scholarly journals Late-Onset Epilepsy and Occult Cerebrovascular Disease

2014 ◽  
Vol 34 (4) ◽  
pp. 564-570 ◽  
Author(s):  
Lorna M Gibson ◽  
Martha F Hanby ◽  
Sarah M Al-Bachari ◽  
Laura M Parkes ◽  
Stuart M Allan ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Late Onset ◽  
Cerebral Metabolism ◽  
Neurovascular Unit ◽  
Barrier Dysfunction ◽  
Increased Risk ◽  
Antiepileptic Drug Treatment ◽  
History Of ◽  
Ischemic Attack ◽  
The Relationship

The interface between cerebrovascular disease (CVD) and epilepsy is complex and multifaceted. Late-onset epilepsy (LOE) is increasingly common and is often attributed to CVD, and is indeed associated with an increased risk of stroke. This relationship is easily recognizable where there is a history of stroke, particularly involving the cerebral cortex. However, the relationship with otherwise occult, subcortical CVD is currently less well established yet causality is often invoked. In this review, we consider the diagnosis of LOE in clinical practice—including its behaviour as a potential mimic of acute ischemic stroke and transient ischemic attack; evidence for an association between occult CVD and LOE; and potential mechanisms of epileptogenesis in occult CVD, including potential interrelationships between disordered cerebral metabolism and perfusion, disrupted neurovascular unit integrity, blood–brain barrier dysfunction, and inflammation. We also discuss recently recognized issues concerning antiepileptic drug treatment and vascular risk and consider a variety of less common CVD entities associated with seizures.

scholarly journals Occult Cerebrovascular Disease and Late-Onset Epilepsy: Could Loss of Neurovascular Unit Integrity Be a Viable Model?

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Lorna M. Gibson ◽  
Stuart M. Allan ◽  
Laura M. Parkes ◽  
Hedley C. A. Emsley
Keyword(s):  
Cerebrovascular Disease ◽  
Late Onset ◽  
Neurovascular Unit ◽  
Regional Cerebral Blood ◽  
Blood Brain Barrier Disruption ◽  
Increased Risk ◽  
Unit Function ◽  
Cerebrovascular Risk ◽  
Brain Barrier Disruption ◽  
Viable Model

Late-onset epilepsy (LOE) first occurs after 60 years of age and may be due to occult cerebrovascular disease (CVD) which confers an increased risk of stroke. However, patients with late-onset epilepsy are not currently consistently investigated or treated for cerebrovascular risk factors. We discuss how abnormalities of neurovascular unit function, namely, changes in regional cerebral blood flow and blood brain barrier disruption, may be caused by occult cerebrovascular disease but present clinically as late-onset epilepsy. We describe novel magnetic resonance imaging methods to detect abnormal neurovascular unit function in subjects with LOE and controls. We hypothesise that occult CVD may cause LOE as a result of neurovascular unit dysfunction.

A controlled family study of late-onset non-affective psychosis (late paraphrenia)

1997 ◽  
Vol 170 (6) ◽  
pp. 511-514 ◽  
Author(s):  
R. J. Howard ◽  
C. Graham ◽  
P. Sham ◽  
J. Dennehey ◽  
D. J. Castle ◽  
...  
Keyword(s):  
At Risk ◽  
Late Onset ◽  
Psychiatric Morbidity ◽  
Late Life ◽  
Lifetime Risk ◽  
First Degree Relatives ◽  
Healthy Elderly ◽  
Increased Risk ◽  
Age Range ◽  
The Relationship

