Stroke

#1 in 2 women and 1 in 3 men will develop #dementia, #stroke or #parkinsonism

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  • Noticias Médicas Univadis

A new study estimates that one in two women and one in three men will develop dementia, stroke or parkinsonism during their life.

While lifetime risks of other serious illnesses, such as cardiovascular disease are well known and used to raise public awareness, the researchers say this is not the case for dementia, stroke or parkinsonism.

To estimate the lifetime risk of these conditions, they examined data on more than 12,000 people who took part in the population-based Rotterdam Study between 1990 and 2016.

They found the lifetime risk for any of these diseases at age 45 was 48.2 per cent (95% CI 47.1%-51.5%) in women and 36.2 per cent (95% CI 35.1%-39.3%) in men. The risk of combined disease was higher in women than in men. Preventive strategies that delay disease onset by one to three years could theoretically reduce lifetime risk for developing any of these diseases by 20 to 50 per cent, they said.

The authors say the new estimates may improve awareness of the burden of the conditions in the population.

The study is published in the Journal of Neurology, Neurosurgery & Psychiatry

#Stroke doubles #dementia risk

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  • Noticias Médicas Univadis

Findings from a new analysis suggest stroke could more than double the risk of dementia.

Researchers analysed data from 36 studies of prevalent stroke that included 1.9 million participants and 12 studies of incident stroke that included 1.3 million participants to examine the relationship between stroke and all-cause dementia risk.

Both prevalent and incident strokes were identified as strong independent risk factors for all-cause dementia. Prevalent stroke was associated with almost 70 per cent greater risk of all-cause dementia (hazard ratio [HR] 1.69; 95% CI 1.49-1.92; P<.00001), while incident stroke was associated with more than double the risk of dementia (HR 2.18; 95% CI 1.90-2.50; P<.00001). The authors noted that significant heterogeneity was observed, and the association with prevalent stroke appeared stronger in men.

This latest study builds on previous research which had established the link between stroke and dementia, though had not quantified the degree to which stroke actually increased dementia risk.

Presenting their findings in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the authors said, given the consequences for people with dementia and their families and the significant implications for social and healthcare costs, stroke prevention strategies should be integrated into multimodal health interventions to reduce dementia risk.

#Should #marital status be considered a risk factor for #CVD and #stroke?

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  •  Noticias Médicas Univadis

Findings from a new study have prompted researchers to suggest that marital status should be considered in the risk assessment for cardiovascular disease (CVD) and that outcomes of CVD based on marital status merits further investigation.

As part of the study, researchers examined data from 34 studies with more than 2 million participants including from Europe, Scandinavia, North America, the Middle East, and Asia to determine how marital status influences CVD and prognosis after CVD.

They found that compared with married participants, being unmarried (never married, divorced or widowed) was associated with increased odds of CVD (OR 1.42) and coronary heart disease (CHD) (OR 1.16), as well as CHD death (OR 1.43) and stroke death (OR 1.55). Being divorced was associated with increased odds of CHD, while those who were widowed were more likely to develop a stroke. Single men and women with myocardial infarction had increased mortality compared with married participants.

Presenting the findings in Heart, the authors said: “Future research should focus around whether marital status is a surrogate marker for other adverse health behaviour or cardiovascular risk profiles that underlies our reported findings, or whether marital status should be considered as a risk factor by itself.”

#Stroke reclassified as #neurological disease in #ICD-11

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  • Noticias Médicas Univadis

The World Federation of Neurology (WFN) has welcomed the publication of the World Health Organization’s (WHO) new International Statistical Classification of Diseases and Related Health Problems (ICD-11). The new system proposes a number of changes to the previous edition which will impact on neurology practice.

Among the key changes in the document is the classification of stroke as a neurological disease rather than a circulatory disease, which the WFN says will have important implications for funding of neurological services. “With the recognition of stroke being a neurological disease we see an important clarification that a sufficient number of neurologists will be needed to apply all those lifesaving modern treatments in stroke which were not available 25 years ago,” said Prof Raad Shakir, Chair of the Neuroscience Topic Advisory Group (TAG) and WFN Past President.

The newly emerging spectrum of autoimmune encephalopathies is mentioned in detail which, Prof Wolfgang Grisold, Secretary General of the WFN, said will help to increase awareness for these diseases.

The WFN has highlighted how other important disorders are reflected in ICD-11 which were not recognised more than 25 years ago when ICD-10 was published, including neuroimmunological conditions and prion diseases.

