Abstract W P121: Patterns Of Vessel Involvement In Patients With Intracranial Atherosclerosis Across Ages

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Tamara Strohm ◽  
Russell Cerejo ◽  
Jason Mathew ◽  
Irene Katzan ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Age Groups ◽  
Vascular Risk Factors ◽  
Posterior Circulation ◽  
Intracranial Stenosis ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Basilar Arteries ◽  
Vessel Involvement

Introduction: Intracranial atherosclerosis has been well studied in the aging population, much less is known about atherosclerotic stenosis in the young. Clinicians seek to control traditional vascular risk factors in this population, but differences in patterns of stenosis may call for varied treatment approaches. This study sought to compare age to the distribution of vessel involvement in patients with moderate-severe intracranial stenosis. Methods: This is a retrospective cohort study of patients with intracranial stenosis seen in the stroke clinic of a tertiary center from 2008-2013. Inclusion criteria were moderate-severe intracranial stenosis clinically felt to be due to atherosclerosis with ≥3 traditional vascular risk factors. Patients with other mechanisms of intracranial stenosis were excluded. Stenosis location and severity were based on cerebral angiography, CTA, or MRA. Patients were divided into young (< 50 yr), middle-age (51-64 yr), or older (≥ 65 yr). All 69 patients ≤50 yr were included; a random sample of 69 patients > 50 were selected for this analysis. Results: There were similar rates of vascular risk factors except HTN, which was less common in the young group (81.2% young, 100% middle, 96.8% older, p=0.0006). The location of stenoses varied by age category. Older patients had more posterior circulation involvement compared to the younger groups (p = 0.046), with more frequent involvement of vertebral and basilar arteries (p = 0.012) (Table). The occurrence of stenosis in the distal ICA and MCA vessels were similar among age groups. The frequency of ACA stenosis was highest in the young category (p = 0.026). Conclusion: There are differences in anatomic locations of presumed intracranial atherosclerosis across age groups with older patients (> 65 yrs) having a higher rate of posterior circulation disease. This suggests potential differences in pathophysiological mechanisms. These findings warrant further investigation.

Abstract WP116: Patterns of Vascular Calcification in Young Patients With Intracranial Stenosis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tamara Strohm ◽  
Irene Katzan ◽  
Ken Uchino
Keyword(s):  
Risk Factors ◽  
Vascular Calcification ◽  
Young Patients ◽  
Vascular Risk Factors ◽  
Intracranial Stenosis ◽  
Intracranial Calcification ◽  
Vascular Risk ◽  
Atherosclerotic Stenosis ◽  
Significant Difference ◽  
Determine Mechanism

Introduction: Intravascular calcification is thought to be a marker of atherosclerosis in patients with stenosis and vascular risk factors. Little is known about the utility of quantifying intracranial calcification to help determine mechanism of stenosis. The objective of our study was to compare presence and patterns of intracranial calcification in patients with intracranial stenosis due to atherosclerosis and other etiologies. Methods: Retrospective cohort study of 89 patients < 50 years with diagnosis of intracranial stenosis who had undergone CT angiogram from 2008-2013; 44 had presumed atherosclerosis as etiology ( > 3 vascular risk factors with no other identified cause). CTAs were reviewed for presence and location of intracranial calcification. Results: Of patients with atherosclerotic stenosis, 28 (64%) had intravascular calcification compared to 16 (36%) of those with stenosis of other etiologies (P=0.0039). There was no significant difference in pattern or location of stenosis between groups. One-third had calcification outside the region of stenosis in both groups. Distal internal carotid artery and distal vertebral artery were the most common sites of intracranial calcification (Table). Conclusion: Intracranial calcification is more commonly seen in patients < 50 years old with stenosis secondary to atherosclerosis, but the pattern and location was similar between groups. More research is needed to determine the utility of using the presence of vascular calcification to help determine mechanism of intracranial stenosis in the young.

