EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

2021 ◽  
pp. 174749302110265
Author(s):  
Moamina Ismail ◽  
Vincent CT Mok ◽  
Adrian Wong ◽  
Lisa Au ◽  
Brian Yiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Early Onset Dementia ◽  
Delayed Onset ◽  
Lower Baseline ◽  
History Of ◽  
Ischemic Attack ◽  
Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEε4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEε4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of ≥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

scholarly journals Stroke Risk Factors, Subtypes and Outcome in Elderly Thai Patients

2021 ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
P Value ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Ischemic Attack

Abstract Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients.Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied.Result: 542 patients were included. The average age was 68.78±12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%). Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths) compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value<0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient's death.Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Ischemic Stroke Patients Demonstrate Increased Carotid Plaque Microvasculature Compared to (Ocular) Transient Ischemic Attack Patients

2017 ◽  
Vol 44 (5-6) ◽  
pp. 297-303 ◽  
Author(s):  
Raf H.M. van Hoof ◽  
Floris H.B.M. Schreuder ◽  
Patty Nelemans ◽  
Martine T.B. Truijman ◽  
Narender P. van Orshoven ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Clinical Risk Factors ◽  
Dce Mri ◽  
Clinical Risk ◽  
Cerebrovascular Events ◽  
Ischemic Attack ◽  
Prospective Longitudinal

Background: Patients with a recent ischemic stroke have a higher risk of recurrent stroke compared to (ocular) transient ischemic attack (TIA) patients. Plaque microvasculature is considered as a feature of plaque vulnerability and can be quantified with carotid dynamic contrast-enhanced MRI (DCE-MRI). The purpose of this cross-sectional study was to explore the association between plaque microvasculature and the type of recent cerebrovascular events in symptomatic patients with mild-to-moderate carotid stenosis. Methods: A total of 87 symptomatic patients with a recent stroke (n = 35) or (ocular) TIA (n = 52) underwent carotid DCE-MRI examination. Plaque microvasculature was studied in the vessel wall and adventitia using DCE-MRI and the pharmacokinetic modeling parameter Ktrans. Statistical analysis was performed with logistic regression, correcting for associated clinical risk factors. Results: The 75th percentile adventitial (OR 1.97, 95% CI 1.18-3.29) Ktrans was significantly associated with a recent ischemic stroke compared to (ocular) TIA in multivariate analysis, while clinical risk factors were not significantly associated with the type of event. Conclusions: This study indicates a positive association of leaky plaque microvasculature with a recent ischemic stroke compared to (ocular) TIA. Prospective longitudinal studies are needed to investigate whether Ktrans or other plaque characteristics may serve as an imaging marker for predicting (the type of) future cerebrovascular events.

scholarly journals Stroke risk factors, subtypes and outcome in elderly Thai patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chatpol Samuthpongtorn ◽  
Tul Jereerat ◽  
Nijasri C. Suwanwela
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
The Elderly ◽  
Younger Patients ◽  
Factors Associated ◽  
Stroke Risk Factors ◽  
History Of ◽  
Aged Society ◽  
Ischemic Attack

Abstract Background Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients. Method All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied. Result Five hundred forty-two patients were included. The average age was 68.78 ± 12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%) and was associated with poor outcome. Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value< 0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient’s death. Conclusion The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

scholarly journals Quantifying the Contribution of Risk Factors for Ischemic Stroke in Patients with a History of TIA

ISRN Stroke ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
Duncan C. Ramsey ◽  
Mark G. Burnett ◽  
Matthew C. Cowperthwaite
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Patient Population ◽  
Stroke Risk ◽  
Significant Risk ◽  
Individual Risk ◽  
Readmission Rates ◽  
Cardiovascular Comorbidities ◽  
History Of ◽  
Ischemic Attack

Background. Patients with a history of transient ischemic attack (TIA) are known to be at higher risk for a stroke. We sought to investigate predictors of individual risk for an ischemic stroke within 30 days of a TIA. Methods and Results. A retrospective analysis of 57,585 TIA admissions was collected from 155 United States hospitals. Data describing each admission included demographic and clinical data, and information about the admitting hospital. Cerebrovascular disease was the primary readmission reason (19% of readmissions) in the TIA patient population. The prevalence of 30-day ischemic stroke readmissions was 11 per 1,000 TIA admissions; however, 53% of stroke readmissions occurred within one week. Hierarchal regression models suggested that peripheral vascular disease and hypertensive chronic kidney disease were significant individual stroke risk factors, whereas history of myocardial infarction, essential hypertension, and diabetes mellitus was not associated with significant stroke risk. Certified stroke centers were not associated with significantly lower stroke readmission rates. Conclusions. The results suggest that cardiovascular comorbidities confer the most significant risk for an ischemic stroke within 30 days of a TIA. Interestingly, certified stroke centers do not appear to be associated with significantly lower stroke-readmission rates, highlighting the challenges managing this patient population.

