Abstract 175: Stroke and 10-year Risk of Dementia and Cognitive Impairment Among Older Mexican Americans

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Elizabeth R Mayeda ◽  
Mary N Haan ◽  
John Neuhaus
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mexican Americans ◽  
Vascular Risk Factors ◽  
Competing Risk ◽  
Vascular Risk ◽  
Stroke Event ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Incidence Of Dementia

Background: Stroke is a leading cause of death in the United States and has been linked to an increased risk of dementia and cognitive impairment. The prevalence of stroke and vascular risk factors are higher among Mexican Americans than non-Hispanic whites, but the literature on stroke and dementia and cognitive impairment among this growing ethnic group remains largely unexplored. Objective: We evaluated the association between non-fatal stroke and incidence of dementia/cognitive impairment without dementia (CIND) in a cohort of older Mexican Americans, accounting for the competing risk of mortality. Methods: The present study included 1,617 participants from the Sacramento Area Latino Study on Aging (SALSA), a population-based study of Mexican Americans aged 60-98 years, who were free of dementia/CIND at baseline in 1998-1999 and followed through 2007. At annual study visits, stroke events were identified by self-report of a physician diagnosis or hospitalization and dementia and CIND cases were identified with a three-phase clinical assessment protocol. We evaluated the association between baseline and time dependent stroke and incidence of dementia/CIND with Fine and Gray competing risk regression models to account for the competing risk of mortality. Results: There were 221 participants with a history of stroke at baseline or who experienced a non-fatal stroke during the study. Over a mean follow-up of 6.5 years, there were 159 incident dementia/CIND cases and 298 deaths (n=61 deaths due to stroke). After accounting for the competing risk of mortality and adjusting for sex, education, waist circumference, diabetes, and systolic blood pressure, individuals with a stroke event had a three-fold increased risk of dementia/CIND compared to those with no stroke event (hazard ratio=2.97, 95% CI: 2.05-4.30). Conclusions: These results suggest that among older Mexican Americans, stroke is strongly associated with incidence of dementia/CIND, even after accounting for traditional vascular risk factors and the competing risk of mortality.

NCMP-06. THE RISK AND BURDEN OF THROMBOEMBOLIC AND HEMORRHAGIC EVENTS IN PATIENTS WITH MALIGNANT GLIOMA RECEIVING BEVACIZUMAB

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi148-vi148
Author(s):  
Alexander Ou ◽  
Heather Lin ◽  
Ying Yuan ◽  
Charles Bornstein ◽  
Kristin Alfaro-Munoz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Status ◽  
Univariate Analysis ◽  
Vascular Complications ◽  
Concurrent Chemotherapy ◽  
Vascular Risk Factors ◽  
Competing Risk ◽  
Vascular Risk ◽  
Acute Hemorrhage ◽  
Increased Risk

Abstract BACKGROUND Patients with high-grade gliomas (HGG) often receive anti-angiogenic therapy with bevacizumab to slow disease progression and/or palliate neurological symptoms. Bevacizumab has been associated with an increased risk of two major vascular complications: venous thromboembolism (VTE) and intracranial hemorrhage (ICH). We sought to identify clinical, pathologic, and radiographic variables correlated with risk of either event occurring in patients with HGG receiving bevacizumab. METHODS We retrospectively identified 94 patients with HGG who received bevacizumab at our center from 2015-2021. Variables included demographics, performance status, IDH, MGMT, vascular risk factors, baseline anti-coagulant/anti-platelet use, concurrent chemotherapy, and presence of macrobleeds on MRI (>1 cm3 susceptibility) at the time of bevacizumab initiation. We conducted competing risk analysis using subdistribution hazard models with death as competing risk for ICH or VTE. The effects of covariates on the incidence of hemorrhage or VTE were evaluated in univariate and multivariate settings. RESULTS Of 94 patients, 36 (38.3%) and 27 (28.7%) developed VTE and ICH, respectively. 31 (33%) did not develop either. ICH and VTE events occurred after a mean of 4.46 and 5.94 cycles of bevacizumab, respectively. 20 had baseline anti-platelet/anticoagulant use, and 16 had prior VTEs. Patients with macrobleeds on MRI had a larger HR of developing acute hemorrhage [HR=2.368 (1.112, 5.043), p=0.0254]. Patients older than 50 trended toward larger HR of developing VTE in univariate analysis that approached significance [HR=1.799 (0.889, 3.637), p=0.1023]. Sex, performance status, IDH, MGMT, vascular risk factors, baseline anticoagulant/anti-platelet use and concurrent chemotherapy were not significantly associated with occurrence of VTE. CONCLUSIONS The presence of macrobleeds on MRI is associated with increased risk of developing acute ICH while on bevacizumab. Older age at diagnosis of HGG may be associated with an increased risk of VTE in patients receiving bevacizumab. Larger studies are needed to confirm these findings.