Late-onset depression: genetic, vascular and clinical contributions

2001 ◽  
Vol 31 (8) ◽  
pp. 1403-1412 ◽  
Author(s):  
I. HICKIE ◽  
E. SCOTT ◽  
S. NAISMITH ◽  
P. B. WARD ◽  
K. TURNER ◽  
...  
Keyword(s):  
Risk Factors ◽  
Apolipoprotein E ◽  
Gene Mutation ◽  
Early Onset ◽  
Older Patients ◽  
Late Onset ◽  
Mthfr Gene ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Control Subjects

Background. Neuropsychiatric research needs to examine the relationships between aetiological, genotypic and clinical risk factors and behavioural phenotypes. These relationships can now be examined in older patients with depressive disorders.Methods. Key behavioural features, clinical and vascular risk factors and putative genotypes for late-onset neurodegenerative disorders and/or vascular disease were recorded in 78 older patients with depression (mean age = 54·9 years, S.D. = 14·1) and 22 healthy control subjects (mean age = 55·5 years, S.D. = 9·6).Results. Two or more vascular risks were more common in older patients (65% v. 26% of control subjects, P < 0·01), and in patients with late-onset disorders (82% v. 57% in patients with early-onset disorders, P < 0·05). Patients with late-onset depression had a higher prevalence of the homozygous or heterozygous forms of the C677T mutation of the methylenetetrahydrofolate reductase enzyme (MTHFR)(74% v. 48% in patients with early-onset disorders, P < 0·05). In a multivariate model, only presence of the MTHFR gene mutation predicted late-onset depression (odds ratio = 3·8, 95% CI = 1·1–12·9). Neither apolipoprotein E epsilon 4 or epsilon 2 was associated with depression, late-onset depression, cognitive impairment, or psychomotor change. Patients with apolipoprotein E epsilon 4 were less likely to have psychotic forms of depression.Conclusions. Patients with late-onset depression had an increased rate of the C677T MTHFR gene mutation and other vascular risk factors. This suggests that a proportion of these patients may have genetically-determined and/or other vascular aetiologies. Patients at risk of these disorders may be assisted by currently-available preventative strategies.

scholarly journals Hypertension and Hypercholesterolemia Modify Dementia Risk in Relation to APOE ɛ4 Status

2021 ◽  
pp. 1-12
Author(s):  
Jagan A. Pillai ◽  
Kou Lei ◽  
James Bena ◽  
Lisa Penn ◽  
James B. Leverenz
Keyword(s):  
Risk Factors ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Age Groups ◽  
Cox Proportional Hazards ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cox Proportional Hazards Models ◽  
Dementia Risk ◽  
Dementia Onset

Background: There is significant interest in understanding the role of modifiable vascular risk factors contributing to dementia risk across age groups. Objective: Risk of dementia onset was assessed in relation to vascular risk factors of hypertension and hypercholesterolemia among cognitively normal APOE ɛ4 carriers and non-carriers. Methods: In a sample of prospectively characterized longitudinal cohort from the National Alzheimer’s Coordinating Center database, 9,349 participants met criteria for normal cognition at baseline, had a CDR-Global (CDR-G) score of zero, and had concomitant data on APOE ɛ4 status and medical co-morbidities including histories of hypertension and hypercholesterolemia. Multivariable Cox proportional hazards models adjusted for well-known potential confounders were used to compare dementia onset among APOE ɛ4 carriers and non-carriers by young (≤65 years) and old (>  65 year) age groups. Results: 519 participants converted to dementia within an average follow up of 5.97 years. Among older APOE ɛ4 carriers, hypercholesterolemia was related to lower risk of dementia (HR (95% CI), 0.68 (0.49–0.94), p = 0.02). Among older APOE ɛ4 non-carriers, hypertension was related to higher risk of dementia (HR (95% CI), 1.44 (1.13–1.82), p = 0.003). These results were corroborated among a subset with autopsy data characterizing underlying neuropathology. Among younger participants, vascular risk factors did not impact dementia risk, likely from a lower frequency of vascular and Alzheimer’s as etiologies of dementia among this cohort. Conclusion: A history of hypercholesterolemia related to a lower risk of dementia among older APOE ɛ4 carriers, while hypertension related to a higher risk of dementia among older APOE ɛ4 non-carriers.

