Neurosarcoidosis Presenting With Recurrent Strokes

Neurosarcoidosis is a rare but important cause of stroke as it is treatable. Cases reported thus far have primarily been in young people who are relatively healthy. Here we report the case of a 73-year-old woman presenting with recurrent strokes and high-grade intracranial stenosis caused by probable neurosarcoidosis. This is unique as neurosarcoidosis is not usually considered as an etiology for recurrent strokes in our patient’s age-group. We review and categorize published cases of neurosarcoidosis causing stroke and describe a classification scheme for certainty of diagnosis. Given the implications of this diagnosis for secondary stroke prevention, we recommend that neurosarcoidosis be considered in the differential for patients with few vascular risk factors, recurrent strokes refractory to medical treatment, or possible vasculitis even in the elderly patients.

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Abstract P614: Effect Sizes of Vascular Risk Factors for Stroke Occurrence by Age Among West Africans

Stroke ◽

10.1161/str.52.suppl_1.p614 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mayowa Owolabi ◽

FRED S SARFO ◽

Onoja Akpa ◽

Joshua Akinyemi ◽

Albert Akpalu ◽

...

Keyword(s):

Risk Factors ◽

Middle Age ◽

Meat Consumption ◽

The Elderly ◽

Vascular Risk Factors ◽

Effect Sizes ◽

Modifiable Risk Factors ◽

Age Group ◽

Vascular Risk ◽

Elderly Age

Background: Age is a non-modifiable risk factor for stroke occurrence due its influence on vascular risk factor acquisition. In sub-Saharan Africa, the effect sizes of vascular risk factors for stroke occurrence by age is unknown. Objective: To quantify the magnitude and direction of the effect sizes of key modifiable risk factors of stroke according to three age groups: <50years(young), 50-65 years(middle age) and >65 years(elderly) in West Africa. Methods: The Stroke Investigative Research and Educational Network (SIREN) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with evidence of an acute stroke. Controls were age-and-gender matched stroke-free adults. Detailed evaluations for vascular, lifestyle, stroke severity and outcomes were performed. We used conditional logistic regression to estimate adjusted odds ratios (aOR) of vascular risk factors of stroke. Results: Among 3,553 stroke cases, 813(22.9%) were young, 1441(40.6%) were middle-aged and 1299(36.6%) were elderly. Five modifiable risk factors were consistently associated with stroke occurrence regardless of age namely hypertension, dyslipidemia, diabetes mellitus, regular meat consumption and non-consumption of green vegetables. Among the 5 co-shared risk factors, the effect size, aOR(95%CI) of dyslipidemia, 4.13(2.64-6.46), was highest among the young age group, hypertension, 28.93(15.10-55.44) and non-consumption of vegetables 2.34(1.70-3.23) was highest among the middle-age group while diabetes, aOR of 3.50(2.48-4.95) and meat consumption, 2.40(1.76-3.26) were highest among the elderly age group. Additionally, among the young age group cigarette smoking and cardiac disease were associated with stroke. Furthermore, physical inactivity and salt intake were associated with stroke in the middle-age group while cardiac disease was associated with stroke in the elderly age group. Conclusions: Age has a profound influence on the profile, magnitude and direction of effect sizes of vascular risk factors for stroke occurrence among West Africans. Population-level prevention of stroke must target both co-shared dominant risk factors as well as factors that are unique to specific age bands in Africa.

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Hip fractures in elderly with evaluation of risk factors

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20205306 ◽

2020 ◽

Vol 8 (12) ◽

pp. 4365

Author(s):

