Antemortem Visit-To-Visit Blood Pressure Variability Predicts Cerebrovascular Lesion Burden in Autopsy-Confirmed Alzheimer’s Disease

Background: Blood pressure variability is linked to Alzheimer’s disease (AD) risk and MRI-based markers of cerebrovascular disease. Less is known about the role of blood pressure variability in postmortem evaluation of cerebrovascular disease and AD. Objective: To determine whether antemortem blood pressure variability predicts cerebrovascular and AD pathology and follow-up cognitive change in autopsy-confirmed AD. Methods: National Alzheimer’s Coordinating Center participants (n = 513) underwent 3-4 approximately annual blood pressure measurements and were confirmed to have AD at postmortem evaluation. A subset (n = 493) underwent neuropsychological evaluation at follow-up. Regression models examined relationships between blood pressure variability and cerebrovascular and AD pathological features and follow-up cognitive change. Results: Elevated blood pressure variability predicted increased postmortem cerebrovascular lesion burden (ß = 0.26 [0.10, 0.42]; p = 0.001; R 2 = 0.12). Increased blood pressure variability predicted specific cerebrovascular lesion severity, including atherosclerosis in the Circle of Willis (OR = 1.22 [1.03, 1.44]; p = 0.02) and cerebral arteriolosclerosis (OR = 1.32 [1.04, 1.69]; p = 0.03). No significant relationships were observed between blood pressure variability and AD pathological findings, including Braak & Braak stage, neuritic plaques or diffuse plaques, or cerebral amyloid angiopathy, or follow-up cognitive decline. Conclusion: Findings suggest that elevated blood pressure variability is related to postmortem cerebrovascular lesion burden in autopsy-confirmed AD, independent of average blood pressure and AD neuropathology. Blood pressure fluctuation may selectively promote atherosclerotic and arteriolosclerotic brain lesions with potential implications for cognitive impairment and dementia.

Simulation of superselective catheterization for cerebrovascular lesions using a virtual injection software

Background This report addresses the feasibility of virtual injection software based on contrast-enhanced cone-beam CTs (CBCTs) in the context of cerebrovascular lesion embolization. Intracranial arteriovenous malformation (AVM), dural arteriovenous fistula (AVF) and mycotic aneurysm embolization cases with CBCTs performed between 2013 and 2020 were retrospectively reviewed. Cerebrovascular lesions were reviewed by 2 neurointerventionalists using a dedicated virtual injection software (EmboASSIST, GE Healthcare; Chicago, IL). Points of Interest (POIs) surrounding the vascular lesions were first identified. The software then automatically displayed POI-associated vascular traces from vessel roots to selected POIs. Vascular segments and reason for POI identification were recorded. Using 2D multiplanar reconstructions from CBCTs, the accuracy of vascular traces was assessed. Clinical utility metrics were recorded on a 3-point Likert scale from 1 (no benefit) to 3 (very beneficial). Results Nine cases (7 AVM, 1 AVF, 1 mycotic aneurysm) were reviewed, with 26 POIs selected. Three POIs were in 2nd order segments, 8 POIs in 3rd order segments and 15 POIs in 4th order segments of their respective arteries. The reviewers rated all 26 POI traces – involving a total of 90 vascular segments – as accurate. The average utility score across the 8 questions were 2.7 and 2.8 respectively from each reviewer, acknowledging the software’s potential benefit in cerebrovascular embolization procedural planning. Conclusion The operators considered CBCT-based virtual injection software clinically useful and accurate in guiding and planning cerebrovascular lesion embolization in this retrospective review. Future prospective studies in larger cohorts are warranted for validation of this modality.

Cause of death and significant disease found at autopsy

The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.

Desarrollo y aportes desde una psicología positiva de la salud al abordaje de la salud / enfermedad

La APA reconoce 54 divisiones a manera de grupos de interés entre las que están la psicología de la salud y la psicología de la rehabilitación. Además, quien fuera presidente de esta asociación en 1998 impulsó la psicología positiva como perspectiva desde la necesidad de virar la atención hacia el funcionamiento psíquico óptimo y con ello a las fortalezas y virtudes humanas. Objetivo: explorar en la literatura científica sobre salud física los abordajes bajo una perspectiva de la psicología positiva. Método: búsqueda detallada en PsycArticles con los términos “positive psychology” AND “health” en AB (abstract). Se revisaron 16 artículos luego de seleccionar solo aquellos que abordaron condiciones de salud física particulares bajo una mirada desde la psicología positiva. Se realizó una exploración inicial de contenido y un análisis de los hallazgos y discusiones de los artículos. Resultados: Se presentan resultados para 11 enfermedades o deficiencias de salud objeto de aproximación desde la psicología positiva en los artículos revisados (cáncer, diabetes, enfermedad coronaria, enfermedad musculoesquelética, enfermedad cerebrovascular, lesión medular, obesidad, esclerosis múltiple, fibromialgia, abuso de sustancias y síntomas físicos) y las variables o categorías positivas que se consideraron en las investigaciones (optimismo, resiliencia, crecimiento postraumático, bienestar, satisfacción con la vida, afecto positivo, sentido, adherencia al tratamiento, calidad de vida y atención plena). Así mismo se reseñan las intervenciones positivas y las perspectivas futuras que se desprendieron de la revisión. Discusión: delimitar una psicología positiva de la salud requiere fortalecer la producción y la evidencia científica en esta materia. Se trata de un campo prometedor tanto en el desarrollo de estrategias de prevención y educación para la salud como de intervención en deficiencias de salud específicas, encaminado en todo caso, al bienestar y calidad de vida relacionado con la salud especialmente.

A proposal for a new pial arteriovenous fistulas grading scale for neuroendovascular procedures and literature review

Pial arteriovenous fistulas are an unusual type of cerebrovascular lesion. The vascular supply of this type of injury comes from cortical and pial vessels which are not located in the dura leaflets. With the aim to make a grading scale for this type of injury, we conducted a literature search using the keywords "pial arteriovenous fistulas", "embolization" associated with "outcome". Angiographic and imagenological characteristics typically found in pial arteriovenous fistulas were taken and was developed a preliminary classification system that must be validated in future studies. Pial arteriovenous fistulas are associated with a poor natural history and the establishment of an individualized therapeutic strategy can provide a good prognosis. The endovascular management of these lesions is safe and effective.