The Spectrum of Cerebrovascular Disease and Associated Cognitive Decline

2019 ◽  
pp. 574-599
Author(s):  
Victoria J. Williams ◽  
Steven E. Arnold ◽  
David H. Salat
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cerebrovascular Disease ◽  
Cognitive Decline ◽  
Vascular Dementia ◽  
Structure And Function ◽  
Vascular Risk Factors ◽  
Vascular Health ◽  
Vascular Risk ◽  
And Function

Throughout the lifespan, common variations in systemic health and illness contribute to alterations in vasculature structure and function throughout the body, significantly increasing risk for cardiovascular and cerebrovascular disease (CVD). CVD is a prevalent cause of mortality in late life; it also promotes brain alterations, contributing to cognitive decline and, when severe, vascular dementia. Even prior to diseased states, individual variation in CVD risk is associated with structural and functional brain alterations. Yet, how cumulative asymptomatic alterations in vessel structure and function contribute to more subtle changes in brain tissue integrity and function that emerge in late life is unclear. Finally, vascular risk factors are associated with the clinical progression of neurodegenerative diseases such as Alzheimer’s disease (AD); however, recent theory posits that vascular degeneration may serve a contributory role in these conditions. This chapter reviews how lifespan changes in vascular health contribute to degenerative changes in neural tissue and the subsequent development of cognitive impairment and/or vascular dementia. It first discusses associations between vascular risk factors and cognition and also how declining vascular health may lead to cognitive impairment and dementia. Next, it identifies basic aspects of cerebrovascular anatomy and physiology sustaining tissue health and discusses how vulnerabilities of this system contribute to neurodegenerative changes. Finally, it reviews evidence of vascular contributions to AD and presents ideas for future research to better understand the full spectrum of cerebrovascular contributions to brain aging, cognitive decline, and dementia.

scholarly journals Vascular risk factors and cognitive impairment in a stroke-free cohort

Neurology ◽  
2011 ◽  
Vol 77 (19) ◽  
pp. 1729-1736 ◽  
Author(s):  
F. W. Unverzagt ◽  
L. A. McClure ◽  
V. G. Wadley ◽  
N. S. Jenny ◽  
R. C. Go ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Vascular Risk Factors ◽  
Vascular Risk

Abstract WP179: Rate of Pulmonary Embolism After Cerebral Venous Thrombosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
Michael P Lerario ◽  
Steven R Messe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Vascular Risk Factors ◽  
Emergency Department Visits ◽  
Administrative Claims ◽  
Cerebral Vein ◽  
Vascular Risk ◽  
Index Hospitalization ◽  
Increased Risk

