Disparities in stroke may be due to socioeconomics, demographics, risk factors (RF) and ethnicity. Asian data are scant. This retrospective hospital-based study aimed to explore demographics, RF, ...stroke subtypes and mechanisms among the Chinese, Malays and Indians in Singapore. Stroke was subtyped into haemorrhagic stroke (HS) and ischaemic stroke (IS). For IS, the clinical syndrome was classified using the Oxfordshire Community Stroke Project (OCSP) classification while the stroke mechanism was categorised using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. During the study period 1 June 2015 to 31 December 2023, data were collected on 1165 patients, with a mean age of 65.6 ± 12.9 yr; 47.4% were female, 83% were Chinese and hypertension (63.5%) and hyperlipidaemia (60.3%) were the most common RF. HS comprised 23.5% (95%CI 21.1–26.1%) (intracerebral 21.7%, subarachnoid 1.3%) of the patients, while IS comprised 76.5% (95%CI 73.9–78.9%) (small artery occlusion 29.0%, cardioembolism 13.3%, large artery atherosclerosis 9.4%, stroke of other determined aetiology 6.2%, stroke of undetermined aetiology 18.6%); 55% of patients had lacunar syndrome. A multivariable analysis showed that HS was associated with ethnicity (p = 0.044), diabetes mellitus (OR 0.27, 95%CI 0.18–0.41, p < 0.001) and smoking (OR 0.47, 95%CI 0.34–0.64, p < 0.001). There were no significant inter-ethnic differences by the OCSP (p = 0.31) or TOAST (p = 0.103) classification. While differences in stroke subtype in Asia may be due to RF, ethnicity has a role. More studies are needed to further explore this.
Background-There is no validated dementia screening tool for multi-ethnic Asian populations comprising Chinese, Malays, and Indians. This study aimed to establish the psychometric properties of the ...Community Screening Instrument for Dementia (CSI-D), Chinese Mini Mental State Examination (CMMSE), and Elderly Cognitive Assessment Questionnaire (ECAQ) in multi-ethnic Singapore. Methods-Participants were randomly drawn from a community-based neurological diseases study of older adults conducted in Singapore, with oversampling to allow similar subject numbers from the three major ethnicities: Chinese, Malay, and Indian. The CSI-D, CMMSE, and ECAQ were administered by trained research nurses using a standardised translated questionnaire in a language the participant was most conversant in. Participants were independently diagnosed as a case/non-case of dementia using the DSM-IV. Results-There were 259 participants (85 Chinese, 85 Malays, and 89 Indians, mean age 70.15 years, 65.4% female, 58.8% had no/minimal formal education); 22.8% (
= 59) had dementia. Correlations between the measures were substantial. All the measures had acceptable overall discriminative abilities. Diagnostic accuracies of the instruments did not differ across the ethnic groups. Effects of education were present in the cognitive screening measures. Conclusions-The CSI-D, CMMSE, and ECAQ are valid dementia instruments in this multi-ethnic Asian setting.
Stroke is a significant cause of admission to Singapore's acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the ...public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms COVID-19 suspect patients (CSPs) are evaluated separately by staff wearing full personal protective equipment (PPE). Triage is not delayed. CSPs needing hyperacute therapies are sent to a specially prepared scanner; if not, imaging is deferred to the latter part of the day. CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Investigation and rehabilitation are done within the room. ASU rounds are attended by essential members, communication by electronic means. Multidisciplinary team rounds have largely ceased, and discussions are via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff make daily calls to update families. Mild stroke patients may be sent home with rehabilitation advice. Out-patient rehabilitation centers are closed. Patients return for out-patient visits only if needed; medications are sent to their home, and nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control.
Advances in Neurological Diseases and Stroke Venketasubramanian, Narayanaswamy
Journal of cardiovascular development and disease,
02/2023, Letnik:
10, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Neurological diseases are a major cause of death and disability worldwide ....
Mechanisms of Stroke in COVID-19 Spence, J David; de Freitas, Gabriel R; Pettigrew, L Creed ...
