169,832 research outputs found
Cerebrovascular assessment for the risk prediction of Alzheimer’s disease.
No full textCerebrovascular Assessment for the Risk Prediction of Alzheimer's Disease.
Silvestrini M, Viticchi G, Altamura C, Luzzi S, Balucani C, Vernieri F.
Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Increasing evidence is emerging that vascular disease and its risk factors play a
role in the development of Alzheimer's disease (AD) and affect the probability of
an adverse outcome. The aims of this review are to explore the relationship
between vascular risk factors and AD and to discuss the potential use of vascular
markers in the clinical approach to cognitive impairment. Moreover, we present
evidence about the potential use of ultrasonographic and neuroradiologic markers
of cognitive impairment in order to establish possible treatment strategies in
subjects with a clinical profile at risk of developing AD
Cerebral hemodynamics and cognitive performances in bilateral asymptomatic carotid stenosis.
No full textCerebral hemodynamics and cognitive performance in bilateral asymptomatic carotid
stenosis.
Balucani C, Viticchi G, Falsetti L, Silvestrini M.
From the Department of Neurology (C.B.), University of Perugia, Perugia, Italy;
Department of Neurology and Stroke Center (C.B.), SUNY Downstate Medical Center,
Brooklyn, NY; Neurological Clinic (G.V., M.S.), Marche Polytechnic University,
Ancona; and Internal and Subintensive Medicine (L.F.), Ospedali Riuniti, Ancona,
Italy.
OBJECTIVES: To evaluate cognitive performance in subjects with bilateral
asymptomatic carotid stenosis (B-ACS) compared to subjects with unilateral ACS
and to subjects with no carotid stenosis (CS) and to explore the relationship
between cognitive performance and cerebral hemodynamics status in B-ACS. METHODS:
The neuropsychological investigation included phonemic (ph) and categorical (ca)
Verbal Fluency (VF) tests for exploring the left brain functions and Colored
Progressive Matrices (CPM) and Complex Figure Copy Test (CFCT) for the right
brain. Cerebral hemodynamics status was assessed using the transcranial
Doppler-based breath-holding index test. RESULTS: A total of 333 subjects were
included: 127 B-ACS, 73/77 left/right unilateral ACS, 56 no CS, mean age 70 ±
3.78 years, 65% male. Subjects with B-ACS and subjects with unilateral ACS showed
significantly lower scores in all cognitive tests compared to subjects with no CS
(p < 0.05). Subjects with B-ACS with left impaired hemodynamics status showed a
significantly reduced ph-VF score, from 13.4 (95% confidence interval [CI]
11.2-15.8) to 7.5 (95% CI 5.4-9.7), and a reduced ca-VF score, from 19.7 (95% CI
18.1-24.1) to 10.8 (95% CI 9.5-15.1), compared to subjects with no CS. Similarly,
impaired cerebral hemodynamics in the right side was associated with a
significantly reduced CPM score, from an estimated mean of 34.2 (95% CI
29.8-35.4) to 24.6 (95% CI 20.2-25.8), and CFCT score from 37.0 (95% CI
32.0-37.4) to 27.1 (95% CI 23.3-28.7). All comparisons were p < 0.05. CONCLUSION:
Subjects with B-ACS and subjects with unilateral ACS are more likely to have
cognitive dysfunction compared to subjects with no CS. There appears to be a link
between cognitive dysfunction and hemodynamics impairment due to carotid
stenosis
Cerebral hemodynamics and cognitive performance in bilateral asymptomatic carotid stenosis (letter)
No full textCerebral vascular reactivity and cognitive performance in patients with extracranial asymptomatic carotid stenosis
No full textBackground: Preliminary studies have reported cognitive dysfunction
in unilateral asymptomatic carotid stenosis (ACS). Impaired
cerebral hemodynamic status measured by cerebrovascular reactivity
has been associated with cognitive dysfunction in unilateral
ACS.
Aims: (1) To evaluate cognitive performance in bilateral ACS compared
to unilateral ACS and healthy subjects and (2) to explore the
relationship between cognitive performance and cerebral hemodynamic
status in bilateral ACS.