Introduction: Cerebral vein thrombosis (CVT) is associated with an increased risk of subsequent venous thromboembolism. It is unknown whether the risk of pulmonary embolism (PE) after CVT is similar to that of PE after deep venous thrombosis (DVT). Methods: We performed a retrospective cohort study using administrative claims data from all emergency department visits and hospitalizations in California from 2005-2011, New York from 2006-2013, and Florida from 2005-2013. We identified patients with CVT or DVT as well as the primary outcome of PE using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes. In order to minimize misclassification error, patients with both CVT and DVT during the same index hospitalization were excluded and patients with CVT were censored at the time of development of DVT and vice versa. Kaplan-Meier survival statistics and Cox proportional hazards models were used to compare the risk of PE after CVT versus after DVT while adjusting for demographics, vascular risk factors, and the Elixhauser comorbidity index. Results: We identified 4,450 patients with CVT and 217,589 patients with DVT. During a mean follow-up of 2.0 (±1.7) years, 124 patients with DVT developed a PE and 18,698 patients with DVT developed a PE. Patients with CVT were younger (mean age 45 vs 63), more often female (71% vs 52%), more often pregnant, and had fewer vascular risk factors than patients with DVT. During the index hospitalization, the rate of PE was 1.5% (95% confidence interval [CI], 1.1-1.8%) in patients with CVT and 6.2% (95% CI, 6.1-6.3%, p<0.001) in patients with DVT. By 5 years, the cumulative rate of PE after CVT was 3.7% (95% CI, 3.0-4.4%) compared to 10.5% (95% CI, 10.3-10.6%, p<0.001) after DVT. After adjustment for demographics and comorbidities, CVT was associated with a significantly lower hazard of PE when compared to DVT (hazard ratio, 0.31; 95% CI, 0.26-0.38). Conclusion: In a large, heterogeneous population, we found that the risk of PE after CVT was significantly lower than that of PE after DVT. Among patients with CVT, the greatest risk for PE was apparent during the index hospitalization.

scholarly journals Mild cognitive impairment: Incidence and vascular risk factors in a population-based cohort

Neurology ◽  
2013 ◽  
Vol 80 (23) ◽  
pp. 2112-2120 ◽  
Author(s):  
M. Ganguli ◽  
B. Fu ◽  
B. E. Snitz ◽  
T. F. Hughes ◽  
C.-C. H. Chang
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Population Based ◽  
Vascular Risk Factors ◽  
Vascular Risk

CARE MANAGEMENT TO PROMOTE TREATMENT ADHERENCE IN PATIENTS WITH COGNITIVE IMPAIRMENT AND VASCULAR RISK FACTORS: A DEMONSTRATION PROJECT

2017 ◽  
pp. 1-6
Author(s):  
L.M. Bonner ◽  
A. Hanson ◽  
G. Robinson ◽  
E. Lowy ◽  
S. Craft
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Care Management ◽  
Intervention Group ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Management Intervention ◽  
Dementia Risk ◽  
Dementia Prevention ◽  
Management Protocol

Dementia prevention is highly important. Improved control of vascular risk factors has the potential to decrease dementia risk, but may be difficult. Therefore, we developed and piloted a care management protocol for Veterans at risk for dementia. We enrolled 32 Veterans with diabetes and hypertension, at least one of which was poorly controlled, and cognitive impairment. Participants were randomly assigned to a 6-month care management intervention or to usual care. At enrollment, 6-months and 12-months, we assessed cognitive performance, mood, and diabetes and hypertension control. At follow-up, diastolic blood pressure was lower in intervention participants at 6 months (p=.041) and 12 months (p=.022); hemoglobin A1c, global mental status and mood did not differ between groups. Recall of a distractor list (p=.006) and logical memory long-delay recall (p=.036) were better at 6 months in the intervention group (p=.006). Care management may contribute to improved control of dementia risk factors.

scholarly journals Vascular Events, Vascular Disease and Vascular Risk Factors—Strongly Intertwined with COVID-19

2020 ◽  
Vol 22 (11) ◽  
Author(s):  
Adrian Scutelnic ◽  
Mirjam R. Heldner
Keyword(s):  
Risk Factors ◽  
Vascular Disease ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Vascular Events ◽  
Increased Risk ◽  
Clinical Benefits ◽  
Infection And Inflammation ◽  
Unhealthy Diet ◽  
New Perspective

