Young Adult Stroke in Taiwan: etiologies and outcomes

Abstract Background Early-onset adult stroke has not been fully characterized in Asians. Objectives We investigated the etiologic subtypes, risk factors and 1-year outcomes of early-onset stroke (16 – 55 years of age) in a Taiwanese cohort. Methods We retrospectively reviewed consecutive patients with acute stroke admitted to the Taipei Veterans General Hospital in Taiwan between 2009 and 2017. Patients were classified by age of onset (≤ or > 55) and etiologic subtypes and regularly followed for 1 year. Results Among all stroke patients (n=8155), 17.6% (n=1310) were early-onset, who had slightly more spontaneous hemorrhagic stroke (50.8%) than ischemic stroke (49.2%). The most common etiologic subtypes of hemorrhagic stroke were hypertensive intracerebral hemorrhage (ICH), subarachnoid hemorrhage and undetermined ICH. The most common subtypes of infarction were large artery atherosclerosis, other determined diseases (52.5% arterial dissection) and embolic stroke of undetermined source. Smoking, alcohol overdrink, obesity, ischemic heart disease and family history of stroke were more in the early-onset than the elderly patients. The early-onset patients with familial stroke (n=87, 6.6%) were more males and more commonly had infarction than those without familial stroke. Monogenic diseases accounted for 5.7% of young familial stroke. At 1-year follow-up, the early-onset patients with infarction displayed greater functional improvements but more stroke recurrence than those with ICH. Conclusions Hypertensive hemorrhagic stroke and large artery atherosclerosis or dissection occlusion are characteristically common etiologies of young stroke in Taiwan. Early-onset infarction had higher recurrence yet better 1-year outcomes than early-onset ICH. Patients with familial versus non-familial aggregation had more ischemic infarction and monogenic diseases.

Download Full-text

Age, Age of Onset and Course of Primary Depressive Illness in the Elderly*

The Canadian Journal of Psychiatry ◽

10.1177/070674378302800204 ◽

1983 ◽

Vol 28 (2) ◽

pp. 102-104 ◽

Cited By ~ 32

Author(s):

Martin G. Cole

Keyword(s):

Elderly Patients ◽

Depressive Episode ◽

Early Onset ◽

Age Of Onset ◽

Late Onset ◽

The Elderly ◽

Depressive Illness ◽

Physical Illness ◽

Course Of Illness

Thirty-eight elderly patients with primary depressive illness (Feighner criteria) were followed up for 7–31 months. In the absence of persistent organic signs and severe physical illness, age of onset (first depressive episode after 60) but not age was significantly related to course of illness. Compared to early onset depressives, late onset depressives were more likely to remain completely well during the follow-up period and less likely to have frequent or disabling relapses.

Download Full-text

A Family with Multiple Instances of Definite, Probable and Possible Early-Onset Alzheimer's Disease

The British Journal of Psychiatry ◽

10.1192/bjp.159.4.524 ◽

1991 ◽

Vol 159 (4) ◽

pp. 524-530 ◽

Cited By ~ 9

Author(s):

H. Karlinsky ◽

E. Madrick ◽

J. Ridgley ◽

J. M. Berg ◽

R. Becker ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Early Onset ◽

Age Of Onset ◽

Diagnostic Difficulties ◽

History Of ◽

Early Onset Alzheimer’S Disease ◽

The Mean ◽

Age Of Death

A family with a multigenerational history of proven or suspected early-onset Alzheimer's disease (AD) consistent with autosomal-dominant inheritance is described. To date, the pedigree comprises five generations in which there are 13 known affected individuals. The mean age of onset of cognitive deficits in those for whom data are available (n = 11) is 47.6 (s.d. 3.0) years and the mean age of death (n = 10) is 58.8 (s.d. 4.0) years. The variability in the extent and quality of available data illustrates the diagnostic difficulties encountered in ascertaining such an extended pedigree, and the need for caution in interpreting the evidence.

Download Full-text

Early Onset Obsessive-Compulsive Disorder With and Without Tics

CNS Spectrums ◽

10.1017/s1092852900023014 ◽

2009 ◽

Vol 14 (7) ◽

pp. 362-370 ◽

Cited By ~ 30

Author(s):

Maria Alice de Mathis ◽

Juliana B. Diniz ◽

Roseli G. Shavitt ◽

Albina R. Torres ◽

Ygor A. Ferrão ◽

...

Keyword(s):

Obsessive Compulsive Disorder ◽

Early Onset ◽

Age Of Onset ◽

Age At Onset ◽

Clinical Manifestations ◽

Tic Disorders ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Diagnostic And Statistical Manual ◽

History Of

ABSTRACTIntroduction: Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations.Objective: The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated.Methods: Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the “early onset” group (EOG): before 11 years of age, 75 patients hadResults: The EOG had a predominance of males, higher frequency of family history of OCS, higher mean scores on the “aggression/violence” and “miscellaneous” dimensions, and higher mean global DY-BOCS scores. Patients with EOG without tic disorders presented higher mean global DY-BOCS scores and higher mean scores in the “contamination/cleaning” dimension.Conclusion: The current results disentangle some of the clinical overlap between early onset OCD with and without tics.

