-
Fukuoka Igaku Zasshi = Hukuoka Acta... Nov 1998
Review
Topics: Cerebrovascular Disorders; Disorders of Excessive Somnolence; Drive; Female; Humans; Male; Memory Disorders; Middle Aged
PubMed: 10068297
DOI: No ID Found -
The American Journal of Geriatric... Feb 2005Depression may occur as a result of vascular disease in a significant subpopulation of elderly persons. Indirect support for vascular disease as an underlying etiology... (Review)
Review
Depression may occur as a result of vascular disease in a significant subpopulation of elderly persons. Indirect support for vascular disease as an underlying etiology of late-life depression includes the high rate of depression in patients with vascular disease, the frequency of "silent stroke" and white-matter hyperintensities in late-life depression, and the lower frequency of positive family histories of depression in such patients. The authors evaluate the associations of late-life depression with cerebrovascular disease by reviewing the existing pathophysiological, prognosis, and treatment-outcomes studies. Findings are based on review of the current literature systematically searched in electronic databases. Review of such studies indicates a high frequency of depression in older patients with cardiovascular and cerebrovascular diseases, and the possibility of a bidirectional relationship between depression and vascular disease. Studies examining patients with vascular depression have found that such patients have different symptom profiles, greater disability, and higher risk for poorer outcomes than those with nonvascular depression. Since the vascular depression hypothesis was proposed as a conceptual framework, evidence has accumulated that patients with vascular depression may have poorer outcomes that may be related in part to executive dysfunction and consequent disability. However, the association of vascular risk factors with geriatric depression has not been consistent in the studies to-date. Although an association between a subset of late-life depression and vascular disease is clear, significant gaps remain in our understanding. Further research is needed to establish the precise linkages and interactions between vascular disease and geriatric depression.
Topics: Age of Onset; Aged; Apolipoproteins E; Brain; Cerebrovascular Disorders; Dementia; Depressive Disorder, Major; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Magnetic Resonance Imaging; Male; Prognosis; Risk Factors; Treatment Outcome
PubMed: 15703317
DOI: 10.1176/appi.ajgp.13.2.88 -
Panminerva Medica Sep 2012Both cerebrovascular disease (CVD) and depression are common conditions in the elderly, and there is emerging evidence of a bi-directional relationship: 1) depression... (Review)
Review
Both cerebrovascular disease (CVD) and depression are common conditions in the elderly, and there is emerging evidence of a bi-directional relationship: 1) depression can cause CVD and stroke, transient ischemic attack; and 2) subcortical CVD are associated with increased risk for depression. The frequency of poststroke depression is highest during the first month after the stroke, but remains high even after several years. Depression is associated with poorer functional prognosis and higher mortality after stroke. There is good evidence that severity of functional impairment, high neuroticism, low social support as well as genetic factors are associated with an increased risk for post-stroke depression. Deep white matter lesions are the most consistent imaging correlate of depression. Potential mechanisms mediating the association between depression and CVD are neuroinflammation and HPA-axis activation, fronto-subcortical circuit lesions, and serotonergic dysfunction. Antidepressants have demonstrated effect on poststroke depression in meta-analyses, and such drugs as well as vitamin B can reduce the incidence of depression in stroke survivors. In addition, serotonergic drugs may strengthen poststroke motor and cognitive recovery, potentially through restorative mechanisms. Psychotherapeutic strategies such as problem-solving therapy seem to be effective. There is emerging evidence that treatment of cardiovascular disease and risk-factors can reduce the risk for late-life depression, but more studies are needed to test this hypothesis.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Atherosclerosis; Carotid Intima-Media Thickness; Cerebrovascular Disorders; Clinical Trials as Topic; Dementia, Vascular; Depressive Disorder; Female; Humans; Inflammation; Male; Models, Biological; Prognosis; Risk; Stroke Rehabilitation
PubMed: 22801433
DOI: No ID Found -
Seminars in Neurology Apr 2011There is a complex relationship between seizures and encephalopathy. Seizures alone without any underlying neurologic or medical illness can be the sole cause of... (Review)
Review
There is a complex relationship between seizures and encephalopathy. Seizures alone without any underlying neurologic or medical illness can be the sole cause of encephalopathy. Often these patients have a history of epilepsy, in which case accurate diagnosis is straightforward. Acute neurologic conditions often contribute to encephalopathy, but also increase the risk of seizures--many of which are subclinical. In these scenarios, it can be difficult to determine whether the encephalopathy is caused by seizures, the underlying neurologic disorder, or both. In addition, systemic diseases are commonly associated with encephalopathy; they may also increase the risk of seizures, although less commonly than acute neurologic conditions, and therefore may go unrecognized. This review will examine common and uncommon causes of seizures in encephalopathic patients, typical clinical presentations as well as diagnosis and treatment.
