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Cerebral Small Vessel Disease and Kidney Function Predict Long-Term Survival in Patients With Acute Stroke.

https://arctichealth.org/en/permalink/ahliterature96237
Source
Stroke. 2010 Jul 29;
Publication Type
Article
Date
Jul-29-2010
Author
Niku K J Oksala
Tapani Salonen
Timo Strandberg
Anni Oksala
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Timo Erkinjuntti
Author Affiliation
From the Division of Vascular Surgery, Department of Surgery, University of Tampere and Tampere University Hospital, Tampere, Finland; the School of Medicine, Forensic Medicine, University of Tampere and the Laboratory Centre Research Unit, Tampere University Hospital, Tampere, Finland; the Department of Medicine, Tampere University Hospital, Tampere, Finland; the Institute of Health Sciences/Geriatrics, University of Oulu and University Hospital, Unit of General Practice, Oulu, Finland; and the Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
Source
Stroke. 2010 Jul 29;
Date
Jul-29-2010
Language
English
Publication Type
Article
Abstract
BACKGROUND AND PURPOSE: Cerebral small vessel disease reflected by white matter lesions (WMLs) in MRI and kidney function reflected by estimated glomerular filtration rate (eGFR) is closely associated in patients without stroke. We studied whether eGFR and WMLs predict long-term survival in patients with acute stroke. METHODS: After exclusion of patients with low eGFR (N=5 [1.3%]; /=60 mL/min/1.73 m(2)). Of the patients, 108 (28.6%) had mild, 68 (18.0%) had moderate, and 202 (53.4%) had severe WMLs. In logistic regression analysis adjusted with age and sex, eGFR /=60 mL/min/1.73 m(2) or only mild to moderate WMLs, or both, was associated with improved survival compared with all other combinations. CONCLUSIONS: Cerebral small vessel disease is closely associated with kidney function in patients with acute stroke. Cerebral small vessel disease and kidney function are closely associated predictors of poor poststroke survival.
PubMed ID
20671250 View in PubMed
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Haptoglobin Hp2 Variant Promotes Premature Cardiovascular Death in Stroke Survivors.

https://arctichealth.org/en/permalink/ahliterature284104
Source
Stroke. 2017 Jun;48(6):1463-1469
Publication Type
Article
Date
Jun-2017
Author
Petra Ijäs
Susanna Melkas
Jani Saksi
Antti Jula
Matti Jauhiainen
Niku Oksala
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Perttu Lindsberg
Timo Erkinjuntti
Source
Stroke. 2017 Jun;48(6):1463-1469
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cardiovascular Diseases - genetics - mortality
Cross-Sectional Studies
Female
Finland - epidemiology
Follow-Up Studies
Genotype
Haptoglobins - genetics
Humans
Male
Middle Aged
Stroke - genetics - mortality
Survivors
Abstract
Haptoglobin (Hp) is an acute phase plasma protein protecting tissues from oxidative damage. It exists in 2 variant alleles (hp1/hp2) giving rise to 3 protein isoforms with different biochemical properties and efficiency to limit oxidative stress. We previously found that hp2 variant is associated with stroke risk in the patients with carotid stenosis and the risk of ischemic cardiovascular events in a general population cohort. This study examined the hypothesis that Hp genotype is associated with general cardiovascular risk in patients with stroke.
Hp was genotyped in SAM study (Helsinki Stroke Aging Memory, n=378). A total of 1426 individuals ascertained from a nationally representative cross-sectional health survey served as population controls.
Hp genotype frequencies were 15.6% (hp1-1), 44.2% (hp1-2), and 40.2% (hp2-2) in patients with stroke. During a mean of 7.5-year follow-up after first-ever stroke, hp2 carriers had a substantially higher rate of cardiac deaths (24.5% versus 8.5%; P=0.006) and a trend toward more fatal strokes (23.5% versus 13.6%; P=0.122). The combined risk of ischemic cardiovascular deaths was 2.4-fold higher among hp2 carriers (95% confidence interval, 1.28-4.43) after adjustment for major cardiovascular risk factors.
Hp2 allele is associated with premature ischemic cardiovascular deaths after first-ever ischemic stroke.
