Cardiovascular risk factors influence onset and progression of Alzheimer’s disease. Among cognitively healthy people, changes in brain structure and function associated with high blood pressure, ...diabetes, or other vascular risks suggest differential regional susceptibility to neuronal damage. In patients with Alzheimer’s disease, hippocampal and medial temporal lobe atrophy indicate early neuronal loss preferentially in key areas for learning and memory. We wanted to investigate whether this regional cortical thinning would be modulated by cardiovascular risk factors. We utilized high-resolution magnetic resonance imaging and a cortical unfolding technique to determine the cortical thickness of medial temporal subregions in 30 patients with Alzheimer’s disease. Cardiovascular risk was assessed using a sex-specific multivariable risk score. Greater cardiovascular risk was associated with cortical thinning in the hippocampus CA2/3/dentate gyrus area but not other hippocampal and medial temporal subregions. APOE genotype, a family history of Alzheimer’s disease, and age did not influence cortical thickness. Alzheimer’s disease-related atrophy could mask the influence of genetic risk factors or age on regional cortical thickness in medial temporal lobe regions, whereas the impact of vascular risk factors remains detectable. This highlights the importance of cardiovascular disease prevention and treatment in patients with Alzheimer’s disease.
Background: The purpose of the study was to translate the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) into German and to evaluate the construct and concurrent validity ...in people with mild to moderate dementia. Methods: IDDD data of two pooled samples (n = 301) were analyzed regarding ceiling and bottom effects, internal consistency, factor reliability and correlations with corresponding scales on cognition and activities of daily living. Results: We found minimal bottom (< 5%) and ceiling (≤ 2%) effects, good internal consistency (Cronbach's α > 0.7) and moderate to good factor reliability (0.66–0.87). Low correlations with cognition (Pearson coefficient: < 0.17) confirmed the differences between cognitive testing and activities of daily living (ADL). Minor correlations with other ADL scores (r < 0.2) indicated that different scores cover a different range of ADLs. The original two factor model could not be confirmed. A suggested four factor model distinguishing initiative and performance of basic and instrumental ADL demonstrated better indices of fit and higher correlations with corresponding scales. Conclusion: A four factor model of the IDDD can be used in dementia research for assessing initiative in and performance of basic and household activities of daily living. The findings suggest that ADL scales correlate only poorly and that further development of the IDDD is needed to cover a broader range of ADLs.
Stroke-associated immunosuppression and inflammation are increasingly recognized as factors triggering infections and thus potentially influencing outcome after stroke. Several studies have ...demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes for patients with ischemic stroke or intracerebral hemorrhage. Thus far, in patients with subarachnoid hemorrhage the association between NLR and outcome is insufficiently established. The authors sought to investigate the association between NLR on admission and functional outcome in aneurysmal subarachnoid hemorrhage (aSAH).
This observational study included all consecutive aSAH patients admitted to a German tertiary center over a 5-year period (2008-2012). Data regarding patient demographics and clinical, laboratory, and in-hospital measures, as well as neuroradiological data, were retrieved from institutional databases. Functional outcome was assessed at 3 and 12 months using the modified Rankin Scale (mRS) score and categorized into favorable (mRS score 0-2) and unfavorable (mRS score 3-6). Patients' radiological and laboratory characteristics were compared between aSAH patients with favorable and those with unfavorable outcome at 3 months. In addition, multivariate analysis was conducted to investigate parameters independently associated with favorable outcome. Receiver operating characteristic (ROC) curve analysis was undertaken to identify the best cutoff for NLR to discriminate between favorable and unfavorable outcome in these patients. To account for imbalances in baseline characteristics, propensity score matching was carried out to assess the influence of NLR on outcome measures.
Overall, 319 patients with aSAH were included. Patients with unfavorable outcome at 3 months were older, had worse clinical status on admission (Glasgow Coma Scale score and Hunt and Hess grade), greater amount of subarachnoidal and intraventricular hemorrhage (modified Fisher Scale grade and Graeb score), and higher rates of infectious complications (pneumonia and sepsis). A significantly higher NLR on admission was observed in patients with unfavorable outcome according to mRS score (median IQR NLR 5.8 3.0-10.0 for mRS score 0-2 vs NLR 8.3 4.5-12.6 for mRS score 3-6; p < 0.001). After adjustments, NLR on admission remained a significant predictor for unfavorable outcome in SAH patients (OR 95% CI 1.014 1.001-1.027; p = 0.028). In ROC analysis, an NLR of 7.05 was identified as the best cutoff value to discriminate between favorable and unfavorable outcome (area under the curve = 0.614, p < 0.001, Youden's index = 0.211; mRS score 3-6: 94/153 61.4% for NLR ≥ 7.05 vs 67/166 40.4% for NLR < 7.05; p < 0.001). Subanalysis of patients with NLR levels ≥ 7.05 vs < 7.05, performed using 2 propensity score-matched cohorts (n = 133 patients in each group), revealed an increased proportion of patients with unfavorable functional outcome at 3 months in patients with NLR ≥ 7.05 (mRS score 3-6 at 3 months: NLR ≥ 7.05 82/133 61.7% vs NLR < 7.05 62/133 46.6%; p = 0.014), yet without differences in mortality at 3 months (NLR ≥ 7.05 37/133 27.8% vs NLR < 7.05 27/133 20.3%; p = 0.131).
Among aSAH patients, NLR represents an independent parameter associated with unfavorable functional outcome. Whether the impact of NLR on functional outcome is related to preexisting comorbidities or represents independent causal relationships in the context of stroke-associated immunosuppression should be investigated in future studies.
OBJECTIVETo evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify ...pathophysiologic factors influencing edema evolution.