P451: The effect of vascular risk factors on GFR in older patients during lithium use

2014 ◽  
Vol 5 ◽  
pp. S223-S224
Author(s):  
E.J.M. van Melick ◽  
I. Wilting ◽  
R.M. Kok ◽  
A.C.G. Egberts
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Vascular Risk Factors ◽  
Vascular Risk

Vascular risk factors in older patients with depression: outcome of electroconvulsive therapy versus medication

2017 ◽  
Vol 33 (2) ◽  
pp. 371-378 ◽  
Author(s):  
Harm-Pieter Spaans ◽  
Rob M. Kok ◽  
Filip Bouckaert ◽  
Julia F. Van Den Berg ◽  
Orlaith C. Tunney ◽  
...  
Keyword(s):  
Risk Factors ◽  
Electroconvulsive Therapy ◽  
Older Patients ◽  
Vascular Risk Factors ◽  
Vascular Risk

Abstract WP450: Cognitive Impairment and Asymptomatic Intracranial Atherosclerotic Stenosis in General Population

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
M.Fareed K. Suri ◽  
Jincheng Zhou ◽  
Ye Qiao ◽  
Haitao Chu ◽  
Adnan I Qureshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
African Americans ◽  
Previous History ◽  
Vascular Risk Factors ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Atherosclerosis Risk In Communities ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis

Background: There is growing evidence suggesting that intracranial atherosclerosis is associated with cognitive impairment. We investigated the association between asymptomatic intracranial atherosclerosis and cognitive impairment in the bi-racial Atherosclerosis Risk in Communities (ARIC) cohort. Methods: ARIC participants who underwent high-resolution 3T magnetic resonance angiography, and a neuropsychology battery and neurological examination adjudicated by an expert panel, to detect mild cognitive impairment (MCI) and dementia. We adjusted for demographic and vascular risk factors in weighted logistic regression analysis, accounting for stratified sampling design and attrition, to determine the association of intracranial atherosclerotic stenosis (ICAS) with cognitive impairment. Results: In 1705 participants (mean age 76 ± 5.3, 41% men, 71% Whites and 29% African-Americans) with adequate imaging quality and no previous history of stroke, MCI was identified in 578 (34%) and dementia in 79 (4.6%). In white participants, after adjustment for demographic and vascular risk factors, ICAS ≥50% (vs no ICAS) was strongly associated with dementia (odds ratio [OR] 4.1, 95% confidence interval [CI] 1.7-10) and with any-cognitive impairment (OR 1.7, 95% CI 1.06 - 2.8). In contrast, no association was found between ICAS ≥50% and MCI or dementia in African-Americans, though sample size was limited and estimates were imprecise. Conclusion: Our results suggest asymptomatic ICAS is independently associated with cognitive impairment and dementia in Whites

Impact of vascular risk factors on clinical outcome in older patients with depression receiving electroconvulsive therapy

L Encéphale ◽  
2019 ◽  
Vol 45 ◽  
pp. S74
Author(s):  
Lucie Jurek ◽  
Jérôme Brunelin ◽  
Jean Michel Dorey ◽  
Filipe Galvao
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Electroconvulsive Therapy ◽  
Older Patients ◽  
Vascular Risk Factors ◽  
Vascular Risk

Abstract WP271: The Role of Ring Finger Protein213 Variant in Patients With Intracranial Atherosclerotic Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hyung Jun Kim ◽  
Oh Young Bang ◽  
In-Young Baek ◽  
Jae-Hwan Kim ◽  
Ye Sel Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Moyamoya Disease ◽  
Ring Finger ◽  
Vascular Risk Factors ◽  
Imaging Features ◽  
Intracranial Atherosclerosis ◽  
Vascular Risk ◽  
Intracranial Atherosclerotic Disease ◽  
Tandem Lesions

