scholarly journals Total small vessel disease burden and functional outcome in patients with ischemic stroke

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242319
Author(s):  
Wi-Sun Ryu ◽  
Sang-Wuk Jeong ◽  
Dong-Eog Kim
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Logistic Regression Analysis ◽  
Small Vessel Disease ◽  
Ordinal Logistic Regression ◽  
Small Vessel ◽  
Vessel Disease ◽  
Ordinal Logistic Regression Analysis

Background Cerebral small vessel disease (SVD) is comprised of lacunes, cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and enlarged perivascular space (EPVS). We investigated the cumulative effect of SVD on 3-month functional outcome following ischemic stroke using the total SVD score. Methods The total SVD score of 477 acute ischemic stroke patients with adequate brain MRI was analyzed. We used multivariable ordinal logistic regression analysis to investigate the independent impact of total SVD score on ordinal modified Rankin Scale (mRS) score at 3-month after ischemic stroke. Results Mean age was 66±14 years, and 61% were men. The distribution of the total SVD score from 0 to 4 was 27%, 24%, 26%, 16%, and 7%, respectively. The proportion of mRS scores 2 or greater was 16% and 47% in total SVD score 0 and 4, respectively. Multivariable ordinal logistic regression analysis results showed that compared with the total SVD score of 0, total SVD scores of 2, 3, and 4 were independently associated with higher mRS scores with adjusted odds ratios (95% confidence intervals) of 1.68 (1.02–2.76), 2.24 (1.25–4.00), and 2.00 (1.02–4.29). Lacunes, CMBs, WMHs but not EPVS were associated with mRS scores at 3 months. However, the impact of each SVD marker on stroke outcome was smaller than that of the total SVD score. Conclusion We found an independent association between total SVD scores and functional outcome at 3 months following ischemic stroke. The total SVD score may be useful for stratification of patients who are at a high-risk of unfavorable outcomes.

scholarly journals Reduced Ejection Fraction and Augmented Right Atrium are Independent Risk Factors of Deep Regional CBF in Cerebral Small Vessel Disease

2020 ◽  
Author(s):  
Xiaodong Chen ◽  
Danli Lu ◽  
Ning Guo ◽  
Zhuang Kang ◽  
Ke Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Ejection Fraction ◽  
Logistic Regression Analysis ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease ◽  
Echocardiographic Parameters

Abstract Background: Systemic cardiac hypoperfusion is a well-acknowledged contributor to ischemic leukoencephalopathy. However, it has remained elusive how atherosclerosis-mediated cardiac remodelling modifies cerebral perfusion homeostasis as well as neuroimaging burden in cerebral small vessel disease (CSVD) development. Methods: This retrospective study identified 103 CSVD patients (CSVD burdenlow 0~1, n=61 and CSVD burdenhigh 2~4, n=42) from Sep. 2017 to Dec. 2019 who underwent transthoracic echocardiography(n=81), structural magnetic resonance imaging and arterial spin labelling. Total CSVD burden was graded according to the ordinal “small vessel disease” rating score (0-4). We investigated the univariate and multivariate linear regression of mean deep regional cerebral blood flow (CBF) as well as logistic regression analysis of CSVD burdenhigh. Results: Augmented right atrial diameter (B coefficient, -0.289; 95% CI, -0.578 to -0.001; P=0.049) and decreased left ventricular ejection fraction (B coefficient, 32.555; 95% CI, 7.399 to 57.711; P=0.012) were echocardiographic parameters linked with declined deep regional CBF in CSVD patients. Binary logistic regression analysis demonstrated decreased mean deep CBF (OR 0.894; 95% CI 0.811-0.985; P=0.024) was independently associated with higher CSVD burden after adjusted for clinical confounders. Multivariate receiver operating characteristics curve combing clinical risk factors, mean deep CBF and echocardiographic parameters showed predictive significance for CSVD burdenhigh diagnosis (area under curve=84.25%, 95% CI 74.86% - 93.65%, P<0.0001). Conclusion: The interrelationship of “cardiac -deep regional CBF-neuroimaging burden” reinforces the importance and prognostic significance of echocardiographic and cerebral hemodynamic assessment in CSVD early-warning.