Topics: Animals; Brain Neoplasms; Cerebrovascular Disorders; Electroencephalography; Encephalitis; Humans; Seizures
PubMed: 21590624
DOI: 10.1055/s-0031-1277987 -
The American Journal of Psychiatry Nov 1990Follow-up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events. The...
Follow-up studies of psychiatric patients with panic disorder have shown an abnormally high mortality rate in men due to cardiovascular and cerebrovascular events. The authors report that in the New Haven portion of the Epidemiologic Catchment Area program the risk for stroke in persons with lifetime diagnoses of panic disorder was over twice that in persons with other psychiatric disorders or no psychiatric disorder. After adjustments for demographic differences between groups, the risk was even higher. While the results should be interpreted cautiously because of the small sample and absence of medical examinations, these findings are consistent with clinical studies showing an association between panic disorder and cardiovascular/cerebrovascular events.
Topics: Adolescent; Adult; Aged; Anxiety Disorders; Cardiovascular Diseases; Catchment Area, Health; Cerebrovascular Disorders; Cross-Sectional Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Panic; Risk Factors; United States
PubMed: 2221163
DOI: 10.1176/ajp.147.11.1504 -
International Review of Psychiatry... Oct 2006Neuropsychiatric syndromes are common in the setting of cerebrovascular disease. The most frequent psychiatric syndrome after stroke is depression. Emotionalism and... (Review)
Review
Neuropsychiatric syndromes are common in the setting of cerebrovascular disease. The most frequent psychiatric syndrome after stroke is depression. Emotionalism and apathy after stroke are also frequent and under-detected symptoms. Treatment principles are broadly similar to those currently used to treat non-organically ill patients. The evidence for pharmacological and psychological treatment for depression after stroke is scant, and of variable quality. Currently there is evidence of efficacy for both tricyclic antidepressants and SSRIs in the management of depression but the latter are better tolerated. Randomized controlled trials of antidepressants for post-stroke emotionalism are positive and this is encouraging. The current evidence base for psychological interventions either as first line or augmentative strategies is too limited and inconclusive to permit definite recommendations. Future studies might include multi-modal interventions using the principles of active case management and pharmacological studies which target both specific neuropsychiatric symptoms and underlying cerebrovascular disorder.
Topics: Antidepressive Agents; Antidepressive Agents, Tricyclic; Cerebrovascular Disorders; Electroconvulsive Therapy; Humans; Mental Disorders; Psychotherapy; Psychotic Disorders; Transcranial Magnetic Stimulation
PubMed: 17085364
DOI: 10.1080/09540260600935462 -
Clinics in Geriatric Medicine Nov 1993It is clear from this article that additional studies examining what factors can be used to predict the outcome of stroke and what process achieves the best outcome most... (Review)
Review
It is clear from this article that additional studies examining what factors can be used to predict the outcome of stroke and what process achieves the best outcome most effectively need to be developed. The available data support the usefulness of a coordinated rehabilitation program in the treatment of the functional impairment that occurs after the stroke. The process of rehabilitation is a vibrant and exciting one for all individuals involved. It is a unique process in medicine in which the physician does not "do" anything to the patient, but rather he or she leads a multidisciplinary team in providing a milieu in which the patient can improve and better his or her functional abilities. The process of seeing patients improve and overcome the often overwhelming sequelae of stroke to return home in an independent fashion is gratifying not only for the patient but also for the members of the rehabilitation team. In rehabilitation there is a focus on not only the health of the patient but also a strong focus on the quality of life and functional independence once the patient returns home.
