Clinical Determinants of Dementia Related to Stroke

Among 251 patients examined 3 months after the onset of acute ischemic stroke, we diagnosed dementia in 66(26.3%) by using modified DSM-III-R criteria based on neuropsychological, neurological, functional, and psychiatric examinations. We uses a logistic regression model to derive odds rations(ORs) for clinical factors independently related to dementia in this cross-sectional sample. Dementia was significantly associated with age, education, and race. A history of prior stroke (OR= 2.7) and diabetes mellitus (OR=2.6) was also independently related to dementia, but hypertension and cardiac disease were not. Stroke fearures associated with dementia included lacunar infarction compared with all other subtypes combined (OR=2.7) was also independently related to dementia, but hypertension and cardiac disease were not. Stroke features associated with dementia included lacunar infarction compared with all other subtypes combined (OR= 2.7) and hemisphetic laterality in relarion to brainstem or cerebellar location. There was a predominance of dementia in patients with left-sided lesions(Or-4.7), an effect not explained by aphasis. Dementia was especially common with infarctions in the left posterior cerebral and anterior cerebral artery territories. A major dominant hemispheral syndrome (reflecting size and laterality) was also independently associated with dementia (OR=3.9). We suggest that dementia after ischemic stroke is a result of multiple independent factors, including both small subcrtical and large cortical infarcts especially involving the left medial frontal and temporal regions, with additional contributions by demographic and vascular risk factors

Risk Factors for Cerebrovascular Disease as Correlates of Cognitive Function in a Stroke-Free Cohort

We investigated the relationship between risk factors for cerebrovascular disease and cognitive function in 249 stroke-free community volunteers (age, 70.8±6.7 years; education, 12.3±4.6 years) who were given tests of memory, language, visuospatial, abstract reasoning, and attentional skills. Using logistic regression analyses, we examined hypertension, diabetes mellitus, myocardial infarction, angina, hypercholesterolemia, and cigarette smoking as potential correlates of performance within these cognitive domains. Controlling for demographic factors within the logistic models, diabetes mellitus was a significant independent correlate of abstract reasoning deficits (odds ratio, 10.9; 95% confidence interval, 2.2 to 54.9) and visuospatial dysfunction (odds ratio, 3.5; confidence interval, 1.2 to 10.7), while hypercholesterolemia was a significant independent correlate of memory dysfunction (odds ratio, 3.0; confidence interval, 1.4 to 6.6). Prolonged exposure to vascular risk factors such as diabetes mellitus and hypercholesterolemia may lead to atherosclerotic disease, possibly resulting in "silent" infarctions or impaired cerebral blood flow and a decline in cognitive functioning

Low-voltage, high-gain, and high-mobility organic complementary inverters based on N,N'-ditridecyl-3,4,9,10-perylenetetracarboxylic diimide and pentacene

This is the pre-peer reviewed version of the following article: PHYSICA STATUS SOLIDI-RAPID RESEARCH LETTERS 2(2): 47-49, 2008 FULL CITE, which has been published in final form at http://www3.interscience.wiley.com/journal/117862140/abstract.ArticlePHYSICA STATUS SOLIDI-RAPID RESEARCH LETTERS. 2(2): 47-49 (2008)journal articl

Risk of Dementia in First-Degree Relatives of Patients with Alzheimer's Disease and Related Disorders

First-degree relatives of patients with Alzheimer's disease (AD) are at greater risk for dementia when compared with the relatives of their healthy peers, but not when compared with the relatives of patients with Parkinson's disease. This may indicate that the risk of dementia in these relatives is not specific to AD or that these studies are biased. We obtained a family history and vital status information on each first-degree relative of patients attending a clinic and in a group of recruited healthy elderly subjects. Patients formed two groups: probable AD and other forms of dementia or cognitive disorders without dementia. The odds of dementia in first-degree relatives did not differ between patient groups. The odds of dementia in relatives of patients with probable AD or other forms of dementia was six times that in the relatives of the healthy elderly subjects. The cumulative incidence of dementia increased with age in the first-degree relatives of all subjects. Approximately 50% of the first-degree relatives of patients with AD were demented by age 91 years, but almost the same number of the other patient group's relatives were demented as well. That figure was never reached in the healthy elderly subject's relatives. Because the risk of dementia in first-degree relatives of patients with AD was similar to that for patients with other disorders, we cannot exclude the possibility that this is the result of selection and information biases. Our investigation implies that the increased risk of dementia may not be specific to relatives of patients with AD; the risk may also be increased in first-degree relatives of patients with other neurologic disorders

Cerebral Hypoxia and Ischemia in the Pathogenesis of Dementia after Stroke

While it has been reported that ischemic stroke significantly increases the risk of delayed dementia,1,2 the underlying mechanisms are not well understood. Hypoxic and ischemic (HI) injury resulting from cerebral hypoperfusion due to systemic illness has been proposed as a pathogenic mechanism in certain subgroups of patients.1,3 Thus, the aim of this study was to investigate whether cerebral HI injury resulting from certain systemic illnesses (e.g., cardiac arrhythmias, cardiac failure, pneumonia, seizures, sepsis) would be an independent risk factor for the development of incident dementia after ischemic stroke

