Sandra Morović

Vascular characteristics of patients with dementia

Arterial beta stiffness index is a potential risk factor for increased stroke occurrence. Vascular component appears to be significant in both Alzheimers disease (AD) and vascular dementia (VAD). We aimed to further explore vascular characteristics of patients with both types of cognitive decline using non-invasive neurosonological methods. There were 38 patients; 16 diagnosed with AD and 22 with VAD. Vascular risk factors were assessed and ultrasound measurements on common carotid artery (CCA) were performed using Aloka ProSound ALPHA 10 with 13 MHz linear probe. Among AD patients there were 5 with arterial hypertension (AH), 3 with atrial fibrillation (AF), 2 with diabetes mellitus (DM), 6 with hyper lipidemia and 1 smoker. Nineteen VAD patients had AH, 6 had AF, 12 had hyper lipidemia and one was diabetic. We found no statistically significant differences between groups regarding average body mass index (BMI), blood pressure, pulse pressure, intima-media thickness (IMT), CCA diameter or arterial beta stiffness indices. However, the trend of BMI increase, slight blood and pulse pressure decrease, CCA diameter increase and beta stiffness index increase was noted in VAD patients. Even though there was no significant difference found among two explored subgroups of patients with dementia, there was a tendency of greater systolic and diastolic diameters noted in VAD as well as greater stiffness, especially when measured in the right CCA. This indicates that VAD patients may have more prominent vascular changes that may help differentiate the type of dementia and further monitor these individuals. Further studies on a larger number of patients are needed support this evidence.

Evaluation of aging vs dementia by means of neurosonology

Aging is often associated with some cognitive impairment. Greater population life expectancy is one explanation for increased incidence of cognitive impairment cases. Large number of people with cognitive impairment and dementia is becoming one of the most important medical and social problems worldwide. Therefore, prevention of Alzheimer disease is becoming an imperative. Dementia includes a heterogeneous group of disorders, the most common being Alzheimer dementia (AD) and vascular dementia (VD). Most cardiovascular risk factors, such as hypertension, diabetes mellitus, hypercholsterolemia, atrial fibrillation, and smoking are not exclusively risk factors for VD, but also for AD. Intracranial hemodynamics of the aging brain can be assessed by Transcranial Doppler Sonography (TCD), functional TCD with various functional tests, and TCD detection of cerebral emboli. Extracranial circulation can be assessed by means of color Doppler flow imaging (CDFI). New neurosonology techniques and possibilities provide information necessary to closer determine the relation between cognitive deterioration and vascular risk factors, so that the evolution towards dementia could be prevented or at least postponed.

Breath holding index in detection of early cognitive decline

The aim of the study was to evaluate role of breath holding index (BHI) as a functional parameter for intracranial subclinical atherosclerotic changes in recognizing patients who are at risk for developing cognitive impairment of the vascular type. We included 60 volunteers divided into 3 groups according to age and presence of cognitive impairment (healthy subjects 30-40 years old, controls 60-70 years old and subjects with mild cognitive impairment 60-70 years old). We excluded individuals with moderate and severe carotid stenosis. There was a decreasing trend in the mean blood flow velocities of the intracranial blood vessels due to age increase, but it was not statistically significant. BHI values were 1.66±0.20 in the first group, 1.35±0.31 in the second and 0.69±0.30 in the third group. There was a statistically significant difference between the first two groups and the group with a mild cognitive impairment (MCI) in Montreal cognitive assessment (MoCA) score (29±1, 27±1 and 19±1 respectively), no statistically significant difference was found in Mini mental state exam (MMSE) score (29±1, 28±1, and 28±1 respectively). After regressing out age and conventional vascular risk factors, we found a good correlation between the decreasing trend in BHI values and MoCA score, and no statistically significant correlation between the BHI values and MMSE score. Results of our study show that BHI test as a parameter of impaired cerebrovascular reactivity (intracranial small vessel wall dysfunction) might differentiate individuals with early cognitive decline from healthy subjects.