Sakib Arfee ◽

Asma Jabeen ◽

Akib Arfee ◽

Adnan Aadil Arfee

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Hip Fractures ◽

Health Problem ◽

Public Health Problem ◽

The Elderly ◽

Age Group ◽

Medical College ◽

Hip Injuries ◽

Prevention Of Osteoporosis

Background: Fractures in the neck and Perirtrochanteric region of hip contribute significantly to health problem globally. Primary occurrence in elderly osteoporotic people and create a major socioeconomical and public health problem. Almost every such fractures require surgery, hospitalization, and prolonged rehabilitation. The objective of the study was to evaluate the risk factors of hip fractures among the elderly population.Methods: This observational study was conducted among the elderly patients admitted in the department of orthopedics Government Medical College Jammu. Elderly patients regardless of sex and education admitted with hip fractures from August 2019 to July 2020 were included in the study.Results: There were 330 patients admitted with hip injuries. Among these 330 patients admitted with hip fractures, 205 (62.12%) were females and 125 (37.88%) males, mean age was 72.8 years. Age limit was >60 and <100 years. Majority of the patients i.e., 192 (58.18%) were in between the age group of 60 to 79 years.Conclusions: Increasing age is directly proportional to increasing incidence of hip fractures. This proportional rise can be reduced with early steps for prevention of osteoporosis and hence ultimately alleviate the disability and burden of the disease.

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Prognosis and risk factors of ERCP pancreatitis in elderly

Scientific Reports ◽

10.1038/s41598-021-95484-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Erhan Ergin ◽

Nevin Oruç ◽

Galip Ersöz ◽

Oktay Tekeşin ◽

Ömer Özütemiz

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Elderly Patients ◽

Biochemical Analysis ◽

Female Gender ◽

The Elderly ◽

Imaging Findings ◽

Endoscopic Retrograde ◽

Sphincter Oddi ◽

Oddi Dysfunction

AbstractPost Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

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Differing Pattern of Ambulatory Blood Pressure in Very Elderly Men Expresses Dynamics in Atherosclerotic Load in the Senescence

International Journal of Hypertension ◽

10.1155/2012/417291 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Arkadiusz Siennicki-Lantz ◽

Sölve Elmståhl

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Blood Pressure Measurement ◽

Ankle Brachial Index ◽

The Elderly ◽

Population Based ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Pressure Development

To assess an impact of vascular risk factors on ambulatory blood pressure measurement (ABPM) in the elderly, we followed up a population-based cohort of men from 68 until 82 years, when 104 survivors underwent ABPM.Results. At age 68, hypertension and high clinic blood pressure (CBP) did not predict ABPM level. Smoking and low ankle-brachial index (ABI) predicted higher ABPM variability and pulse pressure (PP), but not absolute ABPM values. At age 82, hypertension, high or increasing CBP, strongly positively correlated with all variables of ABPM. Carotid stenosis, low or declining ABI during followup, correlated with higher nocturnal ABPM and PP.Concluding. Hypertension and vascular risk factors in a cohort of 68-year-old men do not result in higher ABPM at age 82, possibly due to inflection point in their pressure development. Higher ABPM reflects instead an increasing CBP and aggravating atherosclerosis during the preceding decade in that part of the cohort with previously favorable risk factor status.

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Prevalence of Cardiovascular Risk Factors in the Elderly Population of Alentejo

Handbook of Research on Health Systems and Organizations for an Aging Society - Advances in Human Services and Public Health ◽

10.4018/978-1-5225-9818-3.ch014 ◽

2020 ◽

pp. 185-195

Author(s):

Maria do Céu Mendes Pinto Marques ◽

Ana Filipa Pereira Vaz ◽

Ana Sofia Emídio Cardoso Leite ◽

Cláudia Sofia Araújo ◽

Cláudia Roque Condeço ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Elderly Population ◽

Research Question ◽

National Level ◽

The Elderly ◽

Regional Level ◽

Age Group ◽

Prevalence Studies

The objective of this chapter is to identify cardiovascular risk factors in the elderly and their prevalence in the elderly population of Alentejo. The research question was elaborated according to the PI[C]OD methodology. The prevalence studies included allow the authors to identify the risk factors with the greatest impact on cardiovascular diseases, with the analysis of at least one of the factors (hypertension, diabetes, smoking, obesity, hypercholesterolemia, alcoholism, and sedentary lifestyle) and their prevalence in the elderly from the region of Alentejo. The results present the prevalence of cardiovascular risk factors, mainly at the national level, compared to those at the regional level, with a small number of exclusive studies in the Alentejo region, while simultaneously disaggregating the results by age group. From the data obtained, it can be concluded that the prevalence of risk factors is generally increased in the elderly population and, consequently, in Alentejo, because it is a region in the interior of the country that is predominantly rural and very old.

