المؤلفون: Duskin, Jonathan, Yechoor, Nirupama, Singh, Sanjula, Mora, Samantha, Senff, Jasper, Kourkoulis, Christina, Anderson, Christopher D, Rosand, Jonathan

مصطلحات موضوعية: Cardiology, Medicine, Neurology and Neuromuscular Diseases, FOS Clinical medicine

الوصف: Introduction:Malnutrition is common in stroke patients and has been associated with poor functional outcomes and increased mortality after stroke. Previous research on nutrition status and post-intracerebral hemorrhage (ICH) outcomes, however, is limited and conflicting.Patients and Methods:Monocenter study of patients with spontaneous deep or lobar ICH from a longitudinal cohort enrolling consecutive patients between 1994 and 2022. Nutrition status was assessed using admission body mass index ( BMI), albumin, total bilirubin, cholesterol, c-reactive protein, hemoglobin a1c, high-density lipoprotein, hemoglobin, low-density lipoprotein, mean corpuscular volume, alanine transaminase, and triglycerides. Main outcome was favorable discharge outcome (mRS 0–2). Multivariable logistic regression was conducted with adjustment for baseline differences.Results:Among 2170 patients, 1152 had deep and 1018 had lobar ICH. Overweight BMI was associated with higher odds of favorable discharge outcome in all (aOR = 3.01, ...

العلاقة: https://dx.doi.org/10.25384/sage.c.7232928Test

الإتاحة: https://doi.org/10.25384/sage.c.7232928.v110.25384/sage.c.7232928Test
https://sage.figshare.com/collections/Nutrition_markers_and_discharge_outcome_in_deep_and_lobar_intracerebral_hemorrhage/7232928/1Test

المؤلفون: Senff, Jasper R, Singh, Sanjula D, Pasi, Marco, Jolink, Wilmar M T, Rodrigues, Mark A, Schreuder, Floris H B M, Staals, Julie, Schreuder, Tobien, Douwes, Jules P J, Talsma, Jelmer, McKaig, Brenna N, Kourkoulis, Christina, Yechoor, Nirupama, Anderson, Christopher D, Puy, Laurent, Cordonnier, Charlotte, Wermer, Marieke J H, Rothwell, Peter M, Rosand, Jonathan, Klijn, Catharina J M, Al-Shahi Salman, Rustam, Rinkel, Gabriël J E, Viswanathan, Anand, Goldstein, Joshua N, Brouwers, H Bart

المصدر: Senff , J R , Singh , S D , Pasi , M , Jolink , W M T , Rodrigues , M A , Schreuder , F H B M , Staals , J , Schreuder , T , Douwes , J P J , Talsma , J , McKaig , B N , Kourkoulis , C , Yechoor , N , Anderson , C D , Puy , L , Cordonnier , C , Wermer , M J H , Rothwell , P M , Rosand , J , Klijn , C J M , Al-Shahi Salman ....

مصطلحات موضوعية: cerebellum, cohort studies, hemorrhagic stroke, recurrence, stroke, survival

الوصف: BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH. METHODS: In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged =18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation. RESULTS: We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years. CONCLUSIONS: The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH ...

العلاقة: https://cris.maastrichtuniversity.nl/en/publications/7c9dc676-a68d-4d58-be65-9ec7a7be4e7cTest

الإتاحة: https://doi.org/10.1161/STROKEAHA.123.044622Test
https://cris.maastrichtuniversity.nl/en/publications/7c9dc676-a68d-4d58-be65-9ec7a7be4e7cTest

المؤلفون: Singh, Sanjula D., Oreskovic, Tin, Carr, Sinclair, Papier, Keren, Conroy, Megan, Senff, Jasper R., Chemali, Zeina, Gutierrez-Martinez, Leidys, Parodi, Livia, Mayerhofer, Ernst, Marini, Sandro, Nunley, Courtney, Newhouse, Amy, Ouyang, An, Brouwers, H. Bart, Westover, Brandon, Rivier, Cyprien, Falcone, Guido, Howard, Virginia, Howard, George, Pikula, Aleksandra, Ibrahim, Sarah, Sheth, Kevin N., Yechoor, Nirupama, Lazar, Ronald M., Anderson, Christopher D., Tanzi, Rudolph E., Fricchione, Gregory, Littlejohns, Thomas, Rosand, Jonathan

المصدر: Frontiers in Neurology ; volume 14 ; ISSN 1664-2295

الوصف: Introduction The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40–69 years, recruited between 2006–2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline. Results The BCS (median: 12; IQR:11–14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50–59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50–59, and 33% (95%CI, 29-37%) among those aged >59. Discussion The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.

