EXPRESS: Long-term Neurobehavioral Correlates of Brain Cortical Microinfarcts in a Memory Clinic Cohort in Singapore

2021 ◽  
pp. 174749302110062
Author(s):  
Xin Xu ◽  
Cheuk Ni Kan ◽  
Christopher Li-Hsian Chen ◽  
Saima Hilal
Keyword(s):  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Functional Decline ◽  
Memory Clinic ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Clinical Assessments ◽  
The Impact

Background Cortical cerebral microinfarcts (CMIs) are a small vessel disease (SVD) biomarker underlying cognitive impairment and dementia. However, it is unknown whether CMIs are associated with neuropsychiatric disturbances, and whether its effects are independent of conventional SVD markers. Aims We investigated the associations of CMI burden with incidence and progression of neuropsychiatric subsyndromes (NPS) in a memory clinic cohort of elderly in Singapore. Methods In this prospective cohort, 496 subjects underwent detailed neuropsychological and clinical assessments, 3T brain MRI, and Neuropsychiatric Inventory assessment at baseline and 2 years later. Cortical CMIs and other SVD markers, including white matter hyperintensities, lacunes, and microbleeds, were graded according to established criteria. NPS were clustered into subsyndromes of Hyperactivity, Psychosis, Affective, and Apathy following prior findings. Functional decline was determined using the Clinical Dementia Rating (CDR) scale. Results The presence of multiple CMIs (≥2) was associated with higher NPS-total (β=4.19, 95% CI=2.81-5.58, p<0.001), particularly Hyperactivity (β=2.01, 95% CI=1.30-2.71, p<0.01) and Apathy (β=1.42, 95% CI=0.65-2.18, p<0.01) at baseline. Between baseline and year-2, multiple CMIs were associated with accelerated progression in NPS-total (β=0.29, 95% CI=0.06-0.53, p=0.015), driven by Hyperactivity (β=0.45, 95% CI=0.17-0.72, p<0.01). Subjects with multiple CMIs also had a faster functional decline, as measured with the CDR-sum-of-boxes scores, when accompanied with NPS-total progression (β=0.31, 95% CI=0.11-0.51, p<0.01), or Hyperactivity (β=0.34, 95% CI=0.13-0.56, p<0.01). Conclusion Cortical CMIs are associated with incidence and progression of geriatric neurobehavioral disturbances, independent of conventional SVD markers. The impact of incident CMIs on neurocognitive and neuropsychiatric trajectories warrants further investigations.

scholarly journals Total Cerebral Small Vessel Disease Burden on MRI Correlates With Medial Temporal Lobe Atrophy and Cognitive Performance in Patients of a Memory Clinic

2021 ◽  
Vol 13 ◽  
Author(s):  
Yangyi Fan ◽  
Ming Shen ◽  
Yang Huo ◽  
Xuguang Gao ◽  
Chun Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Cognitive Status ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Memory Clinic ◽  
Vessel Disease ◽  
Mri Features ◽  
The Impact

