Prior events predict cerebrovascular and coronary outcomes in the PROGRESS trial

<p><b>Background and Purpose:</b> The relationship between baseline and recurrent vascular events may be important in the targeting of secondary prevention strategies. We examined the relationship between initial event and various types of further vascular outcomes and associated effects of blood pressure (BP)–lowering.</p> <p><b>Methods:</b> Subsidiary analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial that established the benefits of BP–lowering in 6105 patients (mean age 64 years, 30% female) with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, plus indapamide in those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s).</p> <p><b>Results:</b> Stroke subtypes and coronary events were associated with 1.5- to 6.6-fold greater risk of recurrence of the same event (hazard ratios, 1.51 to 6.64; P=0.1 for large artery infarction, P<0.0001 for other events). However, 46% to 92% of further vascular outcomes were not of the same type. Active treatment produced comparable reductions in the risk of vascular outcomes among patients with a broad range of vascular events at entry (relative risk reduction, 25%; P<0.0001 for ischemic stroke; 42%, P=0.0006 for hemorrhagic stroke; 17%, P=0.3 for coronary events; P homogeneity=0.4).</p> <p><b>Conclusions:</b> Patients with previous vascular events are at high risk of recurrences of the same event. However, because they are also at risk of other vascular outcomes, a broad range of secondary prevention strategies is necessary for their treatment. BP–lowering is likely to be one of the most effective and generalizable strategies across a variety of major vascular events including stroke and myocardial infarction.</p&gt

Prevalence of parkinsonism and Parkinson's disease in Europe: the EUROPARKINSON collaborative study

Malaltia de Parkinson; Prevalència; Distribució per edatsEnfermedad de Parkinson; Prevalencia; Distribución de edadParkinson Disease; Prevalence; Age DistributionObjectives: To assess and compare the prevalence of parkinsonism and Parkinson's disease in five European populations that were surveyed with similar methodology and diagnostic criteria.Methods: Joint analysis of five community surveys--Gironde (France), eight centres in Italy, Rotterdam (The Netherlands), Girona (Spain), and Pamplona (Spain)--in which subjects were screened in person for parkinsonism. Overall, these surveys comprised 14,636 participants aged 65 years or older.Results: The overall prevalence (per 100 population), age adjusted to the 1991 European standard population, was 2.3 for parkinsonism and 1.6 for Parkinson's disease. The overall prevalence of parkinsonism for the age groups 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 to 89 years was respectively, 0.9, 1.5, 3.7, 5.0, and 5.1. The corresponding age specific figures for Parkinson's disease were 0.6, 1.0, 2.7, 3.6, and 3.5. After adjusting for age and sex, the prevalence figures did not differ significantly across studies, except for the French study in which prevalence was lower. Prevalence was similar in men and women. Overall, 24% of the subjects with Parkinson's disease were newly detected through the surveys.Conclusions: Prevalence of both parkinsonism and Parkinson's disease increased with age, without significant differences between men and women. There was no convincing evidence for differences in prevalence across European countries. A substantial proportion of patients with Parkinson's disease went undetected in the general population

Inunditos como análogos de reservatórios: um exemplo nos depósitos gonduânicos triássicos do Gráben Arroio Moirão, RS