الإتاحة: https://doi.org/10.3389/fneur.2023.1291020Test

المؤلفون: Mayerhofer, Ernst, Zaba, Natalie O., Parodi, Livia, Ganbold, Alena S., Biffi, Alessandro, Rosand, Jonathan, Yechoor, Nirupama, Anderson, Christopher D.

المصدر: Frontiers in Neurology ; volume 14 ; ISSN 1664-2295

مصطلحات موضوعية: Neurology (clinical), Neurology

الوصف: Background Intracerebral hemorrhage (ICH) disproportionally affects underserved populations, and coincides with risk factors for cardiovascular events and cognitive decline after ICH. We investigated associations between social determinants of health and management of blood pressure (BP), hyperlipidemia, diabetes, obstructive sleep apnea (OSA), and hearing impairment before and after ICH hospitalization. Methods Survivors of the Massachusetts General Hospital longitudinal ICH study between 2016 and 2019 who received healthcare at least 6 months after ICH were analyzed. Measurements of BP, LDL and HbA1c and their management in the year surrounding ICH and referrals for sleep studies and audiology up to 6 months after ICH were gathered from electronic health records. The US-wide area deprivation index (ADI) was used as proxy for social determinants of health. Results The study included 234 patients (mean 71 years, 42% female). BP measurements were performed in 109 (47%) before ICH, LDL measurements were performed in 165 (71%), and HbA1c measurements in 154 (66%) patients before or after ICH. 27/59 (46%) with off-target LDL and 3/12 (25%) with off-target HbA1c were managed appropriately. Of those without history of OSA or hearing impairment before ICH, 47/207 (23%) were referred for sleep studies and 16/212 (8%) to audiology. Higher ADI was associated with lower odds of BP, LDL, and HbA1c measurement prior to ICH [OR 0.94 (0.90–0.99), 0.96 (0.93–0.99), and 0.96 (0.93–0.99), respectively, per decile] but not with management during or after hospitalization. Conclusion Social determinants of health are associated with pre-ICH management of cerebrovascular risk factors. More than 25% of patients were not assessed for hyperlipidemia and diabetes in the year surrounding ICH hospitalization, and less than half of those with off-target values received treatment intensification. Few patients were evaluated for OSA and hearing impairment, both common among ICH survivors. Future trials should evaluate whether using the ICH ...

الإتاحة: https://doi.org/10.3389/fneur.2023.1194810Test

المؤلفون: Senff, Jasper R., Singh, Sanjula D., Pasi, Marco, Jolink, Wilmar M.T., Rodrigues, Mark A., Schreuder, Floris H.B.M., Staals, Julie, Schreuder, Tobien, Douwes, Jules P.J., Talsma, Jelmer, McKaig, Brenna N., Kourkoulis, Christina, Yechoor, Nirupama, Anderson, Christopher D., Puy, Laurent, Cordonnier, Charlotte, Wermer, Marieke J.H., Rothwell, Peter M., Rosand, Jonathan, Klijn, Catharina J.M.

المصدر: Stroke (00392499); May2024, Vol. 55 Issue 5, p1210-1217, 8p

المؤلفون: Ashburner, Jeffrey M, Chang, Yuchiao, Porneala, Bianca, Singh, Sanjula D, Yechoor, Nirupama, Rosand, Jonathan M, Singer, Daniel E, Anderson, Christopher D, Atlas, Steven J

المساهمون: Eliot B. & Edith C. Schoolman Fund for Research of Cerebrovascular Disease, McCance Center for Brain Health, Massachusetts General Hospital, National Heart, Lung, and Blood Institute

المصدر: International Journal of Stroke ; ISSN 1747-4930 1747-4949

الوصف: Background: Secondary prevention interventions to reduce post-stroke cognitive impairment (PSCI) can be aided by the early identification of high-risk individuals who would benefit from risk factor modification. Aims: To develop and evaluate a predictive model to identify patients at increased risk of PSCI over 5 years using data easily accessible from electronic health records. Methods: Cohort study that included primary care patients from two academic medical centers. Patients were aged 45 years or older, without prior stroke or prevalent cognitive impairment, with primary care visits and an incident ischemic stroke between 2003 and 2016 (development/internal validation cohort) or 2010 and 2022 (external validation cohort). Predictors of PSCI were ascertained from the electronic health record. The outcome was incident dementia/cognitive impairment within 5 years and beginning 3 months following stroke, ascertained using International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. For model variable selection, we considered potential predictors of PSCI and constructed 400 bootstrap samples with two-thirds of the model derivation sample. We ran 10-fold cross-validated Cox proportional hazards models using a least absolute shrinkage and selection operator (LASSO) penalty. Variables selected in >25% of samples were included. Results: The analysis included 332 incident diagnoses of PSCI in the development cohort (n = 3741), and 161 and 128 incident diagnoses in the internal (n = 1925) and external (n = 2237) validation cohorts, respectively. The C-statistic for predicting PSCI was 0.731 (95% confidence interval (CI): 0.694–0.768) in the internal validation cohort, and 0.724 (95% CI: 0.681–0.766) in the external validation cohort. A risk score based on the beta coefficients of predictors from the development cohort stratified patients into low (0–7 points), intermediate (8–11 points), and high (12–23 points) risk groups. The hazard ratios (HRs) for incident PSCI were significantly different by ...