Background: Cerebral small vessel disease (cSVD) and neurodegeneration are the two main causes of dementia and are considered distinct pathological processes, while studies have shown overlaps and interactions between the two pathological pathways. Medial temporal atrophy (MTA) is considered a classic marker of neurodegeneration. We aimed to investigate the relationship of total cSVD burden and MTA on MRI using a total cSVD score and to explore the impact of the two MRI features on cognition.Methods: Patients in a memory clinic were enrolled, who underwent brain MRI scan and cognitive evaluation within 7 days after the first visit. MTA and total cSVD score were rated using validated visual scales. Cognitive function was assessed by using Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales. Spearman's correlation and regression models were used to test (i) the association between MTA and total cSVD score as well as each cSVD marker and (ii) the correlation of the MRI features and cognitive status.Results: A total of 312 patients were finally enrolled, with a median age of 75.0 (66.0–80.0) years and 40.7% (127/312) males. All of them finished MRI and MMSE, and 293 subjects finished MoCA. Of note, 71.8% (224/312) of the patients had at least one of the cSVD markers, and 48.7% (152/312) of them had moderate–severe MTA. The total cSVD score was independently associated with MTA levels, after adjusting for age, gender, years of education, and other vascular risk factors (OR 1.191, 95% CI 1.071–1.324, P = 0.001). In regard to individual markers, a significant association existed only between white matter hyperintensities and MTA after adjusting for the factors mentioned above (OR 1.338, 95% CI 1.050–1.704, P = 0.018). Both MTA and total cSVD score were independent risk factors for MMSE ≤ 26 (MTA: OR 1.877, 95% CI 1.407–2.503, P &lt; 0.001; total cSVD score: OR 1.474, 95% CI 1.132–1.921, P = 0.004), and MoCA &lt; 26 (MTA: OR 1.629, 95% CI 1.112–2.388, P = 0.012; total cSVD score: OR 1.520, 95% CI 1.068–2.162, P = 0.020). Among all the cSVD markers, microbleed was found significantly associated with MMSE ≤ 26, while no marker was demonstrated a relationship with MoCA &lt; 26.Conclusion: Cerebral small vessel disease was related to MTA in patients of a memory clinic, and both the MRI features had a significant association with cognitive impairment.

scholarly journals The Impact of Function Focused Care From Acute Care to Home Care and Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 629-629
Author(s):  
Silke Metzelthin ◽  
Sandra Zwakhalen ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
The Netherlands ◽  
Home Care ◽  
Acute Care ◽  
Long Term Care ◽  
Functional Decline ◽  
Term Care ◽  
The Us ◽  
The Impact

Abstract Functional decline in older adults often lead towards acute or long-term care. In practice, caregivers often focus on completion of care tasks and of prevention of injuries from falls. This task based, safety approach inadvertently results in fewer opportunities for older adults to be actively involved in activities. Further deconditioning and functional decline are common consequences of this inactivity. To prevent or postpone these consequences Function Focused Care (FFC) was developed meaning that caregivers adapt their level of assistance to the capabilities of older adults and stimulate them to do as much as possible by themselves. FFC was first implemented in institutionalized long-term care in the US, but has spread rapidly to other settings (e.g. acute care), target groups (e.g. people with dementia) and countries (e.g. the Netherlands). During this symposium, four presenters from the US and the Netherlands talk about the impact of FFC. The first presentation is about the results of a stepped wedge cluster trial showing a tendency to improve activities of daily living and mobility. The second presentation is about a FFC training program. FFC was feasible to implement in home care and professionals experienced positive changes in knowledge, attitude, skills and support. The next presenter reports about significant improvements regarding time spent in physical activity and a decrease in resistiveness to care in a cluster randomized controlled trial among nursing home residents with dementia. The fourth speaker presents the content and first results of a training program to implement FFC in nursing homes. Nursing Care of Older Adults Interest Group Sponsored Symposium

Abstract 39: Acute Blood Pressure Dysregulation Increases the Risk of Border Zone Ischemic Lesions in Hypertensive Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Szu-Ju Chen ◽  
Hsin-Hsi Tsai ◽  
Li-Kai Tsai ◽  
Ya-Fang Chen ◽  
Sung-Chun Tang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Border Zone ◽  
Cerebral Hypoperfusion ◽  
White Matter Hyperintensity ◽  
Roc Curve Analysis ◽  
The Difference ◽  
The Impact

