Stroke and Cardio-ankle Vascular Stiffness Index Suzuki, Jun; Sakakibara, Ryuji, MD, PhD; Tomaru, Takanobu, MD, PhD ...
Journal of stroke and cerebrovascular diseases,
02/2013, Volume:
22, Issue:
2
Journal Article
Peer reviewed
Background We investigated the relationship between stroke and cardio-ankle vascular stiffness index (CAVI), a novel noninvasive measure of vascular stiffness. Methods Eighty-five patients with ...cerebrovascular disease who underwent CAVI were enrolled in the current study. They were 63 men and 22 women with a mean age of 70.0 ± 10.8 years. They were divided into 4 groups according to neurologic abnormalities and magnetic resonance imaging (MRI) findings: 12 with transient ischemic attack (TIA), 26 with white matter ischemic lesions (WMLs), 17 with large artery atherosclerosis, and 30 with small vessel occlusion. Eight hundred fifty-four healthy patients (487 men and 367 women; mean age 65.1 ± 9.4 years) served as controls. The results were stratified by gender and age and statistically analyzed using the Fisher, Bonferroni–Dunn, and Scheffe tests. Results The average of CAVI was as follows: control males 60 to 69 years of age, 9.05 ± 0.82 (as a representative value); TIA, 9.3 ± 1.5; WML, 10.3 ± 1.3; large artery atherosclerosis, 10.2 ± 1.2; and small vessel occlusion, 10.0 ± 1.6, respectively. The difference in CAVI between each group and age- and gender-matched controls was 0.492 for TIA (no statistical significance); WML, 0.733 ( P < .001, and P = .002 Scheffe); large artery atherosclerosis, 0.838 ( P < .001, and P = .005 Scheffe); and small vessel occlusion, 1.034 ( P < .001), respectively. Linear regression analysis of CAVI and plaque score revealed a significant relationship in patients with ischemic cerebrovascular disease ( P < .05). Conclusions Compared with healthy control subjects, CAVI is statistically greater in patients with ischemic cerebrovascular diseases, particularly with WML, large artery atherosclerosis, and small vessel occlusion, but not in patients with TIA. CAVI had a clear relationship with carotid ultrasound plaque score. It appears that CAVI is a simple and noninvasive test for indicating atherosclerosis in patients with stroke.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Bladder dysfunction (urinary urgency/frequency), bowel dysfunction (constipation), and sexual dysfunction (erectile dysfunction) (also called “pelvic organ” dysfunctions) are common nonmotor ...disorders in Parkinson's disease (PD). In contrast to motor disorders, pelvic organ autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, peripheral myenteric pathology causing slowed colonic transit (loss of rectal contractions) and central pathology causing weak strain and paradoxical anal sphincter contraction on defecation (PSD, also called as anismus) are responsible for the bowel dysfunction. In addition, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine-oxytocin pathways, which normally promote libido and erection. The pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Dietary fibers, laxatives, and “prokinetic” drugs such as serotonergic agonists are used to treat bowel dysfunction in PD. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Background Gastrointestinal tract (GIT) dysfunction is common in Parkinson’s disease (PD) patients. However, it remains unclear whether levodopa affects GIT function in PD. Objective To ...perform an open study of levodopa’s effects on anorectal constipation in de novo PD patients by the quantitative lower-gastrointestinal autonomic test (QL-GAT). Methods Nineteen unselected de novo PD patients (10 men, 9 women; mean age, 66 years; mean duration of the disease, 2.2 years) were recruited for the study. Eighteen of the patients reported constipation. These patients were treated with 200/20 mg b.i.d. of levodopa/carbidopa for 3 months. Pre- and post-treatment, objective parameters in the QL-GAT that comprised the colonic transit time (CTT) and rectoanal videomanometry were obtained. Results Levodopa was well tolerated by all patients. There was a trend toward subjective improvements in bowel frequency and difficulty defecating. Levodopa did not significantly change CTT of the total colon or any segment of the colon. During rectal filling, levodopa significantly lessened the first sensation ( p < 0.05). It also tended to augment the amplitude of spontaneous phasic rectal contraction (not statistically significant). During defecation, levodopa significantly lessened the amplitude in paradoxical sphincter contraction upon defecation (PSD) ( p < 0.01). It also tended to augment the amplitude of rectal contraction and lessen the amplitude of abdominal strain (not statistically significant). Overall, levodopa significantly lessened post-defecation residuals ( p < 0.05). Conclusions The QL-GAT in the present study showed for the first time that levodopa augmented rectal contraction, lessened PSD, and thereby ameliorated anorectal constipation in de novo PD patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This review article introduces the new concept of vascular incontinence, a disorder of bladder control resulting from cerebral white matter disease (WMD). The concept is based on the original ...observation in 1999 of a correlation between the severity of leukoareosis or WMD, urinary symptoms, gait disorder and cognitive impairment. Over the last 20 years, the realization that WMD is not a benign incidental finding in the elderly has become generally accepted and several studies have pointed to an association between geriatric syndromes and this type of pathology. The main brunt of WMD is in the frontal regions, a region recognized to be crucial for bladder control. Other disorders should be excluded, both neurological and urological, such as normal-pressure hydrocephalus, progressive supranuclear palsy, etc., and prostatic hyperplasia, physical stress incontinence, nocturnal polyuria, etc. Treatment involves management of small vessel disease risk factors and anticholinergic drugs that do not easily penetrate the blood brain barrier to improve bladder control.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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