Topics: Activities of Daily Living; Adult; Aged; Antidepressive Agents; Cerebrovascular Disorders; Depressive Disorder; Female; Geriatric Assessment; Humans; Male; Middle Aged; Remission, Spontaneous; Risk Factors
PubMed: 8281500
DOI: No ID Found -
The Journal of Clinical Psychiatry Dec 2004An understanding of cerebro-vascular effects of selective serotonin reuptake inhibitors (SSRIs) is essential, since SSRIs are a widely used antidepressant, serotonin is... (Review)
Review
OBJECTIVES
An understanding of cerebro-vascular effects of selective serotonin reuptake inhibitors (SSRIs) is essential, since SSRIs are a widely used antidepressant, serotonin is a vasoactive and thrombostatic amine, and there is a bidirectional relationship between depression and cerebrovascular disease.
DATA SOURCES
A MEDLINE search was performed to identify published reports over the period of 1966 through 2003, using the terms SSRIs and antidepressants matched with the terms platelets, coagulation, anticoagulation, bleeding, fibrinolysis, thrombosis, embolism, cerebral ischemia, stroke, cerebrovascular accident, acute and chronic cerebrovascular disease, intracranial hemorrhage, cerebrovascular disorder, and cerebral circulation. Adverse event reports collected from the World Health Organization (WHO), manufacturers, and the Physicians' Desk Reference (PDR) were also examined.
DATA SYNTHESIS
Two case-control studies failed to show an association between SSRI use and intracranial hemorrhage, and of these, 1 showed no association with ischemic stroke. Sixteen studies of SSRI treatment in poststroke patients found no significant cerebrovascular adverse reactions. The WHO data have shown several hundred cases of SSRI-associated cerebrovascular disease, but definitive causal relationships remain undetermined. Four cases of vasoconstrictive stroke related to drug interactions between SSRIs and other serotonergic drugs have been reported. PDR and manufacturer reference sources categorized cerebrovascular reaction as an infrequent or rare adverse event related to SSRI use.
CONCLUSIONS
Available evidence suggests that SSRI treatment has a very low rate of cerebrovascular adverse reaction. Pharmacovigilance is required in the use of SSRIs in high-risk populations for bleeding and vasoconstrictive stroke. More research is warranted to examine the variability of pharmacologic and genetic factors, depressive illness, and stroke on the antiplatelet and vasospastic effects of SSRIs and their significance to cerebrovascular protection or adverse reactions.