Background: Intensive blood pressure (BP) reduction is regarded as the gold standard therapy for acute intracerebral hemorrhage (ICH), but its associations to cerebral hypoperfusion and ischemic lesions have been suspected. This study aims to investigate the impact of acute BP reduction on the development of acute ischemic lesions (AILs) at border zone (BZ) areas in patients with hypertensive ICH. Methods: We enrolled patients with acute hypertensive ICH (hemorrhagic lesions restricted to deep region [Strictly deep-ICH] or located in mixed lobar and deep areas [Mixed-ICH]) who received brain MRI within 7 days after ICH onset. BZ AILs were defined as lesions locating at BZ areas that were hyperintense on DWI sequence and hypointense on ADC series (figure). Acute SBP change was the difference between the initial SBP and the SBP recorded at 24 hours after ICH onset. Results: Of the 274 enrolled patients (62.5 ± 12.7 years old, 65% male), 11 subjects had BZ AILs. Compared to patients without BZ AILs, patients with lesions had wider amount of acute SBP reduction (71.7 ± 33.6 vs. 43.0 ± 32.2 mmHg, P = 0.023), more lobar and deep microbleeds (MB) and larger white matter hyperintensity volume (all p < 0.05). Using ROC curve analysis, acute SBP drop at more than 54mmHg was linked to the occurrence of AILs (sensitivity 82%, specificity 64%, P = 0.002). In multiple logistic regression model, acute SBP decline at above 54mmHg (OR 11.45, 95%CI 2.06 - 63.49, P = 0.005) and higher deep MB burden ( P = 0.032) raised the risk of AILs after adjustment for age, sex, and image markers of cerebral small vessel disease. In subgroup analysis, larger acute SBP drop remained to be an independent risk factor for development of AILs in patients with Mixed-ICH ( P = 0.008), but not in patients with strictly deep-ICH ( P = 0.715). Conclusion: Acute SBP change in hypertensive ICH, especially in Mixed-ICH, increases the risk of AILs at BZ areas, showing widespread microangiopathy that is vulnerable to rapid BP dysregulation to ischemia.

scholarly journals Riding the Crest of the Teachable Moment: Promoting Long-Term Health After the Diagnosis of Cancer

2005 ◽  
Vol 23 (24) ◽  
pp. 5814-5830 ◽  
Author(s):  
Wendy Demark-Wahnefried ◽  
Noreen M. Aziz ◽  
Julia H. Rowland ◽  
Bernardine M. Pinto
Keyword(s):  
Cancer Survivors ◽  
Behavioral Interventions ◽  
Fruits And Vegetables ◽  
Functional Decline ◽  
Adult Survivors ◽  
Lifestyle Changes ◽  
Prostate Cancer Survivors ◽  
Increased Risk ◽  
The Impact

Purpose Cancer survivors are at increased risk for several comorbid conditions, and many seek lifestyle change to reduce dysfunction and improve long-term health. To better understand the impact of cancer on adult survivors' health and health behaviors, a review was conducted to determine (1) prevalent physical health conditions, (2) persistent lifestyle changes, and (3) outcomes of previous lifestyle interventions aimed at improving health within this population. Methods Relevant studies from 1966 and beyond were identified through MEDLINE and PubMed searches. Results Cancer survivors are at increased risk for progressive disease but also for second primaries, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. To improve overall health, survivors frequently initiate diet, exercise, and other lifestyle changes after diagnosis. However, those who are male, older, and less educated are less likely to adopt these changes. There also is selective uptake of messages, as evidenced by findings that only 25% to 42% of survivors consume adequate amounts of fruits and vegetables, and approximately 70% of breast and prostate cancer survivors are overweight or obese. Several behavioral interventions show promise for improving survivors' health-related outcomes. Oncologists can play a pivotal role in health promotion, yet only 20% provide such guidance. Conclusion With 64% of cancer patients surviving > 5 years beyond diagnosis, oncologists are challenged to expand their focus from acute care to managing the long-term health consequences of cancer. Although more research is needed, opportunities exist for oncologists to promote lifestyle changes that may improve the length and quality of life of their patients.

Acute Psychogeriatric Inpatient Treatment Improves Neuropsychiatric Symptoms but Impairs the Level of Functioning in Patients with Dementia

2015 ◽  
Vol 40 (5-6) ◽  
pp. 290-296 ◽  
Author(s):  
Hanna-Mari Alanen ◽  
Anneli Pitkänen ◽  
Kirsti Suontaka-Jamalainen ◽  
Olli Kampman ◽  
Esa Leinonen
Keyword(s):  
Mental State ◽  
Daily Living ◽  
Mini Mental State Examination ◽  
Neuropsychiatric Symptoms ◽  
Functional Decline ◽  
Neuropsychiatric Inventory ◽  
Behavioral Disturbances ◽  
Level Of Functioning ◽  
The Impact ◽  
State Examination