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Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02092-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jinzeng Zuo ◽

Yongcheng Hu

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Intertrochanteric Fracture ◽

Lower Extremities ◽

The Elderly ◽

Intertrochanteric Fractures ◽

Targeted Interventions ◽

Laboratory Test Results

Abstract Objective The purpose of this study was to investigate the incidence, location, and related factors of deep venous thrombosis (DVT) of the bilateral lower extremities after intertrochanteric fractures in the elderly. Methods Retrospective analysis was performed on the elderly patients with intertrochanteric fracture who were admitted from January 2017 to December 2019. At admission, patients receive routine ultrasound Doppler scanning of bilateral lower extremities to detect DVT; those with DVT were assigned to the case group and those without DVT to the control group. Patient data on demographics, comorbidities, injury-related data, and laboratory test results at admission were extracted. Logistic regression analyses were conducted to identify the independent risk factors associated with DVT. Results Five hundred seventy-eight patients were included, among whom 116 (20.1%) had DVT. Among those with DV, 70.7% (82/116) had DVT of the distal type, 24 (29.6%) had DVT of the proximal type, and 10 (10.4%) had mixed DVT. In 76.7% (89/116) of patients, DVT occurred in the fractured extremity, 9.5% (11/116) in the bilateral and 13.8% (16/116) in the non-fractured extremity. Multivariate analyses identified obesity, delay to admission, increased D-dimer level (> 1.44 mg/L) and reduced albumin (< 31.7 g/L) as independent factors. Conclusions Admission incidence of DVT was high in elderly patients with intertrochanteric fractures, especially the proximal DVT. Identification of associated risk factors is useful for individualized assessment risk of DVT and early targeted interventions.

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Treatment with CPAP in Elderly Patients with Obstructive Sleep Apnoea

Journal of Clinical Medicine ◽

10.3390/jcm9020546 ◽

2020 ◽

Vol 9 (2) ◽

pp. 546 ◽

Cited By ~ 1

Author(s):

Tomas Posadas ◽

Grace Oscullo ◽

Enrique Zaldívar ◽

Alberto Garcia-Ortega ◽

José Daniel Gómez-Olivas ◽

...

Keyword(s):

Clinical Trials ◽

Elderly Patients ◽

Obstructive Sleep Apnoea ◽

The Elderly ◽

Sleep Apnoea ◽

Age Group ◽

Obstructive Sleep ◽

Receive Treatment ◽

Therapeutic Tools

The population pyramid is changing as a result of the ever-increasing life expectancy, which makes it crucial to acquire an in-depth understanding of the diseases that most often affect the elderly. Obstructive sleep apnoea (OSA) affects 15%–20% of the population aged over 65 years. Despite this prevalence, there have been very few specific studies on the management of OSA in this age group, even though over 60% of the patients aged over 65-70 years who attend sleep units with suspicion of OSA receive treatment with continuous positive airway pressure (CPAP), on the basis of an extrapolation of the positive results achieved by CPAP in clinical trials involving middle-aged males. However, the latter’s form of presentation, evolution and, probably, prognosis comparing with OSA are not the same as those of elderly patients. Recent clinical trials performed on an exclusive series of elderly patients have shed light on the possible role of CPAP treatment in elderly patients with OSA, but there are still many questions that need to be answered. The physiological increase in the number of sleep-related disorders with the passing of years, and the lack of validated diagnostic and therapeutic tools for this age group are probably the greatest obstacles to define, diagnose and treat OSA in the elderly.

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White matter hyperintensities across the adult lifespan: relation to age, Aβ load, and cognition

Alzheimer s Research & Therapy ◽

10.1186/s13195-020-00669-4 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Antoine Garnier-Crussard ◽

Salma Bougacha ◽

Miranka Wirth ◽

Claire André ◽

Marion Delarue ◽

...