الإتاحة: https://doi.org/10.1177/17474930241246156Test

المؤلفون: Kimball, Tamara, Mayerhofer, Ernst, Senff, Jasper, Marini, Sandro, Rivier, Cyprien A., Kourkoulis, Christina, Oreskovic, Tin, Carr, Sinclair, Falcone, Guido, Yechoor, Nirupama, Rosand, Jonathan, Singh, Sanjula, Parodi, Livia, Anderson, Christopher

المصدر: Neurology ; volume 102, issue 17_supplement_1 ; ISSN 0028-3878 1526-632X

الإتاحة: https://doi.org/10.1212/wnl.0000000000206517Test

المؤلفون: Singh, Sanjula D, Oreskovic, Tin, Carr, Sinclair, Papier, Keren, Conroy, Megan, Senff, Jasper, Chemali, Zeina, Gutierrez-Martinez, Leidys, Parodi, Livia, Mayerhofer, Ernst, Marini, Sandro, Nunley, Courtney, Kourkoulis, Christina, Newhouse, Amy, Ouyang, An, Brouwers, H B, Westover, Brandon, Rivier, Cyprien, Falcone, Guido J, Howard, Virginia J, Howard, George, Sheth, Kevin N, Yechoor, Nirupama, Lazar, Ronald M, Anderson, Christopher D, Tanzi, Rudolph, Fricchione, Gregory, Littlejohns, Thomas, Rosand, Jonathan

المصدر: Stroke ; volume 55, issue Suppl_1 ; ISSN 0039-2499 1524-4628

الوصف: Background: The Brain Care Score (BCS) was developed through a modified Delphi process with practitioners and patients for implementation into primary care to stimulate behavioral changes and lifestyle choices to sustainably reduce the incidence of dementia and stroke ( Fig 1) . Methods: To assess its validity as associated with incidence of dementia and stroke, the BCS was derived from the UK Biobank (UKB) baseline evaluation (2006-2010) for participants aged 40-69. Cox proportional hazards regression were used to estimate associations between the BCS and incident dementia and stroke, adjusted for sex, and stratified by age groups at baseline. Findings: The BCS (median: 12; IQR:11-14) was calculated for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incidents of dementia and 7,259 incidents of stroke during a median follow-up of 12.5 years. On average, a 5-point increase in baseline BCS was associated with a substantial significant decrease in dementia incidence (for those aged <50 years: HR: 0.41 [95%CI: 0.28-0.60], aged 50-59: HR: 0.68 [95%CI: 0.58-0.80], and aged >59 (HR: 0.92 [95%CI: 0.86-0.98]) as well as stroke incidence (for those aged <50 years: HR: 0.52 [95%CI: 0.44-0.61], aged 50-59: HR: 0.48 [95%CI: 0.44-0.53], and aged >59: HR: 0.67 [95%CI: 0.63-0.71]) (Fig 2). Interpretation: The BCS at baseline is strongly associated with risk of dementia and stroke in the UKB. Future research should include investigating the adaptability and implementation of the BCS for patients and providers into routine care worldwide.

الإتاحة: https://doi.org/10.1161/str.55.suppl_1.wmp18Test

المؤلفون: Duskin, Jonathan, Singh, Sanjula D, Senff, Jasper, Kourkoulis, Christina, Anderson, Christopher, Rosand, Jonathan, Yechoor, Nirupama

