Despite being highly preventable, stroke is the second-most common cause of death and disability in the world. Secondary prevention is critical as the stroke recurrence risk is 6- to 15-fold higher ...than the risk of stroke in the general population. Stroke recurrence is associated with higher mortality rates and increased disability levels. Lifestyle modifications should address not single but multiple cardiovascular risk factors to effectively reduce the risk of stroke. Lifestyle modifications on a personal level should include adequate physical activity, a healthy diet, the cessation of smoking and alcohol consumption, and stress reduction. Physical activities should be performed in a healthy environment without air pollution. According to recent studies, up to 90% of strokes might be prevented by addressing and treating ten modifiable stroke risk factors, half of which are related to lifestyle modifications. These lifestyle modifications, which are behavioral interventions, could impact other modifiable risk factors such as arterial hypertension, hyperlipidemia, obesity, diabetes, and atrial fibrillation. The most common obstacles to effective secondary stroke prevention are motor impairment, post-stroke cognitive impairment, post-stroke depression, and stroke subtype. Long-term lifestyle modifications are difficult to sustain and require comprehensive, individualized interventions. This review underlines the benefits of adhering to lifestyle modifications as the most effective secondary stroke prevention measure.
Abstract The aim of the study was to evaluate role of breath holding index (BHI) as a functional parameter for intracranial subclinical atherosclerotic changes in recognizing patients who are at risk ...for developing cognitive impairment of the vascular type. We included 60 volunteers divided into 3 groups according to age and presence of cognitive impairment (healthy subjects 30–40 years old, controls 60–70 years old and subjects with mild cognitive impairment 60–70 years old). We excluded individuals with moderate and severe carotid stenosis. There was a decreasing trend in the mean blood flow velocities of the intracranial blood vessels due to age increase, but it was not statistically significant. BHI values were 1.66 ± 0.20 in the first group, 1.35 ± 0.31 in the second and 0.69 ± 0.30 in the third group. There was a statistically significant difference between the first two groups and the group with a mild cognitive impairment (MCI) in Montreal cognitive assessment (MoCA) score (29 ± 1, 27 ± 1 and 19 ± 1 respectively), no statistically significant difference was found in Mini mental state exam (MMSE) score (29 ± 1, 28 ± 1, and 28 ± 1 respectively). After regressing out age and conventional vascular risk factors, we found a good correlation between the decreasing trend in BHI values and MoCA score, and no statistically significant correlation between the BHI values and MMSE score. Results of our study show that BHI test as a parameter of impaired cerebrovascular reactivity (intracranial small vessel wall dysfunction) might differentiate individuals with early cognitive decline from healthy subjects.
We analyzed all the arguments against chronic cerebrospinal venous insufficiency (CCSVI) as a medical entity, and its association with a disabling demyelinating disease, multiple sclerosis (MS). We ...revised all the findings suggesting a possible connection between these two entities. By comparing the results obtained by different study groups, we noted a great variability in prevalence of CCSVI in MS patients, ranging from 0 to 100%. Overall the reported prevalence is respectively 70% in MS vs. 10% in controls, and a recent meta-analysis assessed an over 13 times increased prevalence in MS.
Postmortem studies show a higher prevalence of intraluminal defects in the main cerebral extracranial vein in MS patients respect to controls. Several pathophysiological studies demonstrate correlation between CCSVI and neglected vascular aspects of MS. Particularly, global hypo-perfusion of the brain, as well as reduced cerebral spinal fluid dynamics inMS was shown to be related to CCSVI. After careful review of all obtained data we can conclude that great variability in prevalence of CCSVI in MS patients can be a result of different methodologies used in vein assessment, training, application of unapproved diagnostic criteria, or different approach to the
problem itself. By many studies it has been shown that CCSVI can be
inserted in the list of multiple factors involved in pathogenesis ofMS, aswell as other neurodegenerative diseases.
Abstract Aging is often associated with some cognitive impairment. Greater population life expectancy is one explanation for increased incidence of cognitive impairment cases. Large number of people ...with cognitive impairment and dementia is becoming one of the most important medical and social problems worldwide. Therefore, prevention of Alzheimer disease is becoming an imperative. Dementia includes a heterogeneous group of disorders, the most common being Alzheimer dementia (AD) and vascular dementia (VD). Most cardiovascular risk factors, such as hypertension, diabetes mellitus, hypercholsterolemia, atrial fibrillation, and smoking are not exclusively risk factors for VD, but also for AD. Intracranial hemodynamics of the aging brain can be assessed by Transcranial Doppler Sonography (TCD), functional TCD with various functional tests, and TCD detection of cerebral emboli. Extracranial circulation can be assessed by means of color Doppler flow imaging (CDFI). New neurosonology techniques and possibilities provide information necessary to closer determine the relation between cognitive deterioration and vascular risk factors, so that the evolution towards dementia could be prevented or at least postponed.
