Abstract 93: Newly-diagnosed Depression Precedes Cognitive Impairment Following Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alessandro Biffi ◽  
Christina Kourkoulis ◽  
Kristin Schwab ◽  
Alison M Ayres ◽  
M. Edip Gurol ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Apoe Genotype ◽  
Systematic Evaluation ◽  
Prior History ◽  
Newly Diagnosed

Introduction: Survivors of Intracerebral Hemorrhage (ICH) are at high risk for developing long-term incident cognitive decline and depression. However, owing largely to limited data on long-term post-ICH depression risk, the degree to which these two forms of post-hemorrhage clinical deterioration overlap is unknown. Hypothesis: post-ICH depression is highly incident, and associated with long-term cognitive decline risk. Methods: We followed longitudinally 695 ICH survivors with no prior history of depression. Exposures of interest included clinical information, known genetic risk factors for ICH / post-ICH dementia (APOE ε2/ε4), and imaging manifestations of cerebral small vessel disease on CT (CT-defined white matter disease [CT-WMD]). We captured outcomes (incident depression and dementia) during follow-up using validated scales administered via telephone every 6 months. Results: A total of 271/695 ICH survivors (40%) developed new-onset mood disorder during a median follow-up time of 49.6 months (Figure). We estimated an incidence rate of 6.9% yearly (95% CI 5.5-8.8%) for post-ICH depression. Independent risk factors for post-ICH depression included lower educational achievements, APOE ε4, and moderate/severe CT-WMD (all p<0.05). Depression and dementia were co-diagnosed in 135/214 individuals (63%). Depression preceded post-ICH dementia in 108/135 cases (80%, 95% CI 71-88%, p = 0.002), with median anticipation of 17.5 months (IQR = 12.8-23.9). Conclusions: we conducted the first-ever systematic evaluation of long-term post-ICH depression, which affects a large proportion of ICH survivors and shares risk factors (education, APOE genotype, CT-WMD severity) with risk for ICH recurrence and post-ICH dementia. Newly diagnosed depression often signals impending onset of dementia after ICH.

Abstract TMP113: Long-term Cognitive Decline After Intracerebral Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Alessandro Biffi ◽  
Christopher D Anderson ◽  
Alison M Ayres ◽  
Steven M Greenberg ◽  
Jonathan Rosand ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Intracerebral Hemorrhage ◽  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Vascular Cognitive Impairment ◽  
Cognitive Status ◽  
Decline Rate ◽  
Severe Manifestation

Introduction: Cerebral small vessel disease (CSVD) is the leading cause of Vascular Cognitive Impairment (VCI). Although Intracerebral Hemorrhage (ICH) is the most severe manifestation of CSVD, VCI among ICH survivors has been the subject of limited investigations. Hypothesis: We sought to test these hypotheses: 1) long-term cognitive decline rates are substantial even among initially non-demented ICH survivors; 2) underlying CSVD plays a substantial role in determining post-ICH long-term cognitive decline. Methods: We enrolled survivors of primary ICH, with no evidence of dementia 6 months post-hemorrhage, in a single-center longitudinal observational study. Presence and severity of CSVD was assessed at enrollment using two established markers of CSVD on CT (CT-defined white hatter hypodensity [CT-WMH]) and MRI (cerebral microbleeds [CMBs]). We captured blood pressure measurements during follow-up via review of medical records. Cognitive performance was assessed using the Modified Telephone Interview for Cognitive Status (TICS-m), a standardized validated telephone-based cognitive battery. We constructed multivariate models of cognitive decline rate, defined as slope of TICS-m scores over time. Results: A total of 275 ICH survivors qualified for inclusion in our analyses; of these 83 (30%) developed incident dementia and 33 (12%) developed incident Mild Cognitive Impairment (MCI) at 5 years (Figure). CSVD imaging markers were associated with cognitive decline rate (CT-WMH: p=0.001, CMBs: p=0.003), as were pulse pressure (p=0.003) and systolic blood pressure variation coefficient (p=0.034). Conclusions: Long-term cognitive decline is frequent and substantial among ICH survivors not demented at time of ICH, and strongly associates with severity of underlying CSVD. Our findings suggest that it is the extent of CSVD and not particular ICH characteristics that are most associated with long-term cognitive decline in survivors of ICH.

