Ayesha Sherzai

Resting-state BOLD networks versus task-associated functional MRI for distinguishing Alzheimer's disease risk groups.

To assess the ability of resting-state functional magnetic resonance imaging to distinguish known risk factors for AD, we evaluated 17 cognitively normal individuals with a family history of AD and at least one copy of the apolipoprotein e4 allele compared to 12 individuals who were not carriers of the APOE4 gene and did not have a family history of AD. Blood oxygen level dependent fMRI was performed evaluating encoding-associated signal and resting-state default mode network signal differences between the two risk groups. Neurocognitive testing revealed that the high risk group performed worse on category fluency testing, but the groups were equivalent on all other cognitive measures. During encoding of novel face-name pairs, there were no regions of encoding-associated BOLD activations that were different in the high risk group. Encoding-associated deactivations were greater in magnitude in the low risk group in the medial and right lateral parietal cortex, similar to findings in AD studies. The resting-state DMN analysis demonstrated nine regions in the prefrontal, orbital frontal, temporal and parietal lobes that distinguished the two risk groups. Resting-state DMN analysis could distinguish risk groups with an effect size of 3.35, compared to an effect size of 1.39 using encoding-associated fMRI techniques. Imaging of the resting state avoids performance related variability seen in activation fMRI, is less complicated to acquire and standardize, does not require radio-isotopes, and may be more effective at identifying functional pathology associated with AD risk compared to non-resting fMRI techniques.

Cerebral perfusion and oxygenation differences in Alzheimer's disease risk.

Functional MRI has demonstrated differences in response to memory performance based on risk for Alzheimers disease (AD). The current study compared blood oxygen level dependent (BOLD) functional MRI response with arterial spin labeling (ASL) perfusion response during an associative encoding task and resting perfusion signal in different risk groups for AD. Thirteen individuals with a positive family history of AD and at least one copy of the apolipoprotien E epsilon4 (APOE4) gene (high risk) were compared to ten individuals without these risk factors (low risk). In the medial temporal lobes (MTLs) the high risk group had an elevated level of resting perfusion, and demonstrated decreased fractional BOLD and perfusion responses to the encoding task. However, there was no difference in the absolute cerebral blood flow during the task. These data demonstrate that individuals with increased risk for Alzheimers disease have elevated MTL resting cerebral blood flow, which significantly influences apparent differences in BOLD activations. BOLD activations should be interpreted with caution, and do not necessarily reflect differences in neuronal activation.

Stroke, food groups, and dietary patterns: a systematic review

Stroke is the fourth leading cause of mortality in the United States, yet it is 80% preventable by addressing lifestyle factors including nutrition. Evaluating the impact of nutrition at the food group and dietary pattern level will provide greater insight into the role of nutrition in stroke. For this purpose, a review of the literature was conducted using the PubMed, Web of Science, and CINAHL Plus online databases. While fruits, vegetables, and soy demonstrated a protective effect, variable findings were observed for fish, animal products, and whole grains. Adherence to DASH, Mediterranean, and prudent dietary patterns reduced the risk of stroke, whereas the Western dietary pattern was associated with increased stroke risk. Low-fat diet was not found to have a protective effect. Additional epidemiological evidence is needed to elucidate the impact of specific dietary patterns and food groups on stroke. Future research should consider developing dietary recommendations for stroke prevention, which are based on clinical trials and have an emphasis on food groups and dietary patterns that are palatable to the general public.

The Women's Health Care Empowerment Model as a Catalyst for Change in Developing Countries

Womens empowerment has been attempted through a number of different fields including the realms of politics, finance, and education, yet none of these domains are as promising as health care. Here we review preliminary work in this domain and introduce a model for womens empowerment through involvement in health care, titled the “womens health care empowerment model.” Principles upon which our model is built include: acknowledging the appropriate definition of empowerment within the cultural context, creating a womens network for communication, integrating local culture and tradition into training women, and increasing the capability of women to care for their children and other women.

Time Trends and Characteristics of Prevalent Dementia among Patients Hospitalized for Stroke in the United States

BACKGROUND Little is known about how prevalent dementia rates among patients with stroke have evolved over the last decade or how this relationship varies by gender, race ethnicity, stroke type, or dementia type. We assessed time trends and demographic predictors of coexisting dementia in a large cohort of patients hospitalized for stroke. MATERIALS AND METHODS Patient admission data between 1999 and 2012 were sourced from the National Inpatient Sample. Patient admission records were included in the retrospective analysis if they were diagnosed with ischemic or hemorrhagic stroke during admission. Predictors of dementia subtype were analyzed using unadjusted and adjusted multinomial logistic regression. RESULTS Of 1,170,051 patients hospitalized for stroke between 1999 and 2012, 66,703 (5.7%) had a coexisting diagnosis of dementia. Female gender was associated with increased odds of Alzheimers dementia (AD) (adjusted odds ratio [aOR] 1.15, 95% confidence interval [CI] 1.11-1.19) but decreased odds of both vascular dementia (VaD) (aOR .50, 95% CI .44-.58) and non-Alzheimers-nonvascular dementia (aOR .79, 95% CI .79, 95% CI .74-.83). Relative to whites, African-Americans had higher odds of AD (aOR 1.25, 95% CI 1.18-1.32) and VaD (aOR 1.51, 95% CI 1.40-1.64). Similarly, Hispanics had increased odds of AD (aOR 1.40, 95% CI 1.30-1.50). CONCLUSIONS Rates of coexisting dementia among patients hospitalized for stroke in the United States have risen over the last decade. Prevalence of dementia among these patients varies by gender and race-ethnicity. Key demographic groups may need to be targeted to reduce disparities in dementia occurrence.