Post-stroke fatigue is still a relatively unexplored, often neglected condition. The fatigue often manifests as physical and mental lack of energy, and many patients mention fatigue as one of the ...most difficult sequels to which they have to adjust. Our aim was to assess the fatigue in 35 three-month post-stroke patients and its relation to personal and stroke-related factors, and to compare them with 35 age- and sex-matched healthy control subjects. The main outcome measures for the fatigue were Fatigue Severity Scale (FSS) and Multidimensional Fatigue Inventory (MFI-20). Barthel index was used for functional status assessment, while anxiety and depressive symptoms were evaluated using Hospital Anxiety and Depression Scale (HADS). Study results showed fatigue to be frequent (45%) and often severe. Post-stroke patients showed higher values of general fatigue dimensions, physical fatigue and reduced activity. The number of subjects reporting fatigue problems on the FSS and MFI-20 scales was significantly greater in the stroke group (16/35; 45%) than in the control group (4/35; 11%; chi2 = 12.5; P < 0.001). Considering associations between fatigue and Barthel index score, age, sex, HADS-A (anxiety) and HADS-D (depression) scores, statistically significant associations were recorded between fatigue and anxiety (P = 0.01) and depression symptoms (P = 0.02). Global fatigue showed positive correlation with Barthel index score too (P = 0.01). Multivariate analysis showed that anxiety and depression symptoms could predict post-stroke fatigue (adjusted R2 = 0.556; P < 0.05). Clinical trials and follow-up studies to find an effective treatment for patients with post-stroke fatigue are warranted.
Recent evidence suggests that lower HDL-cholesterol (HDL-C) may worsen the atherosclerotic process by promoting inflammation and progression from subclinical lesion to clinical event. Carotid ...intima-media thickness (CIMT) is recognized as a marker of early atherosclerosis and used to predict future vascular events. Among the common lipid parameters, LDL has strongest relation with carotid plaque. Cumulative effect of achieving optimal levels of LDL-C, HDL-C, triglycerides and blood pressure is a reduced risk of recurrent stroke and major cardiovascular events. The protective effect of higher HDL-C is maintained at low levels of LDL-C. Studies have demonstrated a trend toward a higher risk of stroke with lower HDL-C and support HDL-C as an important modifiable stroke risk factor. In patients with recent stroke or transient ischemic attack and no coronary heart disease, only lower baseline HDL-C predicted the risk of recurrent stroke. Substantial amount of residual cardiovascular risk remains in patients treated with statins due to elevated triglycerides and low HDL-C, even when LDL-C is well controlled. Niacin promotes significant increase in HDL-C and reduces cardiovascular risk. By combining niacin with the LDL-lowering therapy of statins, the progression of atherosclerosis is slowed down and residual cardiovascular and risk of stroke is reduced. Non-pharmacological control of serum lipids includes regular physical activity and modification in daily diet. In primary prevention, when HDL-C is below the average and other risk factors are present, a statin added to non-pharmacological therapy is appropriate choice. Fibrate therapy may be appropriate in men with manifest coronary disease with isolated low HDL-C. If HDL-C remains low, with or without high triglyceride levels, a fibrate or niacin may be added.
Gender differences in stroke MOROVIĆ, SANDRA; RUNDEK, TATJANA; DEMARIN, VIDA
Periodicum biologorum,
09/2012, Letnik:
114, Številka:
3
Journal Article
Odprti dostop
Everyone is aware ofmany differences betweenmen andwomen in everyday life. But, howdifferent arewe in copingwith diseases?Nowadays, results of stroke studies more often point out gender differences. ...It has been shown that men and women have a different profile of vascular risk factors, different response to medical treatment, therapeutic interventions, as well as post-stroke disability and care. Data have shown women to be significantly older than men when stroke occurs, more likely to suffer cardioembolic stroke and have atrial fibrillation as a risk factor. Also, stroke onset differs
among men and women. Acute stroke in women commonly presents with a coma, paralysis, aphasia, swallowing difficulties and urinary incontinence. Women also show greater disability and handicap after stroke, than men. There has been a noted difference as to where patients are discharged after hospital stay. While women are more often discharged to a chronic facility, men more often return home. These differences may imply some social differences, but also point out the need for careful future management and healthcare planning.
Inadequate attention is being paid to the anxiety and depressive symptoms in acute stroke, although these problems are known to influence the patients' neurological outcome. The aim of our study was ...to assess the prevalence of anxiety and depressive symptoms in the acute stage of ischemic stroke and to identify the factors associated with such problems. Anxiety and depressive symptoms were evaluated using the Hospital Anxiety and Depression Scale in 40 patients with acute ischemic stroke admitted during a period of one month. Statistical analyses were performed by the SigmaStat (Version 2.0) software. Study results showed 55% of study patients to suffer from depressive symptoms and 40% from both anxiety symptoms and depressive symptoms. There was a correlation of depressive symptoms (HADS-D score) with MMSE (p < 0.001), age (p = 0.003) and BI (p < 0.001), and of anxiety symptoms (HADS-A score) with MMSE (p < 0.001) and BI (p = 0.01). There was no significant association of HADS-A and HADS-D score with other patient characteristics. In conclusion, depressive symptoms were more frequent in the acute stage ofischemic stroke. Study patients had a high prevalence of both groups of symptoms. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients' emotional stress and personal suffering, which could improve their neurological outcome.