BackgroundThe relationship between those schizophrenia-like conditions that have their onset in late life and early-onset schizophrenia is unclear. Very few family history studies of patients with late-onset psychosis have been reported, and it is not known whether their relatives have an increased risk of psychosis.MethodInformation was collected on the psychiatric morbidity of 269 first-degree relatives of patients with schizophrenia or delusional disorder with an onset after the age of 60 (late paraphrenia), and 272 first-degree relatives of healthy elderly control subjects, using a research diagnostic instrument.ResultsWith a narrow age range (15–50 years) at risk, the estimated lifetime risk of schizophrenia was 1.3% in the relatives of both cases and controls. With a wider age range (15–90 years) at risk, estimated lifetime risk of schizophrenia was 2.3% for the relatives of cases, and 2.2% for the relatives of controls. However, depression was significantly more common among the relatives of cases than controls.ConclusionThose schizophrenia-like psychoses with onset in late life are not genetically associated with schizophrenia.

scholarly journals Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

2020 ◽  
Vol 12 ◽  
pp. 1759720X2098121
Author(s):  
Gustavo Constantino de Campos ◽  
Raman Mundi ◽  
Craig Whittington ◽  
Marie-Josée Toutounji ◽  
Wilson Ngai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Ischemic Attack ◽  
Meta Analyses ◽  
The Relationship ◽  
Related Mortality

Aims: The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality. Methods: An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( via PubMed and Embase); and (ii) mortality ( via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively. Results: Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses. Conclusion: The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

scholarly journals Hypertension Burden and the Risk of New-Onset Atrial Fibrillation

Hypertension ◽  
2021 ◽  
Vol 77 (3) ◽  
pp. 919-928
Author(s):  
So-Ryoung Lee ◽  
Chan Soon Park ◽  
Eue-Keun Choi ◽  
Hyo-Jeong Ahn ◽  
Kyung-Do Han ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Total Study Population ◽  
Increased Risk ◽  
Burden Scale ◽  
History Of ◽  
Study Population ◽  
Korean National Health Insurance ◽  
Stage 1 ◽  
The Relationship

The association between the cumulative hypertension burden and the development of atrial fibrillation (AF) is unclear. We aimed to investigate the relationship between hypertension burden and the development of incident AF. Using the Korean National Health Insurance Service database, we identified 3 726 172 subjects who underwent 4 consecutive annual health checkups between 2009 and 2013, with no history of AF. During the median follow-up of 5.2 years, AF was newly diagnosed in 22 012 patients (0.59% of the total study population; 1.168 per 1000 person-years). Using the blood pressure (BP) values at each health checkup, we determined the burden of hypertension (systolic BP ≥130 mm Hg or diastolic BP ≥80 mm Hg), stratified as 0 to 4 per the hypertension criteria. The subjects were grouped according to hypertension burden scale 1 to 4: 20% (n=742 806), 19% (n=704 623), 19% (n=713 258), 21% (n=766 204), and 21% (n=799 281). Compared with normal people, subjects with hypertension burdens of 1, 2, 3, and 4 were associated with an 8%, 18%, 26%, and 27% increased risk of incident AF, respectively. On semiquantitative analyses with further stratification of stage 1 (systolic BP of 130–139 mm Hg or diastolic BP of 80–89 mm Hg) and stage 2 (systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg) hypertension, the risk of AF increased with the hypertension burden by up to 71%. In this study, both a sustained exposure and the degree of increased BP were associated with an increased risk of incident AF. Tailored BP management should be emphasized to reduce the risk of AF.

The Relationship of Drug Abuse to Unexplained Sudden Death

2008 ◽  
Vol 132 (12) ◽  
pp. 1903-1906
Author(s):  
Amy C. Gruszecki ◽  
Gerald McGwin, Jr ◽  
C. Andrew Robinson, Jr ◽  
Gregory G. Davis
Keyword(s):  
Drug Abuse ◽  
Cause Of Death ◽  
Control Group ◽  
Manner Of Death ◽  
Increased Risk ◽  
History Of ◽  
Matched Case ◽  
Relationship Of ◽  
The Relationship ◽  
Control Study