Decline of gustatory sensitivity with the progression of Alzheimer's disease

2015 ◽  
Vol 28 (3) ◽  
pp. 511-517 ◽  
Author(s):  
Mariko Sakai ◽  
Manabu Ikeda ◽  
Hiroaki Kazui ◽  
Kazue Shigenobu ◽  
Takashi Nishikawa
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Ordinal Logistic Regression ◽  
Threshold Values ◽  
Ordinal Logistic Regression Analysis ◽  
And Control ◽  
Detection And Recognition

ABSTRACTBackground:Patients with Alzheimer's disease (AD) manifest various impairments in eating behavior. However, few previous studies have directly investigated the gustatory function of AD patients, and results have been inconsistent.Methods:Thirty-two AD patients (Clinical Dementia Rating (CDR) 0.5/1/2, respectively 11/15/6 patients) and 22 normal control participants were examined to measure detection and recognition thresholds of the four elemental tastes (sweet, salty, sour, and bitter), and their ability to discriminate between tastes. Effects of demographic and clinical factors (age, sex, histories of alcohol and tobacco consumption, and CDR grade) on gustatory threshold were examined using ordinal logistic regression analysis. Performance was compared between AD and control groups.Results:Total threshold values (the sum of threshold grades for the four tastes) for detection and recognition of tastes were significantly higher in the AD group. Detection thresholds for sweet, salty, and bitter, and recognition thresholds for sweet and sour, were also significantly higher in the AD group. Ordinal logistic regression analysis revealed that CDR grade was the only factor that significantly affected both total threshold values. Regarding taste discrimination, there were no significant differences between the AD group and control group.Conclusions:These findings suggest that progression of dementia severity accompanies gustatory decline. Although it seemingly paradoxical, weight loss and preference for sweet tastes are frequently, often simultaneously, observed in AD. Gustatory dysfunction may be partially involved in these symptoms. Thus, the nutritional care of patients with AD could be improved by making the taste of meals stronger, while controlling calorie and mineral intake.

scholarly journals Imaging Markers of Brain Frailty and Outcome in Patients With Acute Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Ning Bu ◽  
Mohamed Salah Khlif ◽  
Robin Lemmens ◽  
Anke Wouters ◽  
Jochen B. Fiebach ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Excellent Outcome ◽  
Vessel Disease ◽  
Brain Parenchymal Fraction ◽  
Imaging Markers ◽  
Brain Parenchymal

Background and Purpose: Functional outcome after stroke may be related to preexisting brain health. Several imaging markers of brain frailty have been described including brain atrophy and markers of small vessel disease. We investigated the association of these imaging markers with functional outcome after acute ischemic stroke. Methods: We retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial (AX200 in Ischemic Stroke Trial), a randomized controlled clinical trial of granulocyte colony-stimulating factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (ie, the brain parenchymal fraction) and total brain volumes from routine baseline magnetic resonance imaging data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces, white matter hyperintensities, lacunes, as well as a small vessel disease burden, were rated visually. Functional outcomes (modified Rankin Scale score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes. Results: We enrolled 259 patients with a mean age of 69±12 years and 46 % were female. Increased brain parenchymal fraction was associated with higher odds of excellent outcome (odds ratio per percent increase, 1.078 [95% CI, 1.008–1.153]). Total brain volumes and small vessel disease burden were not associated with functional outcome. An interaction between brain parenchymal fraction and large vessel occlusion on excellent outcome was not observed. Conclusions: Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00927836.

scholarly journals Prevalence and Effect of Cerebral Small Vessel Disease in Stroke Patients With Aspirin Treatment Failure–A Hospital-Based Stroke Secondary Prevention Registry

2021 ◽  
Vol 12 ◽  
Author(s):  
Ping-Song Chou ◽  
Pi-Shan Sung ◽  
Chi-Hung Liu ◽  
Yueh-Feng Sung ◽  
Ray-Chang Tzeng ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Treatment Failure ◽  
Rating Scale ◽  
Small Vessel Disease ◽  
Demographic Data ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Stroke Patients ◽  
Vessel Disease