Methods: Asymptomatic patients with ultrasound evidence of bilateral
or unilateral ACS (60 %-99 % diameter reduction) were
prospectively collected. Healthy subjects (HS) comparable for
demographics and vascular risk profile served as controls. A neuropsychological
investigation included phonemic and categorical
Verbal Fluency (VF) tests to explore the left hemisphere and Colored
Progressive Matrices (CPM), and Complex Figure Test Copy (CFTC)
tests to explore the right hemisphere. Cerebrovascular reactivity
(CVR) to hypercapnia using the transcranial Doppler (TCD) based
breath-holding index (BHI) test was performed in each subject.
Impaired CVR was defined as a BHI\0.69. Generalized linear
multivariate and univariate models were employed to evaluate the
mean difference on left and right cognitive test abilities in bilateral
ACS patients with left and right preserved or impaired CVR. Vascular
risk factors, education years, mini-mental status examination
(MMSE), and current medications were included as covariates.
Results: 333 consecutive subjects were included: 126 bilateral
ACS; 73/75 left/right unilateral ACS; 56 HS; mean age: 70 ± 3.78
years; males: 65 %; education years: 10.3 ± 3.7; MMSE score:
26.7 ± 1.27. Bilateral and unilateral ACS patients showed significantly
lower scores in all cognitive tests compared to HS (p\0.05).
In the multivariate analysis, among bilateral ACS an impaired CVR in
the right side was associated with a significantly reduced CPM score:
from an estimated mean of 32.6 [95 % Confidence Interval (CI):
29.8–35.4) to 23.0 (95 % CI: 20.2–25.8) and the CFTC score from
34.7 (95 % CI: 32.0–37.4) to 26.0 (95 % CI: 23.3–28.7). Similarly, an
impaired CVR on the left side was associated with a reduced phonemic
VF score: 13.5 (95 % CI: 11.2–15.8) to 7.5 (95 % CI: 5.4–9.7)
and categorical VF score from 21.1 (95 % CI: 18.1–24.1) to 12.3
(95 % CI: 9.5–15.1). All comparisons were statistically significant
(p\0.05).
Conclusions: Patients with unilateral or bilateral ACS are more likely
to suffer cognitive dysfunction compared to healthy controls.
Impaired CVR predicts the development of cognitive dysfunction in
bilateral ACS. A non-invasive assessment of CVR using the TCDbased
BHI test may contribute to a more comprehensive risk stratification
in these patients
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Cognitive impairment in subjects with unilateral or bilateral severe internal carotid stenosis
No full textFrom head to toe: Sex and gender differences in the treatment of ischemic cerebral disease
No full textStroke is a major cause of mortality and morbidity, particularly in the older ages. Women have a longer life expectancy and are more likely to experience stroke than men. Interestingly, the increased risk of ischemic stroke in women seems to be independent from age or classical cardiovascular risk factors. Notwithstanding the fact that stroke outcomes and survival are usually poorer in women, current evidence suggests that thrombolysis, antiplatelet and anticoagulant therapies are more beneficial in women than in men. A possible explanation of this paradox might be that females are often undertreated and they have fewer chances to be submitted to an effective and timely treatment for stroke than the male counterpart. The first step in the attempt to solve this obvious discrimination is surely to emphasize any reasons for differences in the therapeutic approach in relation to gender and then to denounce the lack of a sustainable motivation for them. In this article, we aimed to review the existing literature about gender-related differences on efficacy, administration and side effects of the most common drugs used for the treatment of ischemic stroke. The most striking result was the evidence that the therapeutic approach for stroke is often different according to patients' gender with a clear detrimental prognostic effect for women. A major effort is necessary to overcome this problem in order to ensure equal right to treatment without any sexual discrimination
Prevalence of obstructive sleep apnea syndrome in a population of patients with transient global amnesia
No full textObjective The etiology of transient global amnesia (TGA) is largely undetermined. The aim of this study was to investigate whether the prevalence of obstructive sleep apnea syndrome (OSAS), a condition associated with subtle changes in brain structures involved in memory processes, increases in subjects who have previously experienced a TGA episode. Methods Twenty-nine patients who had had a TGA episode were included. A caseâcontrol model was used, matching cases with controls by sex, age, and body mass index category. Diagnosis of OSAS was based on the results of the Berlin Questionnaire, which was later confirmed by means of an all-night polysomnography recording. Results The prevalence of OSAS among TGA patients was significantly higher with respect to that in controls (44.8% vs 13.8%, pâ=â0.020, Ï2test). At logistic regression model, subjects with TGA had an odds ratio of 8.409 (95% confidence intervalâ=â1.674â42.243; pâ=â0.010) of having OSAS when compared with controls. Conclusions According to our findings, an accurate investigation of sleep disturbances could be considered for a complete assessment of patients with TGA. The subtle cerebral anatomo-functional damage induced by the repeated nocturnal apneic episodes may be a pathophysiologic link between OSAS and TGA
Mitomycin C in highly myopic eyes - Author reply
No full textOphthalmology. 2005 Feb;112(2):208-18; discussion 219.