PubMed ID
28487337 View in PubMed
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Post-stroke delirium in relation to dementia and long-term mortality.

https://arctichealth.org/en/permalink/ahliterature134607
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Publication Type
Article
Date
Apr-2012
Author
Susanna Melkas
Jouko V Laurila
Risto Vataja
Niku Oksala
Hanna Jokinen
Tarja Pohjasvaara
Antero Leppävuori
Markku Kaste
Pekka J Karhunen
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki University Central Hospital and Department of Neurological Sciences, University of Helsinki, Helsinki, Finland. susanna.melkas@hus.fi
Source
Int J Geriatr Psychiatry. 2012 Apr;27(4):401-8
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cohort Studies
Delirium - epidemiology - etiology
Dementia - etiology
Educational Status
Female
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Risk factors
Stroke - complications - mortality
Abstract
Delirium is a frequent post-stroke complication that compromises effective rehabilitation and has been associated with poor outcome. We aimed to investigate whether delirium is associated with increased risk of post-stroke dementia and long-term mortality once confounding is taken into account.
The study comprised 263 consecutive acute ischemic stroke patients aged 55-85 years admitted to the emergency department of a university hospital. The cohort included three-month survivors followed up for 10 years. The diagnosis of post-stroke delirium during the first 7 days after stroke was based on the DSM-IV criteria.
Of all the patients, 50 (19.0%) were diagnosed with delirium. Low education, pre-stroke cognitive decline, and severe stroke indicated by a Modified Rankin score between 3 and 5 were risk factors for post-stroke delirium, which was also associated with diagnosis of dementia at 3 months post-stroke. In the Kaplan-Meier analysis, delirium was associated with poor long-term survival (6.1 versus 9.1 years). In the stepwise Cox regression proportional hazards analysis adjusted for demographic factors and risk factors, advanced age (hazard ratio [HR] 1.08) and stroke severity (HR 1.83), but not post-stroke delirium, were associated with poor survival.
In our well-defined cohort of post-stroke patients, acute stage delirium was diagnosed in one in five patients and associated with dementia at 3 months. Advanced age and stroke severity were related to the higher long-term mortality among patients with post-stroke delirium.
PubMed ID
21560162 View in PubMed
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Poststroke dementia is associated with recurrent ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature116255
Source
J Neurol Neurosurg Psychiatry. 2013 Jul;84(7):722-6
Publication Type
Article
Date
Jul-2013
Author
Gerli Sibolt
Sami Curtze
Susanna Melkas
Jukka Putaala
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Niku K J Oksala
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, P.O. Box 340 (Haartmaninkatu 4), , Helsinki 00029 HUS, Finland. gerli.sibolt@hus.fi
Source
J Neurol Neurosurg Psychiatry. 2013 Jul;84(7):722-6
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain Ischemia - complications - epidemiology
Cardiovascular Diseases - complications - epidemiology
Cognition Disorders - etiology - psychology
Cohort Studies
Dementia - epidemiology - etiology
Diagnostic and Statistical Manual of Mental Disorders
Educational Status
Female
Finland - epidemiology
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Memory - physiology
Middle Aged
Neuroimaging
Neuropsychological Tests
Recurrence
Regression Analysis
Risk factors
Stroke - complications - epidemiology - etiology
Tomography, X-Ray Computed
Abstract
To investigate whether poststroke dementia (PSD) diagnosed after ischaemic stroke predicts recurrent ischaemic stroke in long-term follow-up.
We included 486 consecutive patients with ischaemic stroke (388 with first-ever stroke) admitted to Helsinki University Central Hospital who were followed-up for 12 years. Dementia was diagnosed in 115 patients using the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III) criteria. The effects of risk factors and  PSD on survival free of recurrent stroke were estimated using Kaplan-Meier log-rank analyses, and the HRs for stroke recurrence were calculated using Cox proportional hazards models.
In the entire cohort, patients with PSD had a shorter mean time to recurrent stroke (7.13 years, 95% CI 6.20 to 8.06) than patients without dementia (9.41 years, 8.89 to 9.92; log rank p
PubMed ID
23418214 View in PubMed
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Severe cerebral white matter lesions in ischemic stroke patients are associated with less time spent at home and early institutionalization.