Aims: To explore the impact of hospitalization on neuropsychiatric symptoms (NPS) and the level of functioning in patients with dementia. Our aim was also to study the influence of psychotropic medications. Methods: Behavioral disturbances, cognition and functional status of 89 patients were assessed using the Neuropsychiatric Inventory (NPI), Mini-Mental State Examination, Barthel Index, and Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCSADL). Results: The total NPI score decreased from 34.6 to 19.5 (p < 0.001), and ADL decreased from 32.2 to 21.7 (p < 0.001) during the hospital stay (mean of 44 days). For a change in ADL, only the effect of anxiolytics was significant (p = 0.045). For a change in NPI with antipsychotic and anxiolytic doses and Mini-Mental State Examination as covariates, no significant relationship was found. Conclusion: NPS improved significantly during hospitalization, but neither antipsychotic nor anxiolytic medication use explained this improvement. In patients using anxiolytics, the functional decline was substantial. These results do not support anxiolytic use in demented patients with NPS.

Perivascular Spaces in the Basal Ganglia and Long-term Motor Prognosis in Newly Diagnosed Parkinson Disease

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011797
Author(s):  
Seok Jong Chung ◽  
Han Soo Yoo ◽  
Na-Young Shin ◽  
Yae Won Park ◽  
Hye Sun Lee ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Cox Regression ◽  
Small Vessel Disease ◽  
Symptom Control ◽  
Brain Mri ◽  
Freezing Of Gait ◽  
Initial Assessment ◽  
Perivascular Spaces ◽  
Wearing Off

Objectives:To investigate the association between enlarged perivascular spaces (PVSs) in the basal ganglia (BG-PVSs) and long-term motor outcomes in Parkinson’s disease (PD).Methods:We reviewed the medical records of 248 patients with drug-naïve early-stage PD (follow-up >3 years, mean age 67.44 ± 8.46 years, 130 females) who underwent brain MRI and dopamine transporter (DAT) scans at initial assessment. The number of baseline enlarged BG-PVSs was counted on axial T2-weighted images. Then, patients were divided into two groups: a PD group with a low number (0−10) of enlarged PVSs (PD-EPVS−; n = 156) and that with a high number (>10) of enlarged PVSs (PD-EPVS+; n = 92). We used Cox regression models to compare the levodopa-induced dyskinesia (LID)-, wearing-off-, and freezing of gait (FOG)-free times between groups. We also compared longitudinal increases in levodopa-equivalent dose per body weight between groups using a linear mixed model.Results:Patients in the PD-EPVS+ group were older (72.28 ± 6.07 years) and had greater small vessel disease burden than those in the PD-EPVS− group (64.58 ± 8.38 years). The PD-EPVS+ group exhibited more severely decreased DAT availability in all striatal sub-regions except the ventral striatum. The risk of FOG was higher in the PD-EPVS+ group, but the risk of LID or wearing-off was comparable between groups. The PD-EPVS+ group required higher doses of dopaminergic medications for effective symptom control compared to the PD-EPVS− group.Conclusions:This study suggests that baseline enlarged BG-PVSs can be an indicator of the progression of motor disability in PD.

Abstract WP192: Periventricular White Matter Hyperintensities Are Associated With Functional Decline: The Northern Manhattan Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mandip S Dhamoon ◽  
Ying-Kuen Cheung ◽  
Ahmet M Bagci ◽  
Chensy Marquez ◽  
Noam Alperin ◽  
...  
Keyword(s):  
White Matter ◽  
Repeated Measures ◽  
Brain Mri ◽  
Large Population ◽  
Functional Decline ◽  
Brain Regions ◽  
White Matter Hyperintensity ◽  
Periventricular White Matter ◽  
Brain White Matter