Keyword(s):

Risk Factors ◽

Working Memory ◽

Executive Functions ◽

White Matter Hyperintensities ◽

Vascular Risk Factors ◽

Age Group ◽

Vascular Risk ◽

Middle Aged ◽

Adult Lifespan ◽

Middle Aged Adults

Abstract Background White matter hyperintensities (WMH) are very frequent in older adults and associated with worse cognitive performance. Little is known about the links between WMH and vascular risk factors, cortical β-amyloid (Aβ) load, and cognition in cognitively unimpaired adults across the entire lifespan, especially in young and middle-aged adults. Methods One hundred and thirty-seven cognitively unimpaired adults from the community were enrolled (IMAP cohort). Participants underwent (i) a comprehensive neuropsychological assessment of episodic memory, processing speed, working memory, and executive functions; (ii) brain structural T1 and FLAIR MRI scans used for the automatic segmentation of total and regional (frontal, parietal, temporal, occipital, and corpus callosum) WMH; and (iii) a Florbetapir-PET scan to measure cortical Aβ. The relationships of total and regional WMH to age, vascular risk factors, cortical Aβ, and cognition were assessed within the whole sample, but also splitting the sample in two age groups (≤ or > 60 years old). Results WMH increased with age across the adult lifespan, i.e., even in young and middle-aged adults. Systolic blood pressure, diastolic blood pressure, and glycated hemoglobin were all associated with higher WMH before, but not after, adjusting for age and the other vascular risk factors. Higher frontal, temporal, and occipital WMH were associated with greater Aβ, but this association was no longer significant when adjusting for age and vascular risk factors. Higher total and frontal WMH were associated with worse performance in executive functions, with no interactive effect of the age group. In contrast, there was a significant interaction of the age group on the link between WMH and working memory, which was significant within the subgroup of young/middle-aged adults only. Adding cortical Aβ load in the models did not alter the results, and there was no interaction between WMH and Aβ on cognition. Conclusion WMH increased with age and were associated with worse executive functions across the adult lifespan and with worse working memory in young/middle-aged adults. Aβ load was weakly associated with WMH and did not change the relationship found between WMH and executive functions. This study argues for the clinical relevance of WMH across the adult lifespan, even in young and middle-aged adults with low WMH.

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Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study

Frontline Gastroenterology ◽

10.1136/flgastro-2018-100994 ◽

2018 ◽

Vol 9 (4) ◽

pp. 256-261 ◽

Cited By ~ 1

Author(s):

Ayodele Sasegbon ◽

Laura O’Shea ◽

Shaheen Hamdy

Keyword(s):

Risk Factors ◽

Elderly Patients ◽

Elderly Person ◽

Oropharyngeal Dysphagia ◽

The Elderly ◽

Common Source ◽

Increased Risk ◽

The Mean ◽

The Relationship ◽

New Onset

IntroductionElderly people are recognised to be at increased risk of oropharyngeal dysphagia (OPD), the causes of which are multifactorial. Our aim was to identify if sepsis is associated with OPD in the elderly during hospitalisation in the absence of known other risk factors for OPD.MethodsA hospital electronic database was searched for elderly patients (≥65 years) referred for assessment for suspected dysphagia between March 2013 and 2014. Exclusion criteria were age <65 years, pre-existing OPD or acute OPD secondary to acute intracranial event, space-occupying lesion or trauma. Data were collected on factors including age, sex, comorbidities, existing OPD, sepsis, microbiology, recovery of OPD and medication. Sepsis was defined as evidence of a systemic inflammatory response syndrome with a clinical suspicion of infection.ResultsA total of 301 of 1761 screened patients referred for dysphagia assessment met the inclusion criteria. The prevalence of sepsis and subsequent OPD was 16% (51/301). The mean age was 83 years (median 81 years). The most common comorbidity was dementia (31%). The majority (84%) failed to recover swallowing during their hospital stay, 12% had complications of aspiration and 35% died. The most common source of sepsis was from the chest (55%). Other factors contributing to the risk for dysphagia included delirium (22%) and neuroactive medication (41%). However, 10% of patients had sepsis and subsequent OPD without other identified risk factors.ConclusionThe prevalence of sepsis and subsequent dysphagia is significant and should be taken into account in any elderly person in hospital with new-onset OPD without other predisposing risk factors.

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