Download Full-text

Depression in Later Life

The British Journal of Psychiatry ◽

10.1192/bjp.167.5.649 ◽

1995 ◽

Vol 167 (5) ◽

pp. 649-652 ◽

Cited By ~ 101

Author(s):

R. C. Baldwin ◽

Barbara Tomenson

Keyword(s):

Vascular Disease ◽

Early Onset ◽

Rating Scale ◽

Late Onset ◽

Later Life ◽

The Elderly ◽

Course Of Illness ◽

Anxiety Item ◽

History Of ◽

Item Scores

BackgroundDepression in later life is often thought to differ from that at other times of adulthood. The evidence for this is controversial but is important to any proposed organic model of depression in the elderly. Here, early- and late-onset depressions in later life are compared.MethodFifty-seven depressed patients with a mean age of 74 were studied, 21 with an early onset (aged 59 or less) and 36 with a late onset. All were suffering from major depression according to DSM–III–R. The measures at entry included severity and symptoms, cognitive function, antecedent life events, physical health and vascular risk factors and/or vascular disease. We also recorded any family history of mood disorders, as well as the course of illness.ResultsThe anxiety item scores of the Hamilton Depression Rating Scale were significantly higher in those with an early onset, but otherwise symptoms differed little. Heritability was greater in the early-onset group. There was a striking association of vascular disease and/or risk with late-onset patients.ConclusionsVascular disease is associated with late-onset depression. This is consistent with the hypothesis that depression in later life is a more ‘biological’ disorder.

Download Full-text

Trauma and defense style as response predictors of pharmacological treatment in panic patients

European Psychiatry ◽

10.1016/j.eurpsy.2006.09.009 ◽

2007 ◽

Vol 22 (2) ◽

pp. 87-91 ◽

Cited By ~ 18

Author(s):

Letícia Kipper ◽

Carolina Blaya ◽

Cláudia Wachleski ◽

Marina Dornelles ◽

Giovanni Abrahão Salum ◽

...

Keyword(s):

Pharmacological Treatment ◽

Early Onset ◽

Age Of Onset ◽

Depression Scale ◽

Hamilton Depression Scale ◽

Defense Style ◽

Defense Style Questionnaire ◽

Full Remission ◽

Response Predictors ◽

History Of

AbstractBackgroundAs panic disorder (PD) has a chronic course, it is important to identify predictors that might be related to non-remission. The aim of this study is to verify whether history of trauma and defense style are predictors to pharmacological treatment response in PD patients.MethodThe sample was composed by 47 PD patients according to DSM-IV who were treated with sertraline for 16 weeks. Evaluations were assessed by the C.G.I. (Clinical Global Impression), the Hamilton-Anxiety Scale, the Hamilton-Depression Scale, the Panic Inventory and the DSQ-40 (Defense Style Questionnaire) at baseline and after treatment.ResultsFull remission was observed in 61.7% of the sample. The predictors significantly associated with non-remission were: severity of PD (p = 0.012), age of onset (p = 0.02) and immature defenses (p = 0.032). In addition, the history of trauma was associated with early onset of PD (p = 0.043).ConclusionPanic patients had as predictors of worse response to pharmacological treatment the early onset and the severity of PD symptoms as well as the use of immature defenses at baseline. This finding corroborates the relevance of the evaluation of factors that might affect the response so as to enable the development of appropriate treatment for each patient.

Download Full-text

Hoarding disorders: Two different clinical presentations

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1383 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S746-S746

Author(s):

A. Samico ◽

D. Mota ◽

Â. Venâncio ◽

L. Ribeiro

Keyword(s):