Cerebrovascular diseases,
09/2020, Letnik:
49, Številka:
4
Journal Article
Stroke in COVID-19 and SARS-CoV-1 Venketasubramanian, Narayanaswamy; Hennerici, Michael G
Cerebrovascular diseases,
07/2020, Letnik:
49, Številka:
3
Journal Article
Asia, which holds 60% of the world's population, comprises some developing countries which are in economic transition. This paper reviews the epidemiology of stroke in South, East and South-East ...Asia. Data on the epidemiology of stroke in South, East, and South-East Asia were derived from the Global Burden of Disease study (mortality, disability-adjusted life-years DALYs lost because of stroke), World Health Organization (vascular risk factors in the community), and publications in PubMed (incidence, prevalence, subtypes, vascular risk factors among hospitalized stroke patients). Age- and sex-standardized mortality is the lowest in Japan, and highest in Mongolia. Community-based incidence data of only a few countries are available, with the lowest rates being observed in Malaysia, and the highest in Japan and Taiwan. The availability of prevalence data is higher than incidence data, but different study methods were used for case-finding, with different age bands. For DALYs, Japan has the lowest rates, and Mongolia the highest. For community, a high prevalence of hypertension is seen in Mongolia and Pakistan; diabetes mellitus in Papua New Guinea, Pakistan, and Mongolia; hypercholesterolemia in Japan, Singapore, and Brunei; inactivity in Malaysia; obesity in Brunei, Papua New Guinea, and Mongolia; tobacco smoking in Indonesia. Hypertension is the most frequent risk factor, followed by diabetes mellitus and smoking. Ischemic stroke occurs more frequently than hemorrhagic stroke, and subarachnoid hemorrhages are uncommon. There are variations in the stroke epidemiology between countries in South, East, and South-East Asia. Further research on stroke burden is required.
Summary Background The burden of ischaemic and haemorrhagic stroke varies between regions and over time. With differences in prognosis, prevalence of risk factors, and treatment strategies, knowledge ...of stroke pathological type is important for targeted region-specific health-care planning for stroke and could inform priorities for type-specific prevention strategies. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR) to calculate regional and country-specific estimates for ischaemic and haemorrhagic stroke incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life-years (DALYs) lost, by age group (aged <75 years, ≥75 years, and in total) and country income level (high-income and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). Worldwide, the burden of ischaemic and haemorrhagic stroke increased significantly between 1990 and 2010 in terms of the absolute number of people with incident ischaemic and haemorrhagic stroke (37% and 47% increase, respectively), number of deaths (21% and 20% increase), and DALYs lost (18% and 14% increase). In the past two decades in high-income countries, incidence of ischaemic stroke reduced significantly by 13% (95% CI 6–18), mortality by 37% (19–39), DALYs lost by 34% (16–36), and mortality-to-incidence ratios by 21% (10–27). For haemorrhagic stroke, incidence reduced significantly by 19% (1–15), mortality by 38% (32–43), DALYs lost by 39% (32–44), and mortality-to-incidence ratios by 27% (19–35). By contrast, in low-income and middle-income countries, we noted a significant increase of 22% (5–30) in incidence of haemorrhagic stroke and a 6% (–7 to 18) non-significant increase in the incidence of ischaemic stroke. Mortality rates for ischaemic stroke fell by 14% (9–19), DALYs lost by 17% (–11 to 21%), and mortality-to-incidence ratios by 16% (–12 to 22). For haemorrhagic stroke in low-income and middle-income countries, mortality rates reduced by 23% (–18 to 25%), DALYs lost by 25% (–21 to 28), and mortality-to-incidence ratios by 36% (–34 to 28). Interpretation Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts. Funding Bill & Melinda Gates Foundation.
Cerebrovascular disease (CeVD) and neurodegenerative dementia such as Alzheimer's disease (AD) are frequently associated comorbidities in the elderly, sharing common risk factors and ...pathophysiological mechanisms including neuroinflammation. Osteopontin (OPN) is an inflammatory marker found upregulated in vascular diseases as well as in AD. However, its involvement in vascular dementia (VaD) and pre-dementia stages, namely cognitive impairment no dementia (CIND), both of which fall under the spectrum of vascular cognitive impairment (VCI), has yet to be examined. Its correlations with inflammatory cytokines in cognitive impairment also await investigation. 80 subjects with no cognitive impairment (NCI), 160 with CIND and 144 with dementia were included in a cross-sectional study on a Singapore-based memory clinic cohort. All subjects underwent comprehensive clinical, neuropsychological and brain neuroimaging assessments, together with clinical diagnoses based on established criteria. Blood samples were collected and OPN as well as inflammatory cytokines interleukin (IL)-6, IL-8 and tumor necrosis factor (TNF) were measured using immunoassays. Multivariate regression analyses showed significant associations between increased OPN and VCI groups, namely CIND with CeVD, AD with CeVD and VaD. Interestingly, higher OPN was also significantly associated with AD even in the absence of CeVD. We further showed that increased OPN significantly associated with neuroimaging markers of CeVD and neurodegeneration, including cortical infarcts, lacunes, white matter hyperintensities and brain atrophy. OPN also correlated with elevated levels of IL-6, IL-8 and TNF. Our findings suggest that OPN may play a role in both VCI and neurodegenerative dementias. Further longitudinal analyses are needed to assess the prognostic utility of OPN in disease prediction and monitoring.
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