Background: We previously showed that overall brain white matter hyperintensity volume (WMHV) was associated with accelerated long-term functional decline. However, it was unclear whether WMHV in particular brain regions was more predictive of decline. We hypothesized that WMHV in particular brain regions would be more predictive of functional decline. Methods: In the Northern Manhattan MRI study, participants had brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences, with baseline interview and examination. Volumetric WMHV distribution across 14 brain regions (brainstem, cerebellum, and bilateral frontal, occipital, temporal, and parietal lobes, and bilateral anterior and posterior periventricular white matter [PVWM]) was determined separately by combining bimodal image intensity distribution and atlas based methods. Participants had annual functional assessments with the Barthel index (BI, range 0-100) over a mean of 7.3 years and were followed for stroke and myocardial infarction (MI). Due to multiple collinear variables, lasso regression was used to select regional WMHV variables, and adjusted generalized estimating equations models estimated associations with baseline BI and change over time. Results: Among 1195 participants, mean age was 71 (SD 9) years, 460 (39%) were male, 802 (67%) had hypertension and 224 (19%) diabetes. Using lasso regularization, only right anterior PVWM was selected, and each SD increase was associated with accelerated functional decline, of -0.95 additional BI points per year (95% CI -1.20, -0.70) in an unadjusted model, -0.92 points per year (95% CI -1.18, -0.67) with baseline covariate adjustment, and -0.87 points per year (95% CI -1.12, -0.62) after adjusting for stroke and MI. This decline was in addition to a mean decline of -1.13 (95% CI -1.29, -0.97), -1.19 (95% CI -1.36, -1.01), and -1.04 (95% CI -1.21, -0.88) BI points per year, respectively. Conclusions: In this large population-based study with long-term repeated measures of function, periventricular WMHV was particularly associated with accelerated functional decline. Periventricular WMHV may have a greater effect on mobility due to dysfunction in descending leg motor tracts.

scholarly journals The Impact of Dementia and Language on Hospitalizations. A Retrospective Cohort of Long-Term Care Residents.

2020 ◽  
Author(s):  
Karine Riad ◽  
Colleen Webber ◽  
Ricardo Batista ◽  
Michael Reaume ◽  
Emily Rhodes ◽  
...  
Keyword(s):  
Long Term Care ◽  
Functional Decline ◽  
Administrative Databases ◽  
Primary Language ◽  
Term Care ◽  
Language Discordance ◽  
Iatrogenic Complications ◽  
Incidence Of Hospitalization ◽  
The Impact

Abstract Background: Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods: We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results: The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81 – 1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53 – 0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions: Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.

scholarly journals Confirmed central olfactory system lesions on brain MRI in COVID-19 patients with anosmia: a case-series

2020 ◽  
Author(s):  
Yannick Girardeau ◽  
Yoan GALLOIS ◽  
Guillaume DE BONNECAZE ◽  
Bernard ESCUDE ◽  
Clarisse LAFONT ◽  
...  
Keyword(s):  
Orbitofrontal Cortex ◽  
Olfactory System ◽  
Brain Mri ◽  
Case Series ◽  
Olfactory Bulbs ◽  
Olfactory Test ◽  
High Resolution Images ◽  
Smell Disorders ◽  
The Impact

Objective: Anosmia has been listed as a key-symptom associated with the COVID-19 infection. Because it often occurs without any sign of rhinitis, lesions of the central olfactory system have been suspected. To date, however, there is no evidence that anosmia caused by SARS-CoV2 could be the result of brain damage. Methods: We conducted a case-series on 10 consecutive COVID-19 patients who reported anosmia. Each patient prospectively underwent a validated olfactory test (Sniffin Sticks test) and a brain MRI. Results: Hypersignal intensity lesions of the central olfactory system were found in 3 subjects on 3D T2 FLAIR and 2D T2 High Resolution images with a lesion involving the olfactory bulbs and/or the orbitofrontal cortex. These 3 subjects showed a severe and persistent loss of smell on the olfactory test. Mucosal hyperplasia of the upper nasal cavities was found in two other subjects with significant smell disorders. There was no MRI anomaly in two subjects with good smell restoration. Conclusions: Anomalies of the central olfactory system could be responsible for anosmia in patients with COVID-19 infection. Further studies are needed to assess the impact on long-term functional prognosis of these lesions.

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