Browsing by Subject "CEREBROVASCULAR-DISEASE"

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  • Wardlaw, Joanna M; Debette, Stephanie; Jokinen, Hanna; De Leeuw, Frank-Erik; Pantoni, Leonardo; Chabriat, Hugues; Staals, Julie; Doubal, Fergus; Rudilosso, Salvatore; Eppinger, Sebastian; Schilling, Sabrina; Ornello, Raffaele; Enzinger, Christian; Cordonnier, Charlotte; Taylor-Rowan, Martin; Lindgren, Arne G. (2021)
    'Covert' cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
  • Hall, Anette; Pekkala, Timo; Polvikoski, Tuomo; van Gils, Mark; Kivipelto, Miia; Lötjönen, Jyrki; Mattila, Jussi; Kero, Mia; Myllykangas, Liisa; Mäkelä, Mira; Oinas, Minna; Paetau, Anders; Soininen, Hilkka; Tanskanen, Maarit; Solomon, Alina (2019)
    BackgroundWe developed multifactorial models for predicting incident dementia and brain pathology in the oldest old using the Vantaa 85+ cohort.MethodsWe included participants without dementia at baseline and at least 2 years of follow-up (N=245) for dementia prediction or with autopsy data (N=163) for pathology. A supervised machine learning method was used for model development, considering sociodemographic, cognitive, clinical, vascular, and lifestyle factors, as well as APOE genotype. Neuropathological assessments included -amyloid, neurofibrillary tangles and neuritic plaques, cerebral amyloid angiopathy (CAA), macro- and microscopic infarcts, -synuclein pathology, hippocampal sclerosis, and TDP-43.ResultsPrediction model performance was evaluated using AUC for 10x10-fold cross-validation. Overall AUCs were 0.73 for dementia, 0.64-0.68 for Alzheimer's disease (AD)- or amyloid-related pathologies, 0.72 for macroinfarcts, and 0.61 for microinfarcts. Predictors for dementia were different from those in previous reports of younger populations; for example, age, sex, and vascular and lifestyle factors were not predictive. Predictors for dementia versus pathology were also different, because cognition and education predicted dementia but not AD- or amyloid-related pathologies. APOE genotype was most consistently present across all models. APOE alleles had a different impact: epsilon 4 did not predict dementia, but it did predict all AD- or amyloid-related pathologies; epsilon 2 predicted dementia, but it was protective against amyloid and neuropathological AD; and epsilon 3 epsilon 3 was protective against dementia, neurofibrillary tangles, and CAA. Very few other factors were predictive of pathology.ConclusionsDifferences between predictors for dementia in younger old versus oldest old populations, as well as for dementia versus pathology, should be considered more carefully in future studies.
  • Aarnio, Karoliina; Rodriguez-Pardo, Jorge; Siegerink, Bob; Hardt, Juliane; Broman, Jenna; Tulkki, Lauri; Haapaniemi, Elena; Kaste, Markku; Tatlisumak, Turgut; Putaala, Jukka (2018)
    Objective We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW. Methods Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score Results We included a total of 769 patients, of whom 289 (37.6%) were not working at I year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at I year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit. Conclusions NRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.