#22 new #genetic risk factors for #stroke identified

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  • Noticias Médicas Univadis

A landmark international study of DNA samples from 521,612 individuals worldwide has identified 22 new genetic risk factors for stroke, bringing the total number to 32.

As part of the study, researchers performed a multi-ancestry genome-wide-association meta-analysis of 67,162 affected individuals and 454,450 controls. They found approximately half of the identified stroke loci showed shared genetic association with other vascular traits, and the largest genetic correlation was found for blood pressure. The study also identified shared genetic associations with venous thromboembolism and cardiac traits.

Presenting the research in Nature Genetics, the authors said the findings represent a major advance in understanding the genetic underpinnings of stroke. “Understanding these newly identified risk factors for stroke should also enable us to find novel treatments for dementia,” said co-author Dr Sudha Seshadri of the University of Texas Health Science Center in the US.

The study was conducted by members of MEGASTROKE, a large-scale international collaboration launched by the International Stroke Genetics Consortium. Members include research groups from Germany, France, the United Kingdom, Japan, the United States, Iceland, Spain, Switzerland, Italy, Belgium, the Netherlands, Denmark, Sweden, Norway, Finland, Estonia, Poland, Singapore, Australia and Canada.

#Gingko biloba may help boost #memory function after #stroke

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The herbal extract, gingko biloba, may be more effective at boosting memory and the brain’s ‘command and control’ function in stroke survivors, than the use of aspirin alone, suggest the results of a clinical trial, published in Stroke & Vascular Neurology.

Gingko biloba extract (GBE) has long been used as a traditional Chinese herbal treatment for a range of conditions, including depression, memory loss, and confusion. As part of this trial, researchers set out to see if it could also help lessen or halt the cognitive decline associated with ischaemic stroke.

A total of 348 patients with an onset of acute stroke within the previous seven days were randomised to receive either daily treatment with 450 mg of GBE plus 100mg of aspirin, or 100mg of aspirin alone for six months.

The study found patients with stroke who received GBE demonstrated better memory function, executive functions, and neurological function. Additionally, the safety data analysis found that GBE did not increase the incidence of adverse events.

The authors said that while further research is needed, this study suggests GBE could be a promising medication for patients with vascular cognitive impairment

LI S, Zhang X, Qi F et al. Ginkgo biloba extract improved cognitive and neurological functions of acute ischaemic stroke: a randomised controlled trial. Stroke Vasc Neurol. 2017;0: e000104. doi:10.1136/svn- 2017-000104

#Stroke: high rate of #cancer diagnosis within 18 mo of event

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Among stroke survivors, older age, a previous diagnosis of cancer, high levels of fibrinogen and low levels of haemoglobin, may be associated with cancer.
Experts have suggested that stroke survivors should be monitored for the development of cancer in the 18 months after the diagnosis of a stroke. The recommendation follows findings from a new observational study, which found that the incidence of cancer in stroke survivors was almost twice that of the general population.
Scientists followed 381 patients admitted to the stroke unit of Hospital de La Princesa in Madrid, Spain between 2012 and 2014 for 18 months from the diagnosis of stroke. During follow-up, 7.6 per cent of stroke survivors compared with 4.5 per cent of general population were diagnosed with cancer, most frequently in the colon, lung, and prostate.
“When cancer was diagnosed it was usually at an advanced stage, and the diagnosis was made within six months after a stroke. This indicates that the cancer was already present when the stroke occurred but there were no symptoms,” said lead author, Dr Jacobo Rogado.
Dr Rogado says the findings suggest that stroke survivors, particularly older patients who had cancer previously, or who have high fibrinogen or low levels of haemoglobin, should be followed clinically for the development of cancer after their stroke diagnosis.
The findings will be presented at the ESMO 2017 Congress .

Diet drinks linked to stroke and dementia

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The analysis of the Framingham Heart Study Offspring Cohort found a three-fold increased risk of stroke and dementia with daily consumption.

Daily consumption of at least one artificially-sweetened beverage is associated with almost three-times the risk of developing stroke and dementia, compared to drinking such beverages less than once a week, according to new research in the American Heart Association’s journal Stroke .

While the study’s authors caution that their observational study was not designed to prove cause and only shows a trend among one group of people, they said the findings demonstrate a need for more research in this area, given how often people drink artificially-sweetened beverages.
Lead author, Matthew Pase, put the results into context. “Even if someone is three-times as likely to develop stroke or dementia, it is by no means a certain fate,” he said. “In our study, 2 per cent of the people had a new stroke and 5 per cent developed dementia, so we’re still talking about a small number of people developing either stroke or dementia.”

