Brief dementia screening instruments, or mental status tests are frequently used to screen for cognitive impairment. We discuss the strengths and weaknesses of existing mental status tests in ...dementia screening in general. Most screening instruments that are used in clinical practice are developed to detect dementia compatible with Alzheimer's disease, and their value in detecting dementia after stroke is less well known. A stroke may cause both cortical and subcortical deficits, and the clinical expression of post-stroke dementia is different from that of Alzheimer's disease. Existing brief mental status tests have limited value in this patient group because they tend to ignore specific problems which may occur in stroke patients. Some expanded screening instruments, like the CAMCOG, are more useful and have additional diagnostic value. With the growing interest in research for vascular factors in dementia over the past years, however, a specific screening instrument for post-stroke dementia would be a valuable contribution.
BACKGROUND: Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data ...showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction. METHODS AND RESULTS: We used a nested case-control approach among 7983 subjects aged or =55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean duration of follow-up was 2.7 years. Results were adjusted for age and sex. Stroke risk increased gradually with increasing IMT. The odds ratio for stroke per standard deviation increase (0.163 mm) was 1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a previous myocardial infarction or stroke were excluded, odds ratios were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to 1.92) for myocardial infarction. Additional adjustment for several cardiovascular risk factors attenuated these associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to 1.58), respectively. CONCLUSIONS: The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.
To assess the diagnostic value of an extensive cardiac screening and of carotid artery duplex scanning in patients suspected of suffering from retinal embolism, we examined 41 consecutive patients ...(mean age 59.6 years, range 36-74) who presented either with amaurosis fugax or with a retinal artery occlusion. In spite of extensive investigations, we found no cause in 27 patients (66%). In 11 patients (27%), symptoms were likely to be due to a stenosis or an occlusion of the ipsilateral carotid artery. In only 1 patient (2%), the heart was likely to be a source of embolism. We conclude that in patients in this age group suffering from either amaurosis fugax or a retinal artery occlusion, a carotid artery duplex scanning should be performed first as this investigation is more likely to provide useful information than an extensive cardiac screening (ECG, Holter 24-hour monitoring and precordial echocardiography).
Recent randomized controlled trials have shown that new oral anticoagulants (dabigatran, rivaroxaban en apixaban) in patients with atrial fibrillation are equally or more effective in preventing ...cerebral infarction than vitamin K antagonists (VKA). New oral anticoagulants cause significant less intracranial haemorrhages. These results also apply to patients at high risk for complications such as those with a history of cerebral infarction, and those aged 75 years and over. It is not known whether patients in the acute phase after cerebral infarction and those with blood pressure exceeding 180/110 mmHg benefit as well. Monitoring anticoagulation is no longer needed in patients using these new oral anticoagulants, which makes daily use easier but provides less insight into medication compliance. There is no need to switch medication in patients who respond well to VKA. However, new oral anticoagulants should be considered in patients who have problems with VKA and who have a de novo indication for anticoagulation. Practical issues such as interaction with other drugs, medication compliance, antagonizing, monitoring of the anticoagulation and asymptomatic deteriorating renal function should be studied further.
Myocardial infarction survivors have an increased risk of stroke, which is reduced with long‐term anticoagulant therapy. However, an estimated 10‐times increase in risk of bleeding during such ...treatment has been reported. We evaluated the risk of stroke in patients after a myocardial infarction and examined the relationship of the risk of intracranial hemorrhage or cerebral infarction and the intensity of anticoagulant therapy. The study population consisted of 3,404 post‐myocardial infarction patients who took part in a randomized, double‐blind, placebo‐controlled trial. Patients were randomized to treatment with anticoagulants (international normalized ratio range, 2.8–4.8) or matching placebo. Mean follow‐up was more than 3 years. The incidence of stroke analyzed on “intention‐to‐treat” was 0.7 per 100 patient‐years in the anticoagulant patients against 1.2 in placebo, a hazard ratio of 0.60, with 95% confidence interval of 0.40 to 0.90. In the anticoagulation group, 15 patients had cerebral infarction and 17 an intracranial bleeding, 3 of which occurred after withdrawal of treatment. In the placebo group, the numbers were 43 and 2. Of the 14 intracranial bleeds during anticoagulation, 6 occurred at an international normalized ratio between 3.0 and 4.0 and 8 at greater than 4.0. These results confirm that long‐term anticoagulant therapy substantially reduces the risk of stroke in post‐myocardial infarction patients. The increased risk of bleeding complications associated with anticoagulant therapy is offset by a marked reduction in ischemic events. The risk of intracranial bleeding is directly related to the intensity of anticoagulant treatment.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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