Abstract Purpose of review To elucidate the intertwining of vascular events, vascular disease and vascular risk factors and COVID-19. Recent findings Strokes are a leading cause of disability and death worldwide. Vascular risk factors are important drivers of strokes. There are unmodifiable vascular risk factors such as age and ethnicity and modifiable vascular risk factors. According to the INTERSTROKE study, the 10 most frequent modifiable vascular risk factors are arterial hypertension, physical inactivity, overweight, dyslipidaemia, smoking, unhealthy diet, cardiac pathologies, diabetes mellitus, stress/depression and overconsumption of alcohol. Also, infection and inflammation have been shown to increase the risk of stroke. There is high-quality evidence for the clinical benefits of optimal primary and secondary stroke prevention. The COVID-19 pandemic brought a new perspective to this field. Vascular events, vascular disease and vascular risk factors—and COVID-19—are strongly intertwined. An increased risk of vascular events—by multifactorial mechanisms—has been observed in COVID-19 patients. Also, a higher rate of infection with COVID-19, severe COVID-19 and bad outcome has been demonstrated in patients with pre-existing vascular disease and vascular risk factors. Summary At present, we suggest that regular interactions between healthcare professionals and patients should include education on COVID-19 and on primary and secondary vascular prevention in order to reduce the burden of disease in our ageing populations.

scholarly journals Aggregation of Vascular Risk Factors Modulates the Amplitude of Low-Frequency Fluctuation in Mild Cognitive Impairment Patients

2020 ◽  
Vol 12 ◽  
Author(s):  
Liying Zhuang ◽  
Huafu Ni ◽  
Junyang Wang ◽  
Xiaoyan Liu ◽  
Yajie Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Brain Activity ◽  
Low Frequency ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cvd Risk ◽  
Spontaneous Brain Activity ◽  
Main Effect

Background: Several vascular risk factors, including hypertension, diabetes, body mass index, and smoking status are found to be associated with cognitive decline and the risk of Alzheimer's disease (AD). We aimed to investigate whether an aggregation of vascular risk factors modulates the amplitude of low-frequency fluctuation (ALFF) in patients with mild cognitive impairment (MCI).Methods: Forty-three MCI patients and twenty-nine healthy controls (HCs) underwent resting-state functional MRI scans, and spontaneous brain activity was measured by the ALFF technique. The vascular risk profile was represented with the Framingham Heart Study general cardiovascular disease (FHS-CVD) risk score, and each group was further divided into high and low risk subgroups. Two-way ANOVA was performed to explore the main effects of diagnosis and vascular risk and their interaction on ALFF.Results: The main effect of diagnosis on ALFF was found in left middle temporal gyrus (LMTG) and left superior parietal gyrus (LSPG), and the main effect of risk on ALFF was detected in left fusiform gyrus (LFFG), left precuneus (LPCUN), and left cerebellum posterior lobe (LCPL). Patients with MCI exhibited increased ALFF in the LMTG and LSPG than HCs, and participants with high vascular risk showed increased ALFF in the LFFG and LCPL, while decreased ALFF in the LPCUN. An interaction between diagnosis (MCI vs. HC) and FHS-CVD risk (high vs. low) regarding ALFF was observed in the left hippocampus (LHIP). HCs with high vascular risk showed significantly increased ALFF in the LHIP than those with low vascular risk, while MCI patients with high vascular risk showed decreased ALFF in the LHIP than HCs with high vascular risk. Interestingly, the mean ALFF of LHIP positively correlated with word recall test in HCs with high vascular risk (rho = 0.630, P = 0.016), while negatively correlated with the same test in MCI patients with high vascular risk (rho = −0.607, P = 0.001).Conclusions: This study provides preliminary evidence highlighting that the aggregation of vascular risk factors modulates the spontaneous brain activity in MCI patients, and this may serve as a potential imaging mechanism underlying vascular contribution to AD.

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