O estudo de reservatórios de óleo e gás de sistemas continentais tem enfatizado, na última década, arenitos associados a inunditos, provenientes de fluxos hiperpicnais. Contudo, há poucos estudos para entender sua arquitetura e heterogeneidade, resultando em dificuldades de reconhecimento e de exploração. O presente trabalho visa à análise de pacotes triássicos da Bacia do Paraná pertencentes à Formação Santa Maria, que ocorrem como fragmentos isolados sobre o Escudo Sul-Rio-Grandense na região do Gráben Arroio Moirão (RS). Para tanto, fez-se uso de mapeamento sistemático, análise de heterogeneidade de fácies e estratigrafia de sequências, que incluem levantamento de perfis colunares, identificação de associações e sucessões de fácies e superfícies-chave. Além disso, classificaram-se os arenitos e qualificou-se a porosidade com base na análise petrográfica. Foi possível delimitar os principais depósitos de arenitos, no quais predomina geometria tabular, grãos mal selecionados e matriz argilosa. Distinguiram-se cinco ciclos deposicionais granodecrescentes ascendentes, limitados na base e no topo por superfícies erosivas, que marcam heterogeneidades recorrentes. As fácies-reservatório foram classificadas como subarcósios, de matriz argilosa oxidada, com agregados de caulinita, e porosidade intergranular do tipo shrinkage. A integração dos dados resultou na elaboração de um modelo de variação lateral e vertical de fácies de depósitos de inunditos. Nele, identificaram-se fácies constituídas por arenitos grossos a conglomeráticos, com estratificações cruzada tangencial e plano-paralela, como potenciais modelos análogos de reservatórios. Esses resultados possibilitam prospectar outros depósitos arenosos dessa unidade estratigráfica da Bacia do Paraná, para fins de dimensionar regionalmente o análogo de reservatório.The study of oil and gas reservoirs in continental systems has emphasized, in the last decade, sandstones associated with inundites, coming from hyperpicnal flows. However, there are few studies to understand its architecture and heterogeneity, resulting in difficulties for exploration and exploitation. The current work aims at the analysis of Triassic strata from the Paraná Basin belonging to the Santa Maria Formation, which occur as isolated fragments on the Sul-rio-grandense Shield in Arroio Moirão Graben (RS). For this, systematic mapping, facies heterogeneity analysis and sequence stratigraphy were used, including columnar profiles, identification of associations and sequences of facies and key surfaces. In addition, the sandstones were classified and the porosity was qualified based on the petrographic analysis. It was possible to define the main deposits of sandstones, in which predominate tabular geometry, poorly selected grains and clayey matrix. Five ascending granodecrescent depositional cycles were distinguished, limited at the base and at the top by erosive surfaces, which marked recurrent heterogeneities. The reservoir facies were classified as subarcósios, of oxidized clay matrix, with aggregates of kaolinite, and intergranular porosity of the shrinkage type. The integration of the data resulted in the elaboration of a model of lateral and vertical variation inundites deposits facies. In it, facies composed of conglomeratic thick sandstones were identified, with tangential cross stratification and planar stratification, as potential analog models of reservoirs. These results allow the prospection of other sandy deposits from this stratigraphic unit of the Paraná Basin, in order to size the reservoir analogue regionally

Unhealthy behaviours and disability in older adults: Three-City Dijon cohort study

To examine the individual and combined associations of unhealthy behaviours (low/intermediate physical activity, consuming fruit and vegetables less than once a day, current smoking/short term ex-smoking, never/former/heavy alcohol drinking), assessed at start of follow-up, with hazard of disability among older French adults and to assess the role of potential mediators, assessed repeatedly, of these associations

Metabolic Syndrome and Risk for Incident Alzheimer's Disease or Vascular Dementia: The Three-City Study

OBJECTIVE—Associations between metabolic syndrome and its individual components with risk of incident dementia and its different subtypes are inconsistent

Front Neurosci

Background: Anxiety is common in patients with cognitive impairment and dementia. However, whether anxiety is a risk factor for dementia is still not known. We aimed to examine the association between trait anxiety at baseline and the 10-year risk of incident dementia to determine to which extent depressive symptoms influence this relationship in the general population. Methods: Data came from 5,234 community-dwelling participants from the Three-City prospective cohort study, aged 65 years at baseline and followed over 10 years. At baseline, anxiety trait was assessed using the Spielberger State-Trait Anxiety Inventory (STAI), and depressive symptoms using Center for Epidemiologic Studies-Depression Scale (CESD). Use of anxiolytic drugs was also considered. Diagnoses of dementia were made at baseline and every 2 years. To examine the relationship between anxiety exposures and risk of incident dementia, Cox proportional hazard regression models were performed. Results: Taking anxiolytic drugs or having high trait anxiety (STAI score >/= 44) increased the risk of dementia assessed over 10 years of follow-up [Hazard Ratio (HR) = 1.39, 95%CI: 1.08-1.80, p = 0.01 and HR = 1.26, 95%CI: 1.01-1.57, p = 0.04, respectively], independently of a large panel of socio-demographic variables, health behaviors, cardio-metabolic disorders, and additional age-related disorders such as cardiovascular diseases, activity limitations, and cognitive deficit. However, the associations were substantially attenuated after further adjustment for depressive symptoms. Conclusion: Our findings suggest that depressive symptoms shape the association between anxiety trait and dementia. Further research is needed to replicate our findings and extrapolate our results to anxiety disorders