“Although we did not find an association between stroke or dementia and the consumption of sugary drinks, this certainly does not mean they are a healthy option. We recommend that people drink water on a regular basis instead of sugary or artificially-sweetened beverages.”

Cada consumo de cocaína puede multiplicar por 6 el riesgo de ictus en adultos jóvenes (Stroke)

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Incluso en adultos de 30 a 40 años.

Incluso en adultos de 30 a 40 años.

Investigadores de la University of Maryland School of Medicine (Estados Unidos) han observado que cada vez que se consume cocaína se multiplica por seis el riesgo de sufrir un accidente cerebrovascular o ictus, incluso en adultos de 30 a 40 años, según los resultados de un estudio que publica la revista “Stroke”.

En un análisis comparativo de los pacientes que habían sufrido un ictus a una edad más joven vieron que el consumo de cocaína 24 horas antes del infarto cerebral aumentaba sustancialmente el riesgo, hasta ocho veces si se consumía fumándose.

“Entre otros factores, se sabe que la cocaína provoca un rápido aumento de la presión arterial y también puede causar problemas cardíacos que pueden derivar en un accidente cerebrovascular”, ha reconocido Steven J. Kittner, autor principal del estudio.

Los investigadores analizaron los datos de un estudio que se llevó a cabo entre 1992 y 2008 con más de mil pacientes que habían sufrido un ictus isquémico entre los 15 y 49 años en el área de Baltimore y Washington DC. Este tipo de accidente cerebrovascular es el más común y se caracteriza por la obstrucción de un vaso sanguíneo que va al cerebro, en la mayoría de ocasiones como consecuencia de un coágulo de sangre.

Los investigadores compararon estos datos con los de otros 1.152 personas de la misma franja de edad que no habían sufrido un ictus. En ambos casos se les preguntó por el consumo de drogas o medicamentos sin una indicación médica.

De este modo, vieron que las personas que habían sufrido un ictus eran más propensos a fumar tabaco y tener otras enfermedades asociadas como la diabetes o la hipertensión arterial, en comparación con el grupo control.

En cambio, el consumo de cocaína fue similar en ambos grupos, con un 28% en los pacientes con ictus y un 26% en el grupo control que la habían probado en alguna ocasión, por lo que el consumo puntual no podía asociarse a un mayor riesgo de ictus.

Sin embargo, en el grupo de ictus vieron que el haber consumido cocaína el día anterior les hacía seis veces más propensos a sufrir un ictus, frente a quienes no la habían probado. Un resultado que se mantuvo al analizar otras variables como el consumo de alcohol o tabaco.

Sólo 26 personas dijeron haber consumido cocaína menos de 24 horas antes de haber sufrido el ictus, de las que 14 lo hicieron apenas seis horas antes.

El autor del estudio reconoce que un estudio observacional como este no puede “probar” la relación de causalidad entre el consumo de cocaína y el ictus, pero si marca una “fuerte relación” entre ambos factores y, por ello, confía en que al menos consiga disuadir a algunos consumidores.

Prevention of epilepsy as yet ineffective

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Study shows that incidence in younger patients remained unchanged, but increased in elderly patients.

Attempts to prevent new-onset epilepsy have hitherto been largely ineffective. This is underlined in a Finnish study published in “JAMA Neurology”. In the past four decades, the number of new cases remained unchanged in people younger than 65 years but the incidence increased significantly among the elderly.

Together with German researchers from the Epilepsy Research Group in Berlin, scientists from the University of Turku and the National Institute of Health and Welfare in Helsinki analysed data from national Finnish registries, comprising five million people. They looked for first-time diagnosis of epilepsy between 1973 and 2013.

In total, 100,792 people were diagnosed with epilepsy during the four decades studied. In younger patients aged up to 65 years, the incidence did not change during the course of the study: 60 per 100,000 people were diagnosed with epilepsy in 1973, and 40 years later the rate was at 64 per 100,000. However, in people older than 65 years the researchers found a substantial increase: while the rate was at 57 per 100,000 people in 1973, this figure increased to 217 per 100,000 by 2013.

The authors considered the stability in the younger population group as unexpected, as both traffic accidents and military-related injuries had declined. However, the increase among elderly people was expected, because there are more older people in the Finnish population and there is an increase in the incidence of stroke and dementia, known to be risk factors of epilepsy.

There is, therefore, an urgent need to develop anti-epileptogenic drugs that are capable of preventing onset of epilepsy in the preliminary stages, emphasised the researchers. Previous preventive measures have evidently failed.