METHODSThis retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0–3 = favorable, 4–6 = poor).
RESULTSA total of 292 patients were included. Median age was 70 years (interquartile range IQR 62–78), median ICH volume on admission 17.7 mL (IQR 7.9–40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio OR 0.984 95% confidence interval (CI) 0.973–0.994) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 95% CI 1.018–1.103) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 95% CI 1.034–1.477; PSM cohort, n = 124). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 95% CI 1.533–8.679) and fever burden on days 2–3 (OR 1.456 95% CI 1.103–1.920).
CONCLUSIONOur findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.
Stroke-associated immunosuppression and inflammation are increasingly recognized as factors that trigger infections and thus, potentially influence the outcome after stroke. Several studies ...demonstrated that elevated neutrophil-to-lymphocyte ratio (NLR) is a significant predictor of adverse outcomes in patients with ischemic stroke. However, little is known about the impact of NLR on short-term mortality in intracerebral hemorrhage (ICH).
This observational study included 855 consecutive ICH-patients. Patient demographics, clinical, laboratory, and in-hospital measures as well as neuroradiological data were retrieved from institutional databases. Functional 3-months-outcome was assessed and categorized as favorable (modified Rankin Scale mRS 0-3) and unfavorable (mRS 4-6). We (i) studied the natural course of NLR in ICH, (ii) analyzed parameters associated with NLR on admission (NLROA), and (iii) evaluated the clinical impact of NLR on mortality and functional outcome.
The median NLROA of the entire cohort was 4.66 and it remained stable during the entire hospital stay. Patients with NLR ≥4.66 showed significant associations with poorer neurological status (National Institute of Health Stroke Scale NIHSS 18 9-32 vs. 10 4-21; p < 0.001), larger hematoma volume on admission (17.6 6.9-47.7 vs. 10.6 3.8-31.7 mL; p = 0.001), and more frequently unfavorable outcome (mRS 4-6 at 3 months: 317/427 74.2% vs. 275/428 64.3%; p = 0.002). Patients with an NLR under the 25th percentile (NLR <2.606) - compared to patients with NLR >2.606 - presented with a better clinical status (NIHSS 12 5-21 vs. 15 6-28; p = 0.005), lower hematoma volumes on admission (10.6 3.6-30.1 vs. 15.1 5.7-42.3 mL; p = 0.004) and showed a better functional outcome (3 months mRS 0-3: 82/214 38.3% vs. 185/641 28.9%; p = 0.009). Patients associated with high NLR (≥8.508 = above 75th-percentile) showed the worst neurological status on admission (NIHSS 21 12-32 vs. 12 5-23; p < 0.001), larger hematoma volumes (21.0 8.6-48.8 vs. 12.2 4.1-34.9 mL; p < 0.001), and higher proportions of unfavorable functional outcome at 3 months (mRS 4-6: 173/214 vs. 418/641; p < 0.001). Further, NLR was linked to more frequently occurring infectious complications (pneumonia 107/214 vs. 240/641; p = 0.001, sepsis: 78/214 vs. 116/641; p < 0.001), and increased c-reactive-protein levels on admission (p < 0.001; R2 = 0.064). Adjusting for the above-mentioned baseline confounders, multivariable logistic analyses revealed independent associations of NLROA with in-hospital mortality (OR 0.967, 95% CI 0.939-0.997; p = 0.029).
NLR represents an independent parameter associated with increased mortality in ICH patients. Stroke physicians should focus intensely on patients with increased NLR, as these patients appear to represent a population at risk for infectious complications and increased short-mortality. Whether these patients with elevated NLR may benefit from a close monitoring and specially designed therapies should be investigated in future studies.
Background
Our objective was to test the association between hematoma volume and long-term (> 72 h) edema extension distance (EED) evolution and the association between peak EED and early EED ...increase with functional outcome at 3 months in patients with intracerebral hemorrhage (ICH).
Methods
This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. EED, an edema measure defined as the distance between the hematoma border and the outer edema border, was calculated by using absolute hematoma and edema volumes. We used multivariable logistic regression accounting for age, ICH volume, and location and receiver operating characteristic analysis for assessing measures associated with functional outcome and EED evolution. Functional outcome after 3 months was assessed by using the modified Rankin Scale (0–3 = favorable, 4–6 = unfavorable). To identify properties associated with peak EED multivariable linear and logistic regression analyses were conducted.
Results
A total of 292 patients were included. Median age was 70 years (interquartile range IQR 62–78), median ICH volume on admission 17.7 mL (IQR 7.9–40.2), median peak perihemorrhagic edema (PHE) volume was 37.5 mL (IQR 19.1–60.6), median peak EED was 0.67 cm (IQR 0.51–0.84) with an early EED increase up to 72 h (EED
72–0
) of 0.06 cm (− 0.02 to 0.15). Peak EED was found to be independent of ICH volume (
R
2
= 0.001,
p
= 0.6). In multivariable analyses, peak EED (odds ratio 0.224, 95% confidence interval CI 0.071–0.705) and peak PHE volume (odds ratio 0.984 95% CI 0.973–0.994) were inversely associated with favorable functional outcome at 3 months. Receiver operating characteristic analysis identified a peak PHE volume of 26.8 mL (area under the curve 0.695 95% CI 0.632–0.759;
p
≤ 0.001) and a peak EED of 0.58 cm (area under the curve 0.608 95% CI 0.540–0.676;
p
= 0.002) as best predictive values for outcome discrimination.
Conclusions
Compared with absolute peak PHE volume, peak EED represents a promising edema measure in patients with ICH that is largely hematoma volume-independent and nevertheless associated with functional outcome.
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