Abstract Context.—Forensic pathologists regularly investigate the deaths of individuals with a history of drug abuse. Autopsy, including toxicology testing, reveals no cause for death in a subset of this cohort. Objective.—To determine whether deaths with an undetermined cause and manner of death are associated with a history of drug abuse. Design.—Retrospective matched case-control study of 52 decedents whose cause of death remained undetermined following autopsy, matched 1:2 to a control group of living patients admitted for cholecystectomy according to age and date of death or procedure. Results.—Individuals whose cause of death was undetermined were 5.3 times (95% confidence interval, 1.9– 14.5) more likely to have a history of drug abuse than were patients with cholecystitis. Conclusions.—Decedents with a history of chronic drug abuse appear to be at an increased risk of dying by their chronic drug abuse, even in the absence of any anatomical or toxicologic finding at autopsy to account for death.

Abstract 5108: Microalbuminuria is Associated with Progression of Coronary Atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Andrew P DeFilippis ◽  
Holly J Kramer ◽  
Ronit Katz ◽  
Nathan Wong ◽  
Alain Bertoni ◽  
...  
Keyword(s):  
Lipid Lowering ◽  
Albumin Creatinine Ratio ◽  
Ethnic Study ◽  
Median Increase ◽  
Increased Risk ◽  
History Of ◽  
Relationship Of ◽  
The Relationship ◽  
Progression Of Atherosclerosis

Background: Microalbuminuria (MA) is associated with an increased risk of cardiovascular disease (CVD) but the mechanism by which microalbuminuria imparts this increased risk is not known. In this study we assessed the relationship between MA and the development and progression of atherosclerosis by measuring the incidence of new CAC and the progression of existing CAC in individuals free of clinical CVD. Methods : The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective cohort study of 6,814 participants free of clinical CVD at entry who underwent assessment of coronary artery calcification (CAC) by computerized tomography at baseline. Overall, 6,775 individuals had data available on urinary albumin creatinine ratio (UACR); 1,109 individuals were excluded for missing data or macroalbuminuria (UACR≥300 mg/g). Incident CAC was defined as detectable CAC at follow-up among those with CAC=0 at baseline, and absolute CAC score change among those with CAC>0 at baseline. Relative risk (RR) regression adjusted for covariates; and multivariable adjusted median regression was employed to assess the independent relationship of MA with CAC incidence and progression. Results : Of the 5,666 subjects (mean age 62±10 years, 48% males), baseline MA was seen in 424 (7%) participants, who were more likely to have CAC compared to those with normal UACR (62% vs. 48%, p<0.0001). During a mean follow-up of 2.4±0.8 years, those with MA were more likely to develop CAC (28% vs. 15%, p<0.0001) and they had a higher absolute median increase in CAC (47 vs. 29 Agatston Units, p<0.0001). After adjustment for age, gender, ethnicity, site, follow-up duration, diabetes, hypertension, smoking, family history of heart attack, total cholesterol, lipid lowering medications and body mass index; MA was associated with incident CAC (RR 1.65; 95%CI 1.41–2.48) among those with CAC=0 at baseline. Among those with CAC>0 at baseline, MA was associated with a median increase in CAC of 7.93 (95%CI 0.38 –15.47) Agatston Units in multivariable adjusted analyses (variables noted above). Conclusion : MA is independently associated with development of incident CAC and progression of CAC in an asymptomatic multi-ethnic population, and may in part explain its associated increased risk of CVD.