Topics: Adolescent; Adult; Brain Ischemia; Case-Control Studies; Cerebral Hemorrhage; Cerebrovascular Circulation; Cerebrovascular Disorders; Clinical Trials as Topic; Depressive Disorder; Female; Humans; Male; Middle Aged; Risk Factors; Selective Serotonin Reuptake Inhibitors; Stroke
PubMed: 15641869
DOI: 10.4088/jcp.v65n1209 -
Stroke Jun 2019Background and Purpose- Numerous studies have shown that circulating microRNAs (miRNAs) can be used as noninvasive biomarkers of various diseases. This study aimed to... (Clinical Trial)
Clinical Trial
Background and Purpose- Numerous studies have shown that circulating microRNAs (miRNAs) can be used as noninvasive biomarkers of various diseases. This study aimed to identify serum miRNAs that predict the risk of stroke. Methods- The cases were individuals who had been diagnosed with cerebrovascular disorder by brain imaging. The controls were individuals with no history of stroke who had undergone a medical checkup. Serum miRNA profiling was performed for all participants using microarray analysis. Samples were divided into discovery, training, and validation sets. In the discovery set, which consisted of control samples only, serum miRNAs that correlated with the predicted risk of stroke, as calculated using 7 clinical risk factors, were identified by Pearson correlation analysis. In the training set, a discriminant model between cases and controls was constructed using the identified miRNAs, Fisher linear discrimination model with leave-one-out cross-validation and DeLong test. In the validation set, the predictive accuracy of the constructed model was calculated. Results- First, in 1523 control samples (discovery set), we identified 10 miRNAs that correlated with a predicted risk of stroke. Second, in 45 controls and 87 cases (training set), we identified 7 of 10 miRNAs that significantly associated with cerebrovascular disorder (miR-1228-5p, miR-1268a, miR-1268b, miR-4433b-3p, miR-6090, miR-6752-5p, and miR-6803-5p). Third, a 3-miRNA combination model (miR-1268b, miR-4433b-3p, and miR-6803-5p) was constructed in the training set with a sensitivity of 84%, a specificity of 98%, and an area under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.98). Finally, in 45 controls and 86 cases (validation set), the 3-miRNA model achieved a sensitivity of 80%, a specificity of 82%, and an area under the receiver operating characteristic of 0.89 (95% CI, 0.83-0.95) for cerebrovascular disorder. Conclusions- We identified 7 serum miRNAs that could predict the risk of cerebrovascular disorder before the onset of stroke.
Topics: Adult; Aged; Biomarkers; Cell-Free Nucleic Acids; Cross-Sectional Studies; Female; Humans; Male; MicroRNAs; Middle Aged; Models, Biological; Oligonucleotide Array Sequence Analysis; Predictive Value of Tests; Risk Factors; Stroke
PubMed: 31136284
DOI: 10.1161/STROKEAHA.118.023648 -
Stroke Apr 2002The main stumbling block in the clinical management and in the search for a cure of Alzheimer disease (AD) is that the cause of this disorder has remained uncertain... (Review)
Review
BACKGROUND
The main stumbling block in the clinical management and in the search for a cure of Alzheimer disease (AD) is that the cause of this disorder has remained uncertain until now.
SUMMARY OF REVIEW
Evidence that sporadic (nongenetic) AD is primarily a vascular rather than a neurodegenerative disorder is reviewed. This conclusion is based on the following evidence: (1) epidemiological studies showing that practically all risk factors for AD reported thus far have a vascular component that reduces cerebral perfusion; (2) risk factor association between AD and vascular dementia (VaD); (3) improvement of cerebral perfusion obtained from most pharmacotherapy used to reduce the symptoms or progression of AD; (4) detection of regional cerebral hypoperfusion with the use of neuroimaging techniques to preclinically identify AD candidates; (5) presence of regional brain microvascular abnormalities before cognitive and neurodegenerative changes; (6) common overlap of clinical AD and VaD cognitive symptoms; (7) similarity of cerebrovascular lesions present in most AD and VaD patients; (8) presence of cerebral hypoperfusion preceding hypometabolism, cognitive decline, and neurodegeneration in AD; and (9) confirmation of the heterogeneous and multifactorial nature of AD, likely resulting from the diverse presence of vascular risk factors or indicators of vascular disease.
CONCLUSIONS
Since the value of scientific evidence generally revolves around probability and chance, it is concluded that the data presented here pose a powerful argument in support of the proposal that AD should be classified as a vascular disorder. According to elementary statistics, the probability or chance that all these findings are due to an indirect pathological effect or to coincidental circumstances related to the disease process of AD seems highly unlikely. The collective data presented in this review strongly support the concept that sporadic AD is a vascular disorder. It is recommended that current clinical management of patients, treatment targets, research designs, and disease prevention efforts need to be critically reassessed and placed in perspective in light of these important findings.
Topics: Alzheimer Disease; Cerebrovascular Circulation; Cerebrovascular Disorders; Humans; Microcirculation; Risk Factors
PubMed: 11935076
DOI: 10.1161/01.str.0000014421.15948.67