المصدر: Stroke ; volume 55, issue Suppl_1 ; ISSN 0039-2499 1524-4628

الوصف: Introduction: Intracerebral Hemorrhage (ICH) leads to high rates of morbidity and mortality. Malnutrition is common in stroke patients and leads to worse outcomes. Body mass index (BMI) is a widely available marker of nutrition status, however studies on BMI and post-ICH outcomes are limited and have conflicting results. We aim to clarify this relationship by examining the relationship between BMI, nutritional lab markers, ICH severity, and functional outcome at discharge stratified by ICH location. Methods: We leveraged data from an ongoing longitudinal ICH study of adults with spontaneous primary ICH. Patients were divided into underweight, normal weight, overweight, and obese according to World Health Organization BMI criteria. Albumin, B12, total bilirubin, cholesterol, CRP, ferritin, iron, folate, hbA1c, HDL, LDL, hemoglobin, MCV, INR, ALT, triglycerides, and vitamin D were abstracted from health records. Associations between BMI, lab markers, ICH volume, and favorable outcome (mRS 0-2) were analyzed using univariate and multivariable logistic regression stratified by deep versus lobar hemorrhage location, with normal weight as the reference. Results: 1,370 patients (719 with deep hemorrhage, 651 with lobar hemorrhage) were included. There was no association between BMI and ICH volume in patients with deep or lobar hemorrhage. Multivariable analyses adjusting for age, education, diabetes mellitus, coronary artery disease, alcohol use, ICH volume, and intraventricular hemorrhage showed that overweight, but not underweight or obese, subjects had higher odds of favorable outcome on discharge in the deep (OR 3.16, 95% CI 1.36-7.34) and lobar (OR 3.15, 95% CI 1.67-5.94) groups. Albumin (OR 2.27, 95% CI 1.05-4.90) and hemoglobin (OR 1.31, 95% CI 1.09-1.59) were the only labs associated with favorable outcome in the deep hemorrhage group while no markers were associated with favorable outcome in the lobar hemorrhage group. Albumin and hemoglobin were not associated with being overweight. Conclusion: Overweight ...

الإتاحة: https://doi.org/10.1161/str.55.suppl_1.wmp81Test

المؤلفون: Singh, Sanjula D, Rivier, Cyprien, Oreskovic, Tin, Carr, Sinclair, Papier, Keren, Chemali, Zeina, Guiterrez-Martinez, Leidys, Mallick, Akashleena, Parodi, Livia, Mayerhofer, Ernst, Senff, Jasper, Kourkoulis, Christina, Marini, Sandro, Clocchiatti-Tuozzo, Santiago, Nunley, Courtney, Newhouse, Amy, Ouyang, An, Westover, Michael B, Tanzi, Rudolph, Lazar, Ronald M, Pikula, Aleksandra, Ibrahim, Sarah, Brouwers, H, Howard, Virginia J, Howard, George, Yechoor, Nirupama, van Duijn, Cornelia, Littlejohns, Thomas, Sheth, Kevin N, Rosand, Jonathan, Fricchione, Gregory, Anderson, Christopher D, Falcone, Guido J

المصدر: Stroke ; volume 55, issue Suppl_1 ; ISSN 0039-2499 1524-4628

الوصف: Introduction: The 21-point Brain Care Score (BCS), developed via a modified Delphi process with practitioners and patients, is a novel instrument designed to motivate behavioral and lifestyle changes, ultimately aiming to decrease incidence of dementia and stroke (Fig 1). Whether or not BCS components are associated with longitudinal changes in mood disorders is not clear. For this study, we tested the hypothesis that the BCS also significantly correlates to late-life depression incidence in the UK Biobank (UKB). Design / Methods: The BCS was derived from UKB participants (using both the hospital and general practitioners cohort) aged 40-69 years, at baseline (2006-2010). After excluding patients with prevalent psychiatric disorders, we performed multivariable Cox proportional hazard regression models between the BCS and risk of incident late-life depression, adjusting for sex and stratified by age groups (<50, 50-59, >59 years). Results: The total BCS (median: 12; IQR:11-14) was derived for 416,370/502,408 (83%) UKB participants with complete data (mean age: 57; females: 54%). After exclusion of 50,395 participants who had mood or psychiatric disorders other than depression, a total of 365,975 participants were included in our analysis. In total, 6,628 incident cases of late-life depression were documented during the median follow-up period of 13 years. Each five-point increase in BCS was associated with a 59% (HR: 0.41, 95% CI: -0.03-0.85) decreased incidence of late-life depression among UKB participants aged <50, 35% (HR: 0.65, 95% CI: 0.57-0.74) among those aged 50-59; and 28% (HR: 0.72, 95% CI: 0.65-0.79) lower risk among those aged >59). Conclusions: In addition to its associations with dementia and stroke incidence, the BCS strongly correlates with late-life depression incidence in the UK Biobank. Additional research is needed to understand the association between BCS elements and late life depression in additional, diverse cohorts.

الإتاحة: https://doi.org/10.1161/str.55.suppl_1.wmp19Test