Can beta stiffness index be proposed as risk factor for dementia

BACKGROUND AND AIM Changes of arterial stiffness indicate alteration in arterial mechanics predisposing to the evolution of stroke or vascular dementia. The aim of this pilot study was to investigate whether ultrasound parameters, particularly beta stiffness index (BSI), should be further explored as independent markers or risk factors for dementia. PATIENTS AND METHODS There were 38 demented patients included in this study (72.53+/-7.87 yrs) and 33 clinically healthy controls (68.85+/-3.52 yrs). Risk factors were noted and ultrasound measurements performed on common carotid artery (CCA) using eTracking software on Aloka ProSound ALPHA 10 with 13 MHz linear probe. Level of significance was p<0.05. RESULTS Arterial hypertension was present in 24 patients, atrial fibrillation in 9, diabetes in 3, and hypercholesterolemia in 18. Hypertension was present as a single risk factor in 15 controls with average diastolic blood pressure significantly lower in patients. Significantly higher in patients were mean intima-media thickness, systolic and diastolic CCA diameters (CD), and mean BSI in CCA bilaterally. Linear regression analysis for groups of Alzheimers dementia and vascular dementia proved that MMSE of the two groups relates to CCA diameter change (CDc) and BSI change explaining up to 5% of variability. CONCLUSIONS CD, CDc and BSI should be monitored in patients with cognitive decline and further explored as possible independent markers or risk factors; in future studies groups of demented and non-demented patients should be age, sex and risk factor matched.

Perception of stroke in Croatia--knowledge of stroke signs and risk factors amongst neurological outpatients.

Background and purpose:  The aim of this hospital‐based survey was to determine baseline stroke knowledge in Croatian population attending the outpatient services at the Department of Neurology.

Ultrasound subclinical markers in assessing vascular changes in cognitive decline and dementia.

Aging is often associated with some cognitive impairment. Greater population life expectancy is one explanation for increased incidence of cognitive impairment cases. Large numbers of people with cognitive impairment and dementia is becoming one of the most important medical and social problems worldwide. Therefore, prevention of cognitive impairment is an imperative. Dementia includes a heterogeneous group of disorders, the most common being Alzheimers disease and vascular dementia. Most cardiovascular risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, atrial fibrillation, and smoking, are not exclusively risk factors for vascular dementia, but also for Alzheimers disease. Early changes in the blood vessel wall can be detected by early ultrasound screening methods which allow us to detect changes before the disease becomes clinically evident. Intracranial hemodynamics can be assessed by transcranial Doppler sonography (TCD), functional TCD with various functional tests, and TCD detection of cerebral emboli. Extracranial circulation (carotid and vertebral arteries) can be assessed by means of color Doppler flow imaging. Novel ultrasound technology enables non-invasive, portable, bedside detection of early vascular changes such as arterial stiffness, measurement of the intima-media thickness, pulse-wave velocity, flow-mediated dilation, or endothelial dysfunction in order to obtain information necessary to determine more closely the relation between vascular status and disease development, so that the evolution of cardiovascular disease can be prevented or at least postponed. Early disease detection enables in-time management, and studies have shown that careful control of vascular risk factors can postpone or even reverse disease progression.

Stroke care in Central Eastern Europe: current problems and call for action

Stroke is a major medical problem and one of the leading causes of mortality and disability all over in Europe. However, there are significant East–West differences in stroke care as well as in stroke mortality and morbidity rates. Central and Eastern European countries that formerly had centralized and socialist health care systems have serious and similar problems in organizing health and stroke care 20 years after the political transition. In Central and Eastern Europe, stroke is more frequent, the mortality rate is higher, and the victims are younger than in Western Europe. High-risk patients live in worse environmental conditions, and the socioeconomic consequences of stroke further weaken the economic development of these countries. To address these issues, a round table conference was organized. The main aim of this conference was to discuss problems to be solved related to acute and chronic stroke care in Central and Eastern European countries, and also, to exchange ideas on possible solutions. In this article, the discussed problems and possible solutions will be summarized, and introduce ‘The Budapest Statement of Stroke Experts of Central and Eastern European countries’.