Abstract MP02: N-Terminal Pro-B-type Natriuretic Peptide and Risk of Stroke in Those With and Without Cerebrovascular Disease: The REGARDS Cohort

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Kara Landry ◽  
Suzanne Judd ◽  
Dawn Kleindorfer ◽  
George Howard ◽  
Virginia Howard ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Racial Differences ◽  
Natriuretic Peptide ◽  
Stroke Recurrence ◽  
Black And White ◽  
Hazard Ratios ◽  
History Of ◽  
Ischemic Attack ◽  
Prior Stroke

Background: N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), a commonly used marker of cardiac function, is associated with presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke and mortality. Little data are available on the association between NT-pro-BNP levels and stroke recurrence. Objective: We studied the relationship between NT-proBNP with the risk of future ischemic stroke across a spectrum of pre-existing cerebrovascular conditions, ranging from history of stroke symptoms, to prior transient ischemic attack (TIA), to prior stroke. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans age 45 years and older in 2003-14. Among a case-cohort study sample including 1109 stroke cases and a 4311-person cohort random sample, we calculated hazard ratios of future ischemic stroke by baseline NT-proBNP stratified by presence of prior cerebrovascular conditions. Results: In the cohort sample, there were 3056 participants without any history of cerebrovascular disease, 738 with prior stroke symptoms, 196 with history of TIA and 338 with history of prior stroke. In a fully adjusted model, elevated NT-proBNP was associated with risk of stroke in participants without a pre-existing cerebrovascular condition (HR 2.32, 95% CI 1.84, 2.94), and in participants with a history of stroke symptoms (HR 1.67 95% CI 1.01, 2.78) or TIA (HR 2.66, 95% CI 1.00, 7.04), but not among those with prior stroke (HR 1.26, 95% CI 0.71, 2.21). Conclusions: These findings further support the potential for NT-proBNP testing to identify patients who are at highest risk for future stroke, although not in those with prior stroke.

scholarly journals Risk of Dementia in Patients with Leptospirosis: A Nationwide Cohort Analysis

2019 ◽  
Vol 16 (17) ◽  
pp. 3168
Author(s):  
Chun-Hsiang Chiu ◽  
Po-Chung Chen ◽  
Ying-Chuan Wang ◽  
Cheng-Li Lin ◽  
Feng-You Lee ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Cohort Analysis ◽  
Frequency Matching ◽  
Cox Proportional Hazard ◽  
Dementia Risk ◽  
Increased Risk ◽  
Taiwan National Health Insurance ◽  
History Of ◽  
Cox Proportional Hazard Regression ◽  
The Relationship

Background: Studies have linked some bacterial infections with an increased likelihood for development of dementia. However, there is a paucity of data on the relationship between dementia and leptospirosis. In view of this, we conducted a retrospective cohort study to determine whether leptospirosis is a risk factor for dementia. Methods: Data were collected from the Taiwan National Health Insurance Research Databases (2000–2010) to investigate the incidence of and risk factors for dementia in patients with leptospirosis. Patients with leptospirosis who did not have a history of dementia were enrolled in the study. For each leptospirosis patient, four controls were randomly selected after frequency matching of age, sex, and index date. Cox proportional hazard regression models were used for the analyses of dementia risk. Results: A greater risk of dementia was observed in the leptospirosis cohort than in the non-leptospirosis cohort both in patients without any comorbidity (adjusted HR (aHR) = 1.23, 95% CI = 1.06–1.43) and with a comorbidity (aHR = 2.06, 95% CI = 1.7–2.5). Compared with the non-leptospirosis cohort without these comorbidities, the leptospirosis cohort with ≥2 comorbidities exhibited a significantly increased risk of dementia (aHR = 6.11, 95% CI = 3.15–11.9), followed by those with any one comorbidity (adjusted HR = 3.62, 95% CI = 1.76–7.46). Conclusions: Patients with leptospirosis were at a 1.89-fold greater risk of subsequent dementia, but potential genetic susceptibility bias in the study group is a major confound.

scholarly journals DNA damage and brain trauma: a clue to pathophysiology and biomarker development

2019 ◽  
Vol 46 (s2) ◽  
pp. S60
Author(s):  
LN Hazrati
Keyword(s):  
Dna Damage ◽  
Structural Changes ◽  
Morphological Changes ◽  
Memory Loss ◽  
List Type ◽  
Dna Breaks ◽  
Contact Sports ◽  
Increased Risk ◽  
History Of ◽  
The Relationship