Age Of Onset ◽

Health Hazard ◽

The Elderly ◽

Psychiatric Facility ◽

Obsessive Compulsive ◽

Her Family ◽

Compulsive Disorder ◽

History Of ◽

Competing Interest ◽

Clinical Cases

IntroductionHoarding disorders (HD) have increasingly become a public health hazard. It usually emerges during two broad life periods: in early age-of-onset is usually associated with obsessive-compulsive disorder (OCD); in the elderly, it can be due to psychiatric and organic disorders, unrelated to OCD.ObjectivesOur objective is to increase medical awareness and to highlight that both young and elderly people may suffer from this condition.AimsThe aim of this presentation is to address HD and its different presentations.MethodsPresentation of two clinical cases of HD and pathology revision.ResultsA 30-year-old woman was hoarding litter, food and several items in a systematic way, become aggressive when her family tried to clean the house and was admitted several times in a psychiatric facility for cleanliness of her house. She had a history of depressive symptoms and severe OCD, with obsessive thoughts and several verification behaviors. A 78-year-old woman, with history of cerebral vascular disease, was self-neglected, living in a filthy home, with hoarding of litter and many worthless objects in a disorganized way, become aggressive after her relatives try to enter her house and refused to get help of any kind. Later on, she was admitted in a psychiatric facility and diagnosed with vascular dementia.ConclusionsTimely diagnosis and proper management of these two variations of HD will allow more advanced studies in this matter and more effective pharmacological and psychotherapeutic treatments. These clinical cases reinforce the importance of practical guidelines for appropriate approach of these patients with complex and multidimensional needs.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Mania in the elderly

The British Journal of Psychiatry ◽

10.1192/bjp.155.2.220 ◽

1989 ◽

Vol 155 (2) ◽

pp. 220-224 ◽

Cited By ~ 99

Author(s):

Kit Stone

Keyword(s):

Retrospective Study ◽

Family History ◽

Affective Disorders ◽

Age Of Onset ◽

The Elderly ◽

Prior History ◽

Lithium Toxicity ◽

Affective Illness ◽

History Of

A retrospective study of 92 patients admitted with mania, aged over 65 years of age, found that 26% had no prior history of affective illness; 30% had previously only experienced depression, and half of these had at least three episodes of depression before the first manic illness. Patients with a family history of affective disorders had a significantly earlier age of onset of illness. There was evidence of cerebral organic impairment in 24% of the patients, and this group had a significantly later age of onset of illness. Prognosis was good, with only 8% still in hospital at six months. Half of the patients were started on lithium prophylaxis, but this did not significantly alter the number of readmissions. A quarter of those started on lithium developed evidence of lithium toxicity.

Download Full-text

Outcomes of Ischemic Stroke and Associated Factors Among Elderly Patients With Large-Artery Atherosclerosis: A Hospital-Based Follow-Up Study in China

Frontiers in Neurology ◽

10.3389/fneur.2021.642426 ◽

2021 ◽

Vol 12 ◽

Author(s):

Qianqian Wu ◽

Jingjing Cui ◽

Yuanli Xie ◽

Min Wang ◽

Huifang Zhang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Protective Factor ◽

Density Lipoprotein ◽

The Elderly ◽

Outcome Data ◽

Stroke Onset ◽

Stroke Recurrence ◽

Large Artery

Large-artery atherosclerotic (LAA) stroke is the most common subtype of ischemic stroke. However, risk factors for long-term outcomes of LAA stroke in the elderly Chinese population have not been well-described. Therefore, we aimed to assess outcomes and risk factors at 3, 12, and 36 months after LAA stroke onset among stroke patients aged 60 years and older. All consecutive LAA patients aged ≥ 60 years were prospectively recruited from Dongying People's Hospital between January 2016 and December 2018. The clinical features and outcome data at 3, 12, and 36 months after stroke were collected. Differences in outcomes and relationship between outcomes and risk factors were assessed. A total of 1,772 patients were included in our study (61.7% male, 38.3% female). The rates of mortality, recurrence, and dependency were 6.6, 12.6, and 12.6%, respectively, at 3 months after stroke onset. The corresponding rate rose rapidly at 36 months (23.2, 78.7, and 79.7%, respectively). We found the positive predictors associated outcomes at 3, 12, and 36 months after stroke onset. The relative risk (RR) with 95% confidential interval (CI) is 1.06 (1.02–1.10, P = 0.006) at 3 months, 1.06 (1.02–1.10, P = 0.003) at12 months, and 1.10 (1.05–1.15, P < 0.001) at 36 months after stroke onset for age; 1.09 (1.01–1.19, P = 0.029) at 12 months for fasting plasma glucose (FPG) level; 4.25 (2.14–8.43, P < 0.001) at 3 months, 4.95 (2.70–9.10, P < 0.001) at 12 months, and 4.82 (2.25–10.32, P < 0.001) at 36 months for moderate stroke; 7.56 (3.42–16.72, P < 0.001) at 3 months, 11.08 (5.26–23.34, P < 0.001) at 12 months, and 14.30 (4.85–42.11, P < 0.001) at 36 months for severe stroke, compared to mild stroke. Hypersensitive C-reactive protein (hs-CRP) level was an independent risk factor for mortality at different follow-up times, with the RR (95%) of 1.02 (1.01–1.02, P < 0.001) at 3 months, 1.01 (1.00–1.02, P = 0.002) at 12 months. White blood cell count (WBC) level was associated with both stroke recurrence (RR = 1.09, 95%CI: 1.01–1.18, P = 0.023) and dependency (RR = 1.10, 95%CI: 1.02–1.19, P = 0.018) at 3 months. In contrast, a higher level of low-density lipoprotein cholesterol (LDL-C) within the normal range was a protective factor for recurrence and dependency at shorter follow-up times, with the RR (95%) of 0.67 (0.51–0.89, P = 0.005) and 0.67 (0.50–0.88, P = 0.005), respectively. These findings suggest that it is necessary to control the risk factors of LAA to reduce the burden of LAA stroke. Especially, this study provides a new challenge to explore the possibility of lowering LDL-C level for improved stroke prognosis.