Neurosonology: a means of evaluating normal aging versus dementia

The aging of the population and higher life expectancy have led to an increase in the incidence of cognitive changes and dementia. It is important to differentiate between cognitive changes associated with normal aging and those associated with dementia. Dementia is a syndrome caused by a heterogeneous group of disorders, the most common being Alzheimer’s disease and vascular dementia. While cardiovascular risk factors, such as diabetes mellitus, hypertension, hypercholesterolemia, atrial fibrillation and smoking, are particularly relevant in the development of vascular dementia, they may also play a role in Alzheimer’s disease. The control of these risk factors at an early stage may help to delay the onset and reduce the severity of vasculopathy. Cognitive changes and vasculopathy are correlated with decreased mean blood flow velocities in the main arteries of the brain. Intracranial hemodynamics of the aging brain can sucessfully be assessed by a number of methods, including transcranial Doppler sonogra...

Stroke and Dementia in Atrial Fibrillation

1.1 Incidence and prevalence Atrial fibrillation (AF) and its consequences are today’s main epidemiologic concerns. Two most important population based studies, the Framingham Study and the Rotterdam Study, report a lifetime risk of developing AF as one in four people after the age of 40 years. This is opposed to breast cancer which affects one in eight women, or heart failure affecting every fifth individual. (Lloyd-Jones et al., 2004, Mattace-Raso et al., 2006) With aging population, both AF prevalence and incidence are also increasing. (Lakatta & Levy, 2003b) AF represents the most common, highly prevalent cardiac arrhythmia which is the strongest risk factor for ischemic stroke, currently affecting 4,5 to 6 million Europeans and 2,3 to 5,1 million Americans. The prevalence of AF ranges from 2,5% in individuals over 40 yrs of age, 6% in those older than 65, to 12-16% in those over 75 yrs. (Lloyd-Jones et al., 2004; Stewart et al., 2002; Wolf et al., 1991; Kannnel et al., 2008; Miyasaka et al., 2006) AF affects more than 1% of the population in total, and 70% of AF patients are aged between 65 and 85 yrs. (Phillips et al., 1990) This number is expected to double in the next 30 years. (Miyasaka et al., 2006; Savelieva & Camm, 2001; Go et al., 2008).

Carotid Artery Stiffness in Type 2 Diabetes Patients

Purpose: Prevalence of type 2 diabetes mellitus (DM) is increasing. DM is a major risk factor for cerebrovascular diseases. Assessment of arterial structure and function, by non-invasive methods, can be used in early detection of vascular complications. Besides intima-media thickness (IMT), beta stiffness index (BSI) was recently recognized as a surrogate marker of atherosclerosis. The aim of this study was to explore BSI in patients with type 2 DM. Material & Methods: Patients with type 2 DM were examined in our Stroke prevention centre by means of ultrasound with a high-resolution echo-tracking system, on Aloka Prosound alpha 7 system equipped with 8MHz probe. IMT of common carotid artery was measured by highresolution B- mode ultrasound imaging. Results: Altogether 32 DM patients (16 female) were examined (mean age 65, 9₠i, 68, 7 years). Most of patients (26) were hypertensive (142₠i, 621 over 86₠i, 69 mmHg) and had increased BMI (31, 1₠i, 64, 8 kg/m2). Average IMT was 0, 72₠i, 60, 15 (right CCA) and 0, 76₠i, 60, 15 (left CCA). Average BSI was 11, 6₠i, 65, 5 (right CCA) and 11, 8₠i, 63, 8 (left CCA). IMT was significantly correlated with waist circumference and age, while BSI correlated with systolic blood pressure, waist circumference and heart beat rate. Conclusion: Increased carotid IMT and BSI in type 2 DM patients were registered. Further studies are needed to assess the impact of these parameters on stroke risk and outcome.