Mitomycin C modulation of corneal wound healing after photorefractive keratectomy in highly myopic eyes.
Gambato C, Ghirlando A, Moretto E, Busato F, Midena E.
SourceRefractive Surgery Service and Antimetabolite Therapy Research Unit, Department of Ophthalmology, University of Padova, Padova, Italy.
Abstract
PURPOSE: To evaluate the role of topical mitomycin C in corneal wound healing (CWH) after photorefractive keratectomy (PRK) in highly myopic eyes.
DESIGN: Prospective, double-masked, randomized clinical trial.
PARTICIPANTS: Seventy-two eyes of 36 patients affected by high (>7 diopters) myopia.
METHODS: In each patient, one eye was randomly assigned to PRK with intraoperative topical 0.02% mitomycin C application, and the fellow eye was treated with a placebo. Postoperatively, mitomycin C-treated eyes received artificial tears (3 times daily, tapered in 3 months), whereas the fellow eye was treated with fluorometholone sodium 2% and artificial tears (3 times daily, tapered in 3 months).
MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), contrast sensitivity, manifest refraction, and biomicroscopy. Contrast sensitivity was determined using the Pelli-Robson chart. Corneal confocal microscopy documented CWH.
RESULTS: Mean follow-up was 18 months (range, 12-36). No side effects or toxic effects were documented. At 12-month follow-up examination, UCVAs (logarithm of the minimum angle of resolution) were 0.4+/-0.48 and 0.5+/-0.53 (P = .03) in mitomycin C-treated eyes and corticosteroid-treated eyes, respectively. At 1 year, corneal haze developed in 20% of corticosteroid-treated eyes, versus 0% of mitomycin C-treated eyes. At 12, 24, and 36 months, corneal confocal microscopy showed activated keratocytes and extracellular matrix significantly more evident in untreated eyes (Ps = 0.004, 0.024, and 0.046, respectively).
CONCLUSION: Topical intraoperative application of 0.02% mitomycin C can reduce haze formation in highly myopic eyes undergoing PRK.
Comment in
Ophthalmology. 2006 Feb;113(2):357; author reply 357-8
Framingham risk score can predict cognitive decline progression in Alzheimer's disease
No full textThe role of vascular factors in influencing cognitive decline has been extensively investigated, and some difficulties in defining their weight in dementia pathogenesis have emerged. The aim of the study was to investigate the relevance of the Framingham cardiovascular risk profile (FCRP) in influencing cognitive deterioration in a population of Alzheimer's disease (AD) patients. Two hundred eighty-four consecutive AD patients were enrolled. For each patient, FCRP score was calculated. We did a 1-year follow-up to quantify the cognitive decline by recording changes in the Clinical Dementia Rating score. The FCRP score predicted cognitive deterioration with an area under the curve of 0.63 (95% confidence interval: 0.57-0.69; p < 0.0001). In the subpopulation of patients with a genetic increased predisposition to develop cognitive deterioration and with an advanced vascular impairment, the FCRP predictive value significantly increased with an area under the curve of 0.77 (95% confidence interval: 0.52-0.93; p < 0.05). Our findings show that FCRP can predict the progression of deterioration in AD patients. This was particularly evident in patients with major genetic and atherosclerotic risk factors
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