Abstract TP418: Delayed Detection Of Atrial Fibrillation After Ischemic Stroke Or Transient Ischemic Attack

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Maria C Zurru ◽  
LAURA BRESCACIN ◽  
Claudia Alonzo ◽  
Victor Villarroel ◽  
Gabriela Orzuza ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Recurrence Risk ◽  
Improvement Program ◽  
Profile Control ◽  
History Of ◽  
Ischemic Attack

Background and purpose: detection of atrial fibrillation (AF) after ischemic stroke is crucial, because anticoagulation is mandatory in order to decrease recurrence risk. However, there is no agreement regarding the optimal method to detect paroxysmal AF after the event. The aim of this study was to evaluate predictors for delayed detection of AF after ischemic stroke (IS) and transient ischemic attack (TIA). Methods: PROTEGE-ACV is a multidisciplinary stroke quality improvement program coordinated by internists and neurologists within a Buenos Aires healthcare system aimed to optimize secondary stroke preventive care after IS or TIA. Demographic data, vascular risk factors profile control and management were evaluated at the inclusion visit, and IS was categorized according to TOAST classification. Results: From 01/2007 to 04 /2012, 872 ischemic stroke patients were included; mean age was 75 ± 10 years-old and 55% were female. Twenty two percent were cardioembolic and 7% undetermined with more than one mechanism with AF as one of them; 14% of patients had history of AF or diagnosis at hospitalization. Incident AF was diagnosed in 101 (21%) of 473 patients with two or more years of follow-up.. Diagnosis of AF was associated with age older than 80 years (OR 1.96 95% CI 1.25-3), history of hypertension (OR 2.4 95% CI 1.25-4.8), chronic renal failure (OR 2.65 95% CI 1.54-4.55) and stroke recurrence (OR 2.96 95% CI 1.66-5.26). Conclusion: delayed diagnosis of AF was common in this cohort of patients with IS or TIA. Identification of risk factors is important in order to perform a close follow-up of these patients and to determine the best method for this purpose, in order to reduce recurrence risk.

scholarly journals Vascular Risk Factors, Imaging, and Outcomes in Transient Ischemic Attack/Ischemic Stroke Patients with Neuroimaging Evidence of Probable/Possible Cerebral Amyloid Angiopathy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Qihui Zhang ◽  
Anxin Wang ◽  
Xia Meng ◽  
Xiaoling Liao ◽  
Yijun Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Cognitive Assessment ◽  
Vascular Risk Factors ◽  
Amyloid Angiopathy ◽  
Vascular Risk ◽  
Stroke Patients ◽  
Ischemic Attack ◽  
Moca Score

Background. In TIA/ischemic stroke patients, the clinical significance of lobar microbleeds potentially indicating cerebral amyloid angiopathy (CAA) is unknown. We assessed vascular risk factors and outcomes, including cognition, in TIA/ischemic stroke patients with neuroimaging evidence of probable/possible CAA. Methods. This prospective cohort was conducted from August 2015 and January 2018 at 40 centers. 2625 participants were collected. Eligible participants were aged at least 55 years. Montreal Cognitive Assessment (MoCA) score is less than or equal to 26. A total of 1620 patients were included. 1604 (99.0%) and 1582 (97.7%) participants are followed up at 3 and 12 months. The primary outcomes were death or disability (mRS score, 3-6) and Montreal Cognitive Assessment (MoCA) at 3 months and 12 months. Demographic and vascular risk factors were measured at baseline (smoking, alcohol, diabetes, atrial fibrillation, hypertension, hypercholesterolemia, coronary artery disease, ischemic stroke, and transient ischemic attack). Blood samples were collected within 24 hours of admission. MRI was recommended for all patients. MoCA score was evaluated at baseline and follow-up. Results. In total, 291/1620 patients with ischemic stroke/TIA (32.7% female and mean age, 67.8 years) had neuroimaging evidence of probable/possible CAA. Higher age, history of hypertension, atrial fibrillation, ischemic stroke, alcohol, and high glucose at the admission were more common in the patients. Mean MoCA changed from 21.4 at 3 months (SD 5.2) to 22.3 at 12 months (SD 4.7), difference 0.3 (SD 3.8). At the 3-month and 12-month follow-up, there were significant differences in age, education level, and sex among different cognitive groups. Higher age, lower education (less than high school), and female sex were the predictors of changing in MoCA score from 3 months to 12 months. Moreover, age (more than 66 years) and education (less than high school) are strongly associated with MoCA at 3- and 12-month follow-up. 30 of 286 (10.5%) and 37 of 281 (13.2%) patients had poor outcome of death or disability (modified Rankin Scale score, 3-6) at follow-up 3 and 12 months. Cortical superficial siderosis (cSS) was associated with higher mRS at follow-up. cSS status, cSS count 1-2, cSS strictly lobar, and strictly deep might be the risks of outcomes in adjusted analyses. Conclusion. This study suggested that an increasing number of vascular risk factors and imaging markers were significantly associated with outcomes of TIA/ischemic stroke patients with CAA pattern. Male, young patients with high education should get better cognitive recovery.

scholarly journals Antithrombotic selection and risk factor management in ischemic stroke and transient ischemic attack

2014 ◽  
Vol 36 (1) ◽  
pp. E10 ◽  
Author(s):  
Brian S. Katz ◽  
Kelly D. Flemming
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Management Options ◽  
Risk Factor Management ◽  
Stroke Risk Factors ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack ◽  
Selection Of

In addition to appropriate antithrombotic therapy, the identification and treatment of modifiable ischemic stroke risk factors can reduce the likelihood of recurrent stroke. Neurosurgeons should be knowledgeable of the specific risk factors and general recommendations for ischemic stroke, as they may play a significant role in the management options for patients with intracranial and extracranial atherosclerotic disease. The authors of this article review the indications for and selection of antithrombotics in patients with cerebral ischemia. In addition, the identification and secondary prevention of select risk factors are discussed.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Alcivan Batista de Morais Filho ◽  
Thiago Luis de Holanda Rego ◽  
Letícia de Lima Mendonça ◽  
Sulyanne Saraiva de Almeida ◽  
Mariana Lima da Nóbrega ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Natural History ◽  
Hemorrhagic Stroke ◽  
Recent Literature ◽  
Clinical Manifestations ◽  
The Road ◽  
History Of

Abstract Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

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