Strong Association Between Migraine and Transient Global Amnesia: A National Inpatient Sample Analysis

The purpose of this article was to explore sex- and race-specific variables and comorbidities associated with transient global amnesia (TGA) using a nationally representative database. Data were obtained from the Nationwide Inpatient Sample using ICD-9 and procedure codes. Descriptive and survey logistic regression analyses were conducted and adjusted for influence of comorbidities, demographic characteristics, and hospitalization-related factors. Patients with migraines were 5.98 times more likely to also have a diagnosis of TGA compared with patients without migraines. Similarly, patients with TGA were more likely to have hypertension, precerebral disease, and hyperlipidemia. The odds of being diagnosed with TGA was lower among African Americans and Hispanics as well as among patients classified as Asian/Other, compared with Caucasians. TGA was associated with lower hospital charges (

VASCULAR DEMENTIA AND DIETARY PATTERN: A SUBPOPULATION ANALYSIS OF THE ADVENTIST HEALTH STUDY-2

14,242 versus

Age and Race Specific Trends and Mortality for Dementia Hospitalizationin the US

21,319), shorter hospital stays (mean days: 2.49 [SE=0.036] versus 4.72 [SE=0.025]), and routine hospital discharges (91.4% versus 74.5%). Patients with migraines and patients classified as Caucasian had higher odds of being diagnosed with TGA. All minority populations showed a lower rate of diagnosis that fell short of statistical significance.

IC-01-04: Default network connectivity differentiates risk for Alzheimer's disease

Background:The objective of this study is to investigate the association between dietary patterns (vegan, lacto-ovo, pesco-vegetarian, semi-vegetarian and non-vegetarian) and cognitive status among the Biopsychosocial Religion and Health Study (BRHS), a subset of the Adventist Health Study-2 (AHS-2). Methods: The cohort comprises 508 BRHS members residing in Southern California. A cross-sectional analysis was performed on all 508 subjects who completed both, the AHS-2 questionnaire focusing on nutrition and a questionnaire containing many previously validated measures of religion, lifestyle, emotional wellbeing and nutrition. Subjects reported their consumption frequency of red meat, fish, eggs, and dairy products over the past 12 months. Cognitive status was measured by the short standardized version of the California Verbal Learning Test (CVLT) was administered to all study participants in this study, which is a verbal list-learning measure designed to evaluate multiple components of memory. The CVLT performance was reported as a summary Tscore, reflecting level of immediate recall over the five successive trials of the first list, with higher scores reflecting better performance. The purpose of this analysis was to use a best-fit model to determine the relationship between dietary pattern and cognitive status. Results: The mean age of this group was 72 years old (40-106 years old), significantly more females. The majority of the participants were non-vegetarians and lactoovo vegetarian: 39% non-vegetarian, 34% lacto-ovo vegetarian, 12% pesco-vegetarian, 8% semi-vegetarian, and 7% vegan. A factor analysis and a stepwise regression were run to identify any relationships between cognition and specific dietary subtypes, controlling for gender, education, and depression. The results supported a three-factor model comprised of Recall Memory, Passive/ Discrimination Learner, and Active Learner. The results are interpreted as variance inflation factor (VIF). Our analysis indicated a high association of Lacto-ovo vegetarian dietary with Recall Memory factor and Learning Strategy factor. No significance was observed for other dietary factors. Conclusions:A lacto-ovo vegetarian dietary pattern was associated with better subscores of the CVLT, namely Recall Memory factor and Learning Strategy factor scores. Our findings should be interpreted with caution given the intrinsic limitation of a cross-sectional design. Robust longitudinal studies are needed to draw more conclusive outcomes.

Seizures and dementia in the elderly: Nationwide Inpatient Sample 1999–2008

Objective: To explore ethnoracial and gender specific mortality associated with dementia hospitalizations from 1997 to 2008, using a nationally representative database. Design: Cross-sectional. Participants: 354,949,163 from the Nationwide Inpatient Sample (NIS) database using appropriate ICD-9 and procedure codes. Measurements: Descriptive, univariate and multivariable analysis (Linear, Cox) adjusting for comorbidity, hospital factors and socio-demographics were used. Results: Mortality was higher for dementia hospitalizations for all age groups (35-64 years and ≥ 65 years) vs. non-dementia hospitalizations (2.7% vs. 1.5% and 5.5% vs. 4.5%). For individuals aged 35-64 years, dementia hospitalizations were more common among males vs. females (53.8% vs. 46.2%). Crude in-hospital mortality was higher among Whites and males for all age groups and overall mortality declined from 1999 to 2008. Adjusted relative risk of mortality was higher among men as compared to women of all age groups (RR 2.87, 95% CI 2.82-2.92) and also higher among Hispanics and African Americans as compared to Whites (African Americans: RR 2.35, 95% CI 2.21-2.51; Hispanics: RR 2.15, 95% CI 2.06-2.23). Conclusion: African Americans, Hispanics and men bear a disproportionate burden from dementia in the hospital setting. Interventions to improve care outcomes in these populations are important.