https://arctichealth.org/en/permalink/ahliterature277043
Source
Int J Stroke. 2015 Dec;10(8):1192-6
Publication Type
Article
Date
Dec-2015
Author
Gerli Sibolt
Sami Curtze
Susanna Melkas
Tarja Pohjasvaara
Markku Kaste
Pekka J Karhunen
Niku K J Oksala
Timo Erkinjuntti
Source
Int J Stroke. 2015 Dec;10(8):1192-6
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brain - pathology
Brain Ischemia - epidemiology - pathology - therapy
Female
Finland - epidemiology
Follow-Up Studies
Hospitals, University
Humans
Institutionalization - statistics & numerical data
Kaplan-Meier Estimate
Magnetic Resonance Imaging
Male
Middle Aged
Registries
Severity of Illness Index
Stroke - epidemiology - pathology - therapy
Time
White Matter - pathology
Abstract
Cerebral white matter lesions are one imaging surrogate for cerebral small vessel disease. These white matter lesions are associated with increased morbidity and mortality in both the general population and ischemic stroke patients.
To investigate whether severe white matter lesions in a cohort of ischemic stroke patients are associated with fewer days spent at home and earlier permanent institutionalization.
We included 391 consecutive patients aged 55-85 years with ischemic stroke admitted to the Helsinki University Central Hospital (the Stroke Aging Memory cohort) with a 21-year follow-up. Hospitalization and nursing home admissions were reviewed from national registers.white matter lesions were rated using magnetic resonance imaging performed three-months poststroke, dichotomized as none-to-moderate and severe. Kaplan-Meier plots log-rank and binary logistic regression (odds ratio) and Cox multivariable proportional hazards model were used to study the association of white matter lesions with days spent at home and the time of permanent institutionalization. Hazards and odds ratio with their 95% confidence intervals are reported.
Severe white matter lesions were associated with fewer days spent at home, and more frequent, and earlier permanent institutionalization (1487 vs. 2354 days; log-rank P?
PubMed ID
26487377 View in PubMed
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Smoking and the platelet fibrinogen receptor glycoprotein IIb/IIIA PlA1/A2 polymorphism interact in the risk of lacunar stroke and midterm survival.

https://arctichealth.org/en/permalink/ahliterature166289
Source
Stroke. 2007 Jan;38(1):50-5
Publication Type
Article
Date
Jan-2007
Author
Niku K J Oksala
Maarit Heikkinen
Jussi Mikkelsson
Tarja Pohjasvaara
Markku Kaste
Timo Erkinjuntti
Pekka J Karhunen
Author Affiliation
Division of Vascular Surgery, Department of Surgery, Tampere University Hospital, Tampere, Finland.
Source
Stroke. 2007 Jan;38(1):50-5
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Blood Coagulation - genetics
Brain Infarction - genetics - mortality
Cohort Studies
DNA Mutational Analysis
Female
Finland - epidemiology
Follow-Up Studies
Gene Frequency - genetics
Genetic Predisposition to Disease - genetics
Genetic Testing
Genotype
Heterozygote
Humans
Male
Middle Aged
Multivariate Analysis
Platelet Glycoprotein GPIIb-IIIa Complex - genetics
Polymorphism, Genetic - genetics
Smoking - adverse effects - epidemiology
Survival Rate
Abstract
Smoking, increased fibrinogen levels, and platelet activation are related to the risk of ischemic stroke. The platelet fibrinogen receptor glycoprotein (Gp) IIb/IIIa Pl(A1/A2) polymorphism affects the binding of platelets to fibrinogen and is suggested to interact with smoking.
We explored the association of smoking and the Pl(A1/A2) polymorphism with ischemic stroke and survival in the Stroke Aging Memory cohort, comprising 486 consecutive patients (55 to 85 years old) who were analyzed 3 months after an ischemic stroke and followed up for 15 months. Stroke subtype determined by magnetic resonance imaging and GpIIb/IIIa Pl(A1/A2) genotype data were available for 272 patients.