Abstract 17910: Patients with Newly Diagnosed Diabetes Have Comparable Long Term Mortality with Known Diabetics After ST Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bhuvnesh Aggarwal ◽  
Gautam Shah ◽  
Mandeep S Randhawa ◽  
A M Lincoff ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Prior History ◽  
Newly Diagnosed ◽  
St Segment Elevation ◽  
St Segment ◽  
History Of ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes ◽  
Long Term Mortality

Background: A significant proportion of patients presenting with ST segment elevation myocardial infarction (STEMI) have newly diagnosed diabetes mellitus (DM). Hypothesis: Our aim was to identify patients with previously undiagnosed DM and compare their outcomes to those with known DM and without DM after STEMI. Methods: Consecutive patients undergoing primary PCI for STEMI at our center between Jan 2005 - Dec 2012 were included. Routinely performed admission Glycated hemoglobin (HbA1c) was utilized to identify patients with previously undiagnosed DM (HbA1c ≥ 6.5 and no history of DM or diabetes therapy). Patients were compared for in-hospital and long-term mortality based on follow up data from our institutional PCI registry. Results: 1,734 consecutive patients underwent primary PCI for STEMI and follow up data was available for 1,566 (90%) patients. Mean age was 60 years and 67.3% were males. A quarter of the patients (24.3%, n = 382) had prior history of DM and 8% (n=95) of the remainder had undiagnosed DM. Median follow up was 35 months. Mortality was comparable in patients with known DM and newly diagnosed DM both in hospital (11.2% vs. 12.5%, p=0.87) and at long term follow up (Figure 1, 2). Mortality was significantly worse with both groups when compared with patients with no DM (In-hospital mortality 5.6%; p<0.001 for both groups). Conclusions: One in twelve patients presenting with STEMI have previously undiagnosed DM. Cardiologists have a unique opportunity for identification and initiation of diabetic therapy in this vulnerable population. Patients with newly diagnosed DM have similar short and long-term outcomes when compared with patients with a prior history of DM.

scholarly journals Apolipoprotein E2 Genotype Is Associated with a 2-Fold Increase in the Incidence of Type 2 Diabetes Mellitus: Results from a Long-Term Observational Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Cátia Santos-Ferreira ◽  
Rui Baptista ◽  
Manuel Oliveira-Santos ◽  
Regina Costa ◽  
José Pereira Moura ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Apoe Genotype ◽  
Prior History ◽  
Twofold Increase ◽  
Apoe Genotypes

Background. The apolipoprotein E (APOE) polymorphisms are associated with cardiovascular (CV) disease, but its interaction with type 2 diabetes mellitus (T2DM) long-term incidence is unknown. We investigated the association between APOE genotype and long-term (i) CV events and (ii) T2DM incidence in a Southern European primary prevention cohort. Methods. We assessed individual APOE genotypes in a total of 436 patients followed at a lipid clinic, with a 15-year median follow-up time. We collected data on major CV events (CV death, myocardial infarction, and stroke) and T2DM development. Results. No differences were found regarding major CV event incidence among the different APOE genotypes. However, after excluding 39 patients with a prior history of T2DM, APOE2 carriers displayed a higher incidence of T2DM during follow-up (42.2%) than APOE3 (27.1%) and APOE4 (28.7%) carriers. The age-, sex-, triglycerides-, and statin usage-adjusted OR for T2DM incidence in APOE2 carriers was 1.8 (95%CI 1.1-2.9, p=0.03), compared with wild-type APOE3. To address the role of statins as a confounder, we analyzed T2DM incidence in statin-treated patients. Statin-treated APOE2 carriers also had a higher T2DM incidence (57.9%), in comparison with APOE3 homozygotes (31.6%) and APOE4 carriers (32.5%). After adjustment for confounding, APOE2 carriers on statins displayed a similar twofold increase in T2DM risk compared to APOE3 homozygotes (OR 2.1, 95%CI 1.1-4.0, p=0.03). Conclusion. Our findings suggest a twofold increase in T2DM incidence in APOE2 carriers. This may prompt for a specific glucose dysmetabolism follow-up that might be tailored on the APOE genotype.

scholarly journals Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years

2021 ◽  
Vol 13 ◽  
Author(s):  
Mangmang Xu ◽  
Baojin Li ◽  
Di Zhong ◽  
Yajun Cheng ◽  
Qian Wu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Stroke Recurrence ◽  
Poor Functional Outcome ◽  
Vessel Disease

Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH).Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome.Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB &lt; 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038).Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.

scholarly journals At the Heart of Brain Disorders – Preventing Cognitive Decline and Dementia

2015 ◽  
Vol 10 (1) ◽  
pp. 60 ◽  
Author(s):  
Augusto Vicario ◽  
Gustavo H. Cerezo ◽  
◽  
Keyword(s):  
Risk Factors ◽  
Cognitive Decline ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Brain Disorders ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Β Amyloid ◽  
And Control

Vascular risk factors are shared by heart and brain. Vascular brain injury (small vessel disease, stroke) alone or combined with neurodegenerative pathology (β-amyloid depositions) brings about either cognitive decline and vascular dementia or Alzheimer’s disease. Long-term exposure to vascular risk factors precedes the onset of neurocognitive diseases by one or two decades. Early detection and control of modifiable vascular risk factors seem to be the only current strategies to prevent cognitive impairment and dementia.