Mild traumatic brain injury (mTBI) or concussion is a very common occurrence in contact sports, and can cause brain damage with long-term symptoms, including depression, aggression, memory loss, and an increased risk of neurodegeneration later in life. Recently, there has been increased attention towards concussion in sport both in research and media, however the nature and pathophysiology of mTBI-induced neurodegeneration remain unknown. The objective of this study is to identify early pathophysiological markers of TBI. This study used a collection of donated postmortem brains with a history of repetitive mTBI in contact sports and non-TBI control brains. Nanostring ncounter’s immune panel was used to evaluate gene expression, and results showed that brains with a history of TBI tended to group with significantly older brains with no history of TBI in regards to their immune profile. Further analysis of this expression panel revealed that genes associated with senescence and secretory phenotype were upregulated in brains with a history of mTBI. Additionally, immunohistochemistry for γ-H2AX (a marker for double stranded DNA breaks) showed that brains with a history of repetitive TBI accumulated a spectrum of DNA damages not present in controls. This damage was widespread and involved mainly glial cells including oligodendrocytes, and astrocytes. The latter showed morphological changes reminiscent of senescence, including soma swelling and beading of processes. Further, these changes were accompanied by translocation of structural nuclear proteins. These changes preceded the appearance of abnormal protein deposition in the brain. Overall, these results suggest that DNA damage and cellular senescence are upstream events in the manifestation of post-mTBI symptoms and pathology, and represent promising opportunities for discovery of biomarkers for early TBI detection and follow-up of progression.LEARNING OBJECTIVESThe presentation will enable the learner to:1.Explore the relationship between trauma and DNA structural changes2.Explore the relationship between trauma and senescence

scholarly journals Characteristics of Disclosing Childhood Victimization and Risk of Revictimization in Young Adulthood

2019 ◽  
pp. 088626051988993 ◽  
Author(s):  
Michelle P. Desir ◽  
Canan Karatekin
Keyword(s):  
Young Adulthood ◽  
Previous History ◽  
Adverse Outcomes ◽  
Support Networks ◽  
Negative Reaction ◽  
Childhood Victimization ◽  
Increased Risk ◽  
History Of ◽  
The Relationship ◽  
Hispanic White

Experiencing victimization in childhood increases risk of adulthood revictimization, and it is important to understand what may contribute to such risk. One factor that may help to explain the increased risk of future victimization is disclosure. However, the literature is mixed as to whether disclosure of prior victimization is helpful for protecting against adverse outcomes, and much of the research on disclosure focuses solely on sexual victimization. The current study examines the relationship between various forms of childhood and adulthood victimization and whether disclosure moderates this relationship. In addition, this study investigates whether characteristics of disclosure are associated with revictimization risk. The sample included 275 undergraduates ( M age = 19.52 years; 75.6% female, 77.5% non-Hispanic White or Caucasian). Participants reported on previous history of various forms of childhood and adulthood victimization. They also reported whether or not they had disclosed childhood victimization, and, if so, characteristics related to disclosure. Results revealed that number of childhood victimization experiences significantly predicted number of adulthood victimization experiences, and nearly every type of childhood victimization significantly increased risk of experiencing each type of adulthood victimization. Disclosure did not moderate the relationship between childhood and adulthood victimization. Participants who disclosed were more likely to disclose crime and peer/sibling victimization and disclose to parents or friends. Positive reactions to disclosure were more common than negative reactions; however, 75% of disclosers received at least one negative reaction. Finally, revictimized individuals received more overall negative reactions than nonrevictimized individuals. They also received more reactions characterized by the person they disclosed to trying to take control of their decisions or treating them differently. Results highlight the importance of examining relationships between various forms of victimization, considering how characteristics of disclosure relate to risk of revictimization, and the importance of educating potential support networks about appropriate responses to disclosure.

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