In multivariate analysis, smoking was the only factor related to the risk of lacunar infarcts (odds ratio [OR]=1.87, 95% CI=1.05 to 3.31; P=0.033), and it was also a predictor of death (n=24, 8.8%) at 15 months (OR=5.13, 95% CI=1.61 to 16.36; P=0.006), along with age (OR=1.10, 95% CI=1.01 to 1.19; P=0.008). The GpIIb/IIIa Pl(A1/A2) polymorphism alone showed no association with stroke subtype or survival. However, there was a smoking-by-genotype association with the risk of lacunar infarcts (OR=2.10, 95% CI=0.90 to 4.89; P=0.087) and with survival (OR=2.78, 95% CI=0.89 to 8.61; P=0.077). Among younger (55 to 69 years) stroke patients, smokers carrying the Pl(A2) allele were at a higher (OR=5.81, 95% CI=1.26 to 26.80; P=0.024) risk of lacunar infarcts than noncarrier smokers (OR=3.12, 95% CI=1.06 to 9.24; P=0.039). The effect of Pl(A2) and smoking combined on survival was also stronger (OR=8.86, 95% CI=1.68 to 46.55; P=0.010) than the effect of smoking alone (OR=5.06, 95% CI=1.20 to 21.35; P=0.027).
Our results indicate that prothrombotic genetic factors may interact with smoking by modifying the stroke phenotype and affecting midterm survival.
PubMed ID
17138951 View in PubMed
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White matter lesions are related to impaired instrumental activities of daily living poststroke.

https://arctichealth.org/en/permalink/ahliterature160172
Source
J Stroke Cerebrovasc Dis. 2007 Nov-Dec;16(6):251-8
Publication Type
Article
Author
Tarja Ilona Pohjasvaara
Hanna Jokinen
Raija Ylikoski
Hely Kalska
Riitta Mäntylä
Markku Kaste
Timo Erkinjuntti
Author Affiliation
Department of Neurology, Helsinki Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland. Tarja.Pohjasvaara@hus.fi
Source
J Stroke Cerebrovasc Dis. 2007 Nov-Dec;16(6):251-8
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Brain - pathology
Brain Ischemia - complications - pathology - physiopathology
Cognition
Cohort Studies
Female
Finland
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Odds Ratio
Risk assessment
Risk factors
Severity of Illness Index
Stroke - etiology - pathology - physiopathology - psychology
Time Factors
Abstract
White matter lesions (WMLs) are frequent in elderly people, and have been associated with impaired activities of daily living (ADL) and cognitive decline. We sought to examine the role of WMLs and their extent, in regard to basic ADL, instrumental ADL (IADL), and cognitive functions, in a large well-defined cohort examined 3 months after an ischemic stroke.
The study group included 395 of 486 consecutive patients aged 55 to 85 years who, 3 months after an ischemic stroke, completed a neuropsychological test battery and magnetic resonance imaging, and structured medical, neurological, and laboratory evaluations; assessment included an interview with a knowledgeable informant.
The patients with the most severe WMLs (n = 213) were older, in comparison with those with moderate (n = 71) or mild/no (n = 111) WMLs. These patients also more often had Diagnostic and Statistical Manual of Mental Disorders, Third Edition dementia; had a lower Mini Mental Status score; were more often women; more often had impaired immediate and delayed memory performance, executive dysfunction, and impaired basic ADL and IADL functions; and had more infarcts and cortical or central atrophy in magnetic resonance imaging. However, there were no significant differences among the 3 groups in stroke severity measured on the Scandinavian Stroke Scale, in stroke-related depression as measured by the Beck Depression Inventory, or in stroke type. According to multiple logistic regression analysis, higher age (odds ratio 1.067, 95% confidence interval 1.036-1.01) and impaired IADL (odds ratio 0.852, 95% confidence interval 0.778-0.931) significantly correlated with severe WMLs.
Although the degree of WMLs was not associated with stroke severity, it was associated with global cognitive function, impaired memory functions, executive dysfunction, sex, and impaired basic ADL. Age and IADL functions were independent correlates of severe WMLs.
PubMed ID
18035242 View in PubMed
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7 records – page 1 of 1.