Abstract WP359: Higher Risk of Intracerebral Hemorrhage Recurrence Among African American and Latino/Hispanic Individuals

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Axana Rodriguez-Torres ◽  
Christina Kourkoulis ◽  
Kristin Schwab ◽  
Alison M Ayres ◽  
M. Edip Gurol ◽  
...  
Keyword(s):  
Risk Factors ◽  
African American ◽  
Intracerebral Hemorrhage ◽  
Cox Regression ◽  
Apoe Genotype ◽  
Recurrence Risk ◽  
Single Center ◽  
Apoe Ε4 ◽  
Phone Calls

Introduction: Intracerebral hemorrhage (ICH) is more prevalent among African American (AA) and Latino/Hispanic (LH) individuals. While ICH survivors are at high risk for rebleeding, it is unclear whether recurrence risk differs based on race / ethnicity. Hypothesis: We sought to clarify: 1) whether ICH recurrence risk is higher for AA and LH patients; 2) whether this disparity is explained by the most potent ICH risk factors, i.e. hypertension severity and the APOE gene variant ε4. Methods: We conducted a single-center longitudinal study enrolling 738 ICH survivors presenting to a single center from January 2006 to December 2014. Participants had APOE genotype determined at enrollment, and were followed via phone calls and review of medical records. We captured hypertension severity as absolute blood pressure (BP) measures, as well as BP variability (average percent variation during follow-up). We created univariable and multivariable (Cox regression) models to identify risk factors for ICH recurrence. Results: Systolic BP (SBP) was associated with increased ICH recurrence risk ( Hazard Ratio [HR]=1.30, 95% Confidence Interval [CI] 1.02 -1.66, p=0.036), as was SBP variation (HR=1.75 per variation quartile, 95% CI 1.09-2.81, p=0.021). APOE ε4 was also associated with ICH recurrence (HR=1.66, 95% CI 1.10-2.50, p=0.016). After adjusting for BP and APOE ε4, both LH ( HR=1.68, 95% CI 1.01-2.78, p = 0.045 ) and AA ( HR= 2.12, 95% CI 1.14-3.95, p = 0.019 ) patients when at higher risk for ICH recurrence. Both AA and LH patients had a significantly higher systolic BP (SBP) during follow-up (Figure, A); AA individuals also had greater SBP variation during follow up (Figure, B ). Conclusions: AA and LH patients are at higher risk for ICH recurrence, and hypertension severity / APOE ε4 did not fully account for this disparity. Additional studies will be required to further elucidate biological determinants for this health

Abstract P013: Elevated Resting Heart Rate in Mid-Life is Associated With Cognitive Change Over 20-years: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Stephanie Z Wang ◽  
Oluwaseun E Fashanu ◽  
Di Zhao ◽  
Eliseo Guallar ◽  
Rebecca F Gottesman ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cognitive Decline ◽  
Apoe Genotype ◽  
Cognitive Change ◽  
Cognitive Testing ◽  
Word Recall ◽  
Prior History ◽  
Resting Heart Rate ◽  
Cvd Risk

Background: Resting heart rate (RHR) is an easily measured marker that is independently associated with cardiovascular disease (CVD) risk. There are several potential mechanisms by which RHR could affect cognitive function, but little is known about the relation of RHR and cognitive decline. We examined the association of RHR with 20 year cognitive decline in a community-based cohort. Methods: We studied 13,720 middle-aged white and black participants without a prior history of stroke or atrial fibrillation. RHR was obtained from a 12-lead resting electrocardiogram at baseline (1990-1992). Cognitive testing was measured at baseline and at up to two additional visits (1996-1998 and 2011-2013). A 3-test combined cognitive score was summed from these tests: delayed word recall, digit symbol substitution and word fluency. RHR was categorized into groups as < 60 (reference), 60-69, 70-79 and ≥80 bpm. We examined the association of RHR with cognitive decline using linear mixed-effects models adjusted for demographic, socioeconomic, CVD risk factors, and AV nodal blockade use. ApoE genotype was included as a possible predictor. Imputation methods were used to account for attrition over follow-up. Results: Mean (SD) age of participants at baseline was 58 (6) years; 56% were women, 24% black. Average (SD) RHR was 66 (10) bpm, with RHR distribution: <60 (28%), 60-69 (40%), 70-79 (23%), >80 (9%) bpm. Over a mean follow-up of 20 years, participants in each RHR group exhibited cognitive decline (Table Part A). However, there was relatively greater global cognitive decline for those with RHR 70-79 and >80 bpm compared to <60 bpm (Part B). Results were consistent when excluding participants on AV nodal blockade medications. Conclusion: Elevated RHR is independently associated with greater cognitive decline over 20 years. Further studies are needed to determine whether the association is causal or secondary to another underlying process. If causal, future studies can determine whether modification of RHR can reduce cognitive decline.

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