Influence of Education and Occupation on the Incidence of Alzheimer's Disease

Objective. —Several cross-sectional studies have found an association between Alzheimer's disease (AD) and limited educational experience. It has been difficult to establish whether educational experience is a risk factor for AD because educational attainment can influence performance on diagnostic tests. This study was designed to determine whether limited educational level and occupational attainment are risk factors for incident dementia. Design. —Cohort incidence study. Setting. —General community. Participants. —A total of 593 nondemented individuals aged 60 years or older who were listed in a registry of individuals at risk for dementia in North Manhattan, NY, were identified and followed up. Interventions. —We reexamined subjects 1 to 4 years later with the identical standardized neurological and neuropsychological measures. Main Outcome Measure. —Incident dementia. Results. —We used Cox proportional hazards models, adjusting for age and gender, to estimate the relative risk (RR) of incident dementia associated with low educational and occupational attainment. Of the 593 subjects, 106 became demented; all but five of these met research criteria for AD. The risk of dementia was increased in subjects with either low education (RR, 2.02; 95% confidence interval [CI], 1.33 to 3.06) or low lifetime occupational attainment (RR, 2.25; 95% CI, 1.32 to 3.84). Risk was greatest for subjects with both low education and low life-time occupational attainment (RR, 2.87; 95% CI, 1.32 to 3.84). Conclusions. —The data suggest that increased educational and occupational attainment may reduce the risk of incident AD, either by decreasing ease of clinical detection of AD or by imparting a reserve that delays the onset of clinical manifestations

Dementia after Stroke Increases the Risk of Long-Term Stroke Recurrence

Background: Although risk factors for first stroke have been identified, the predictors of long-term stroke recurrence are less well understood. We performed the present study to determine whether dementia diagnosed three months after stroke onset is an independent risk factor for long-term stroke recurrence. Methods: We examined 242 patients (age = 72.0 ± 8.7 years) hospitalized with acute ischemic stroke who had survived the first three months without recurrence and followed them to identify predictors of long-term stroke recurrence. We diagnosed dementia three months after stroke using modified DSM-III-R criteria based on neuropsychological and functional assessments. The effects of conventional stroke risk factors and dementia status on survival free of recurrence were estimated using Kaplan-Meier analyses, and the relative risks (RR) of recurrence were calculated using Cox proportional hazards models. Results: Dementia (RR = 2.71, 95% CI = 1.36 to 5.42); cardiac disease (RR = 2.18, CI = 1.15 to 4.12); and sex, with women at higher risk (RR = 2.03, CI = 1.01 to 4.10), were significant independent predictors of recurrence, while education (RR = 1.90, CI = 0.77 to 4.68), admission systolic blood pressure >160 mm Hg (RR = 1.80, CI = 0.94 to 3.44) and alcohol intake exceeding 160 grams per week (RR = 1.86, CI = 0.79 to 4.38) were weakly related. Conclusions: Our results suggest that dementia significantly increases the risk of long-term stroke recurrence, with additional independent contributions by cardiac disease and sex. Cognitive impairment may be a surrogate marker for multiple vascular risk factors and larger infarct volume that may serve to increase the risk of recurrence. Alternatively, less aggressive medical management of stroke patients with cognitive impairment or noncompliance of such patients with medical therapy may be bases for an increased rate of stroke recurrence

Expression of RAE-1, a ligand of the NKG2D Receptor, in Mice Adipocytes

Although epidemiological evidence has confirmed the role of heavy alcohol consumption as an established risk factor for esophageal, liver, and breast cancers, the molecular mechanisms underlying this effect are not fully understood, particularly with regard to breast cancer. In this study, expression of the retinoic acid early inducible-1 (RAE-1) gene was determined in mice adipocytes. RAE-1 is a ligand of the natural-killer group 2 member D (NKG2D) receptor, which plays a crucial role in tumor immunity. RT-PCR and Western blotting analysis demonstrated that TNF-α treatment induced RAE-1 mRNA and RAE-1 protein expression in adipocytes obtained from differentiated 3T3-F442A cells. Real-time RT-PCR analysis showed that 300 mM ethanol enhanced RAE-1 mRNA expression, which peaked 6 h after administration. In addition, RAE-1 mRNA was detected in visceral adipose tissue obtained from mice. These observations indicate that RAE-1mRNA is expressed in adipocytes and that its expression is enhanced by TNF-α, which has been shown to be induced in adipose tissue by long-term alcohol consumption. Furthermore, ethanol directly enhanced RAE-1 mRNA expression, suggesting that alcohol consumption enhances RAE-1 expression in adipose tissue and might modify tumor immunity. This finding might provide novel insight into the mechanism of alcohol-associated carcinogenesis