection and treatment of TAA in patients without identified causes of stroke. [source] Increased rates of white matter hyperintensities in late-onset bipolar disorderBIPOLAR DISORDERS, Issue 7 2008Jaqueline Hatsuko Tamashiro Objectives:, Magnetic resonance imaging (MRI) studies have reported an increased frequency of white matter hyperintensities (WMH) in association with late-onset (LO) depression, and this has supported the notion that vascular-related mechanisms may be implicated in the pathophysiology of LO mood disorders. Recent clinical studies have also suggested a link between LO bipolar disorder (LO-BD) and cerebrovascular risk factors, but this has been little investigated with neuroimaging techniques. In order to ascertain whether there could be a specific association between WMH and LO-BD, we directly compared WMH rates between LO-BD subjects (illness onset , 60 years), early-onset BD subjects (EO-BD, illness onset <60 years), and elderly healthy volunteers. Methods:, T2-weighted MRI data were acquired in LO-BD subjects (n = 10, age = 73.60 ± 4.09), EO-BD patients (n = 49, age = 67.78 ± 4.44), and healthy subjects (n = 24, age = 69.00 ± 7.22). WMH rates were assessed using the Scheltens scale. Results:, There was a greater prevalence of WMH in LO-BD patients relative to the two other groups in the deep parietal region (p = 0.018) and basal ganglia (p < 0.045). When between-group comparisons of mean WMH scores were conducted taking account of age differences (ANCOVA), there were more severe scores in LO-BD patients relative to the two other groups in deep frontal and parietal regions, as well as in the putamen (p < 0.05). Conclusions:, Our results provide empirical support to the proposed link between vascular risk factors and LO-BD. If extended in future studies with larger samples, these findings may help to clarify the pathophysiological distinctions between bipolar disorder emerging at early and late stages of life. [source] The effect of sildenafil citrate (Viagra) on cerebral blood flow in patients with cerebrovascular risk factorsACTA NEUROLOGICA SCANDINAVICA, Issue 6 2010M. Lorberboym Lorberboym M, Mena I, Wainstein J, Boaz M, Lampl Y. The effect of sildenafil citrate (Viagra) on cerebral blood flow in patients with cerebrovascular risk factors. Acta Neurol Scand: 2010: 121: 370,376. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives,,, Sildenafil citrate is widely used for erectile dysfunction. The present study examined the short-term effects of sildenafil administration in individuals with cerebrovascular risk factors, including patients with a history of stroke. Materials and Methods,,, Twenty-five consecutive male patients with erectile dysfunction and vascular risk factors were included in the study. A perfusion brain SPECT study was performed at baseline and 1 h after the oral administration of sildenafil. Results,,, Associations between any of the risk factors and the perfusion scores were not detected, with the exception of stroke. Stroke patients showed significantly more areas with diminished perfusion after sildenafil administration compared to baseline. Conclusions,,, In patients with diabetes or hypertension, a dose of 50 mg sildenafil does not appear to produce detrimental effects on cerebral blood flow. However, patients with a history of stroke may be at increased risk of hemodynamic impairment after the use of sildenafil. [source] Endothelial nitric oxide synthase Glu298Asp, 4b/a, and ,786T>C gene polymorphisms and the risk of ischemic strokeACTA NEUROLOGICA SCANDINAVICA, Issue 2 2010S. Saidi Saidi S, Mallat SG, Almawi WY, Mahjoub T. Endothelial nitric oxide synthase Glu298Asp, 4b/a, and ,786T>C gene polymorphisms and the risk of ischemic stroke Acta Neurol Scand: 2010: 121: 114,119. © 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Background and purpose,,, Endothelial nitric oxide synthase (eNOS) gene polymorphisms were associated with reduced NO production, and were evaluated as risk factors for ischemic stroke (IS). We investigated the association between eNOS gene ,786T>C (promoter), 27-bp repeat 4b/4a (intron 4), and Glu298Asp (exon 7) polymorphisms with IS in 329 IS patients and 444 controls. Materials and methods,,, Glu298Asp and ,786T>C genotyping was done by PCR-RFLP, 4b/4a was assessed by PCR,ASA. The contribution of eNOS polymorphisms to IS was analyzed by haplotype and multivariate regression analysis. Results,,, Higher frequency of 298Asp allele was seen in IS patients (P = 1.2 × 10,10), which remained independently associated with IS on multivariate analysis after controlling for traditional cerebrovascular risk factors. Allele and genotype distribution of 4b/4a and ,786T>C polymorphisms were comparable between patient and controls. Significantly higher prevalence of 298Asp/4b/,786T and 298Asp/4b/,786C haplotypes were seen in IS cases, thus conferring a disease susceptibility nature to these haplotypes. Multivariate regression analysis confirmed the association of 298Asp/4b/,786T and 298Asp/4b/,786C haplotypes, and in addition identified 298Asp/4a/,786T haplotype to be independently associated with IS, after controlling for traditional cerebrovascular risk factors. Conclusions,,, Genetic variation at the eNOS locus represent genetic risk factor for increased susceptibility to IS. [source] | ||||||||||||||||||||||