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF.Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF.Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25–0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21–0.79 for severe DWMLs].Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

scholarly journals Pola Spasial dan Keputusan Keluarga Bermukim di Permukiman Kumuh Pusat Kota dan Wilayah Pinggiran Kota Malang, Jawa Timur

2021 ◽  
Vol 35 (1) ◽  
pp. 64
Author(s):  
Irvan Ardiansyah ◽  
Satti Wagistina
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Low Income ◽  
Family Members ◽  
Ordinal Logistic Regression ◽  
Economic Conditions ◽  
River Bank ◽  
Ordinal Logistic Regression Analysis ◽  
Economic Needs

Abstrak. Perkembangan kawasan permukiman kumuh di Kota Malang disebabkan oleh faktor urbanisasi dan  penduduk asli yang penghasilan rendah sehingga berakibat pada rendahnya daya beli terhadap rumah layak huni dan berlokasi di zona permukiman ideal. Kedua golongan masyarakat ini mendorong  untuk memilih lokasi bermukim di wilayah yang tidak seharusnya dijadikan kawasan permukiman sehingga menyebakan kemunculan kawasan permukiman kumuh baru. Tujuan penelitian ini adalah; 1) mengetahui pola spasial permukiman kumuh pusat kota dan wilayah pinggiran; 2) mengetahui hubungan kondisi sosial ekonomi masyarakat terhadap permukiman kumuh pusat kota dan wilayah pinggiran. Wilayah kajian permukiman kumuh pusat Kota Malang berada di Kelurahan Kauman, sedangkan wilayah pinggiran berada di Kelurahan Tlogomas. Kedua wilayah tersebut berdasarkan SK Walikota Malang termasuk dalam kawasan permukiman kumuh yang terdapat di Kota Malang. Penelitian ini menggunakan pendekatan kuantitatif. Alat analisis yang digunakan yakni Sistem Informasi Geografis (SIG) dengan metode overlay untuk mengetahui pola spasial permukiman kumuh. Untuk mengetahui keputusan keluarga bermukim di permukiman kumuh digunakan uji regresi logistik ordinal. Hasil penelitian menunjukkan kawasan permukiman kumuh pusat kota memiliki pola linier sepanjang Sungai Kasin. Kawasan permukiman kumuh wilayah pinggiran memiliki pola linier dan memusat. Hasil analisis regresi logistik ordinal menunjukkan keputusan keluarga bermukim di permukiman kumuh secara signifikan dipengaruhi oleh kondisi sosial ekonomi yang meliputi tingkat pendidikan, jumlah anggota keluarga, dan kebutuhan ekonomi untuk permukiman kumah pusat Kota Malang. Keputusan keluarga untuk bermukim di permukiman kumuh wilayah pinggiran dipengaruhi oleh kebutuhan ekonomi, pendapatan, jumlah anggota keluarga, dan jenis pekerjaan.   Abstract. The emergent growing of slums in Malang City has been caused by urbanization and the locals with low income making it hard for them to afford proper housing located in ideal residential zones. These two groups of societies have triggered the choice to reside in the improper areas, and thus new slums emerge. This current study aimed at: 1) describing the spatial pattern of the slums in the down town and suburb area; and 2) investigating the correlation between socio-economic conditions of the societies and the slums in the down towan and suburb area. The slum in down town Malang City was Kauman Sub-district; while the slum in the suburb area was Tlogomas Sub-district. Both locations have been pronounced as the slums within the Decree Statement of the Mayor of Malang. This study was conducted by means of quantitative approach. Geographic Information System (GIS) was employed as the analysis. Overlay method was used to detect the spatial patterns of the slums and ordinal logistic regression was performed to investigate the correlation between socio-economic conditions of the societies and the slums. It has been revealed that the slum in the downtown portrayed a linear pattern along Kasin river bank. The slum in the suburb area showed linear and centered patterns. The ordinal logistic regression analysis resulted in the notion that the decision to reside in the slums has been significantly affected by the socio-economic conditions. The results of ordinal-logistic regression analysis showed that the family's decision to live in the slum was significantly influenced by socio-economic conditions including education level, number of family members, and economic needs for slum in the downtown.  The family's decision to live in the slum areas in surburb area was influenced by economic needs, income, number of family members, and their professions.     

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