Usefulness of data from magnetic resonance imaging to improve prediction of dementia: population based cohort study

© BMJ Publishing Group Ltd 2015. OBJECTIVE: To determine whether the addition of data derived from magnetic resonance imaging (MRI) of the brain to a model incorporating conventional risk variables improves prediction of dementia over 10 years of follow-up. DESIGN: Population based cohort study of individuals aged ≥65. SETTING: The Dijon magnetic resonance imaging study cohort from the Three-City Study, France. PARTICIPANTS: 1721 people without dementia who underwent an MRI scan at baseline and with known dementia status over 10 years' follow-up. MAIN OUTCOME MEASURE: Incident dementia (all cause and Alzheimer's disease). RESULTS: During 10 years of follow-up, there were 119 confirmed cases of dementia, 84 of which were Alzheimer's disease. The conventional risk model incorporated age, sex, education, cognition, physical function, lifestyle (smoking, alcohol use), health (cardiovascular disease, diabetes, systolic blood pressure), and the apolipoprotein genotype (C statistic for discrimination performance was 0.77, 95% confidence interval 0.71 to 0.82). No significant differences were observed in the discrimination performance of the conventional risk model compared with models incorporating data from MRI including white matter lesion volume (C statistic 0.77, 95% confidence interval 0.72 to 0.82; P=0.48 for difference of C statistics), brain volume (0.77, 0.72 to 0.82; P=0.60), hippocampal volume (0.79, 0.74 to 0.84; P=0.07), or all three variables combined (0.79, 0.75 to 0.84; P=0.05). Inclusion of hippocampal volume or all three MRI variables combined in the conventional model did, however, lead to significant improvement in reclassification measured by using the integrated discrimination improvement index (P=0.03 and P=0.04) and showed increased net benefit in decision curve analysis. Similar results were observed when the outcome was restricted to Alzheimer's disease. CONCLUSIONS: Data from MRI do not significantly improve discrimination performance in prediction of all cause dementia beyond a model incorporating demographic, cognitive, health, lifestyle, physical function, and genetic data. There were, however, statistical improvements in reclassification, prognostic separation, and some evidence of clinical utility

Under pressure: Response urgency modulates striatal and insula activity during decision-making under risk

When deciding whether to bet in situations that involve potential monetary loss or gain (mixed gambles), a subjective sense of pressure can influence the evaluation of the expected utility associated with each choice option. Here, we explored how gambling decisions, their psychophysiological and neural counterparts are modulated by an induced sense of urgency to respond. Urgency influenced decision times and evoked heart rate responses, interacting with the expected value of each gamble. Using functional MRI, we observed that this interaction was associated with changes in the activity of the striatum, a critical region for both reward and choice selection, and within the insula, a region implicated as the substrate of affective feelings arising from interoceptive signals which influence motivational behavior. Our findings bridge current psychophysiological and neurobiological models of value representation and action-programming, identifying the striatum and insular cortex as the key substrates of decision-making under risk and urgency

Genetic determinants of cortical structure (thickness, surface area and volumes) among disease free adults in the CHARGE Consortium

Cortical thickness, surface area and volumes (MRI cortical measures) vary with age and cognitive function, and in neurological and psychiatric diseases. We examined heritability, genetic correlations and genome-wide associations of cortical measures across the whole cortex, and in 34 anatomically predefined regions. Our discovery sample comprised 22,824 individuals from 20 cohorts within the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium and the United Kingdom Biobank. Significant associations were replicated in the Enhancing Neuroimaging Genetics through Meta-analysis (ENIGMA) consortium, and their biological implications explored using bioinformatic annotation and pathway analyses. We identified genetic heterogeneity between cortical measures and brain regions, and 160 genome-wide significant associations pointing to wnt/β-catenin, TGF-β and sonic hedgehog pathways. There was enrichment for genes involved in anthropometric traits, hindbrain development, vascular and neurodegenerative disease and psychiatric conditions. These data are a rich resource for studies of the biological mechanisms behind cortical development and aging