Introduction: The Ring Finger Protein213 ( RNF213 ) gene variant is a relatively common variant in general population of East Asian countries (0.43 to 1.8%). Recently, RNF213 is reportedly a susceptibility gene not only for moyamoya disease (MMD) but also for intracranial atherosclerosis (ICAS) in this population. However, the role of this genetic factor in patients with ICAS is unknown. We hypothesized that this variant is involved in the pathogenesis of ICAS. Methods: We conducted a prospective study of patients with ICAS and MMD using high-resolution MRI (HR-MRI) and RNF213 (p.Arg4810Lys variant) gene studies. Patients were classified into intracranial atherosclerosis (ICAS) when relevant plaques existed on HR-MRI and moyamoya disease (MMD) when patients had RNF213 variant and HR-MRI showed no plaque but characteristic features of MMD (negative remodeling and basal collaterals). We compared clinical and neuroimaging features between (a) the RNF213 - ICAS, (b) the RNF213 + ICAS, and (c) MMD group. Results: Among 178 patients analyzed, 79 were the RNF213 - ICAS, 37 the RNF213 variant+ ICAS, and 62 the MMD group. Vascular risk factors were more frequently observed in ICAS than MMD patients, but there was no difference between RNF213 - ICAS and the RNF213 variant+ ICAS. Moreover, the site of occlusive disease was different between ICAS and MMD patients, but not between RNF213 - ICAS and the RNF213 variant+ ICAS. It was more distally located in RNF213 variant+ ICAS than in MMD (p=0.012). Compared to RNF213 - ICAS patients, tandem lesions were significantly more common in RNF213 + ICAS (24.1% vs. 67.6%, p<0.05), after adjusted for vascular risk factors. Conclusions: Patients with ICAS and the RNF213 variant showed distinct clinical and imaging features from MMD patients. A high frequency of tandem lesions in RNF213 + ICAS suggest that this variant may have synergic effects in atherosclerosis which should be tested in a larger cohort.

Abstract TP442: Baseline Cognitive Impairment and Associated Risk Factors in Patients with Intracranial Stenosis in the SAMMPRIS Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Erin V Ilkanich ◽  
Alison P Smock ◽  
George A Cotsonis ◽  
Stephanie Helwig ◽  
Michael J Lynn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Multivariate Analyses ◽  
Recurrent Stroke ◽  
White Matter Lesions ◽  
Vascular Risk Factors ◽  
Intracranial Stenosis ◽  
Baseline Risk ◽  
Vascular Risk ◽  
Moca Score

Background and Purpose: Cognitive impairment is an important outcome in stroke prevention trials. The Montreal Cognitive Assessment (MoCA) score is a cognitive measure used in the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial due to its sensitivity in detecting cognitive impairment in stroke patients. We sought to determine the prevalence of low baseline MoCA scores and the baseline risk factors associated with lower MoCA scores in SAMMPRIS patients. Methods: The main entrance criteria in SAMMPRIS were a TIA or non-disabling stroke within 30 days prior to enrollment attributed to 70-99% intracranial atherosclerosis. Patients with stroke as the qualifying event who had an NIH Stroke Score indicating aphasia or neglect were excluded from these analyses. Low MoCA score was defined as <26, the standard value that has 90% sensitivity for detecting mild cognitive impairment. Baseline demographic, medical history, laboratory, and neuroimaging characteristics were compared between patients with low vs. normal MoCA scores in univariate and multivariate analyses. Results: The prevalence of low baseline MoCA scores was 207/377 (55%). Baseline features associated with low MoCA scores in the univariate analyses are shown in Table 1. In the multivariate analyses, older age (p<0.0001) and physical inactivity (p=0.0166) were associated with low MoCA scores. MoCA score was not related to other vascular risk factors, severity of stenosis, prior stroke, or white matter lesions on CT or MRI. Conclusions: SAMMPRIS patients had a high prevalence of cognitive impairment at baseline, which was not explained by the presence of vascular risk factors, such as hypertension and hypercholesterolemia. This finding suggests that cognitive impairment may be an important source of potential disability in patients with intracranial stenosis.

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