Download Full-text

Detailed clinical characterisation, unique features and natural history of autosomal recessive RDH12-associated retinal degeneration

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313580 ◽

2019 ◽

pp. bjophthalmol-2018-313580 ◽

Cited By ~ 5

Author(s):

Abigail T Fahim ◽

Zaina Bouzia ◽

Kari H Branham ◽

Neruban Kumaran ◽

Mauricio E Vargas ◽

...

Keyword(s):

Natural History ◽

Retinal Degeneration ◽

Early Onset ◽

Vision Loss ◽

Age Of Onset ◽

Retinal Dystrophy ◽

Loss Of Function ◽

Phenotypic Data ◽

History Of ◽

Clinical Records

BackgroundDefects in retinol dehydrogenase 12 (RDH12) account for 3.4%–10.5 % of Leber congenital amaurosis and early-onset severe retinal dystrophy (EOSRD) and are a potential target for gene therapy. Clinical trials in inherited retinal diseases have unique challenges, and natural history studies are critical to successful trial design. The purpose of this study was to characterise the natural history of RDH12-associated retinal degeneration.MethodsA retrospective chart review was performed in individuals with retinal degeneration and two likely disease-causing variants in RDH12.Results57 subjects were enrolled from nine countries. 33 subjects had clinical records available from childhood. The data revealed an EOSRD, with average age of onset of 4.1 years. Macular atrophy was a universal clinical finding in all subjects, as young as 2 years of age. Scotopic and photopic electroretinography (ERG) responses were markedly reduced in all subjects, and a non-recordable ERG was documented as young as 1 year of age. Assessment of visual acuity, visual field and optical coherence tomography revealed severe loss of function and structure in the majority of subjects after the age of 10 years. Widefield imaging in 23 subjects revealed a unique, variegated watercolour-like pattern of atrophy in 13 subjects and sparing of the peripapillary area in 18 subjects.ConclusionsThis study includes the largest collection of phenotypic data from children with RDH12-associated EOSRD and provides a comprehensive description of the timeline of vision loss in this severe, early-onset condition. These findings will help identify patients with RDH12-associated retinal degeneration and will inform future design of therapeutic trials.

Download Full-text

Predictors of functional dependence at hospital discharge in a stroke unit

10.5327/1516-3180.673 ◽

2021 ◽

Author(s):

Isadora Souza Rocha ◽

Paola Nabhan Leonel dos Santos ◽

João Guilherme Bochnia Küster ◽

Maria Angélica Vieira Lizama ◽

Vinícius Riegel Giugno ◽

...

Keyword(s):

Hospital Discharge ◽

High Frequency ◽

Stroke Unit ◽

Hemorrhagic Stroke ◽

Functional Dependence ◽

Hemorrhagic Transformation ◽

Stroke Recurrence ◽

Large Artery ◽

Unit Design ◽

Specialized Care

Introduction: Functional dependence is a common condition poststroke. The specialized care offered at the stroke unit can provide patients with better rehabilitation. We designed a study to evaluate risk factors for functional dependence at hospital discharge in a stroke unit. Design and setting: Prospective cohort study at Hospital Geral Roberto Santos. Methods: Patients were admitted within 72h of ictus. Functional dependence was defined as scores 3-5 on the modified Rankin Scale (mRS). Results: 389 patients were enrolled, with a mean age of 59.3 (±17.9) years, of whom 55.8% were men. The frequency of functional dependence at discharge was 57.1%, 50.3% at 30 days, and 38.8% at 90 days of the ictus. Higher risk of dependence at hospital discharge were associated with stroke recurrence [RR 1.2 (1.0 - 1.5)], polypharmacy [RR 1.3 (1.1 - 1.6)], female sex [RR 1.3 (1.1 - 1.6)], hemorrhagic stroke [RR 1.4 (1.2 - 1.7)], large artery atherosclerosis by TOAST [RR 1.6 (1.2 - 2.0)], hemorrhagic transformation [RR 1.57 (1.3 - 1.9)], infection [RR 1.7 (1.5 - 2.0)] and delirium [RR 1.8 (1.5 - 2.0)] during hospitalization. Conclusions: We have demonstrated a high frequency of functional dependence at hospital discharge from the stroke unit. Understanding which patients may have a worse functional outcome can be a good strategy to articulate access to the rehabilitation.

Download Full-text