Advanced MRI Brain Scan May Help Predict Stroke-related Dementia

An advanced Magnetic Resonance Imaging (MRI) brain scan analysis in patients with stroke-related, small vessel disease helped predict problems with thinking, memory and even dementia, according to new research published in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

When a stroke or other disease damages tiny blood vessels in the brain, the condition is known as small vessel disease. This condition is the most common cause of thinking problems (planning, organizing information and processing speed) and can even lead to dementia. Although early treatment could help patients at risk, no effective test is available to identify them.

This study evaluated the accuracy of a new MRI analysis technique using diffusion tensor imaging (DTI), in predicting thinking problems and dementia related to small vessel disease. A single scan measured the brain in fine detail to reveal damaged areas. By comparing these images to a healthy person’s, researchers were able to classify the brain into areas of healthy versus damaged tissue.

Results showed that participants with the most brain damage were much more likely to develop thinking problems. The analysis also helped predict three-fourths of the dementia cases that occurred during the study.

“We have developed a useful tool for monitoring patients at risk of developing dementia and could target those who need early treatment,” said senior author Rebecca A. Charlton, Ph.D., department of psychology at Goldsmiths, University of London, in the United Kingdom.

The study included 99 patients with small vessel disease caused by ischemic stroke, a type of stroke that blocks the blood vessels deep within the brain. Slightly more than one-third were female, average age 68, and most were Caucasian. All participants were enrolled in the St George’s Cognition and Neuroimaging in Stroke (SCANS) study from 2007 to 2015 in London.

Participants received the MRI scans annually for three years and thinking tests annually for five years. Eighteen participants developed dementia during the study, with an average time to onset of approximately three years and four months.

This advanced MRI analysis offers a highly accurate and sensitive marker of small vessel disease severity in a single measure that can be used to detect who will and will not go on the develop dementia in a five-year period, noted Charlton.

The healthy brain scans used for comparison were from one individual and may not represent the true range of all healthy brains. In addition, the study’s relatively small number of participants all had small vessel disease resulting from one type of stroke, so the results may not apply to people with different forms of the disease.

Source: American Heart Association

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Going Vegetarian Good for Your Heart, But May Up Stroke Risk

Steven Reinberg wrote . . . . . . . . .

Vegetarianism is all the rage these days, but a new study suggests that slicing meat from your diet might raise your risk of stroke slightly.

While vegetarians had a 22% lower risk for heart disease, they had a 20% higher risk for stroke, British researchers found. Meanwhile, people who ate fish but no other meats (pescatarians) had a 13% lower risk of heart disease, with no increased stroke risk.

“The lower risk of heart disease is likely at least partly due to lower weight, lower blood pressure, lower blood cholesterol and lower rates of diabetes linked to pescatarian or vegetarian diets,” said lead researcher Tammy Tong, a nutritional epidemiologist in the Nuffield Department of Population Health at the University of Oxford.

Tong cautioned that this study can’t prove that not eating meat reduces the risk for heart disease or increases the risk for stroke, only that there seems to be a connection.

And the absolute reduction in the risk for heart disease and increased risk for stroke is modest, she said.

“When translated into absolute numbers, this was equivalent to 10 fewer cases of heart disease in the vegetarians than the meat eaters in every 1,000 people eating these diets over 10 years,” Tong said.

As for stroke, three more strokes would be seen among vegetarians compared with meat eaters over the same time, she said.

Why?

Recent evidence suggests that very low cholesterol levels might be linked to a higher risk of hemorrhagic stroke, Tong noted. Vegetarians and vegans might also have low levels of some nutrients, such as vitamin B12, which is only naturally available from animal foods, she added.

“Some research has suggested there may be a link between B12 deficiency and higher stroke risk, but the evidence is not conclusive,” Tong said.

Tong also said that only heart disease and stroke were studied, but other chronic conditions need to be looked at to show the total benefit of a vegetarian diet.

The report was published in the BMJ journal.

Mark Lawrence, a professor of public health nutrition at Deakin University in Melbourne, Australia, said that dietary guidelines have the best advice for vegetarians as well as for fish and meat eaters.

That’s because they consider dietary associations with multiple health outcomes — not just heart disease and stroke, said Lawrence, who co-authored an accompanying journal editorial.

“Shifting towards a plant-based diet can have personal and planetary health benefits, though it does not necessarily mean becoming a vegetarian,” he said.

For the study, Tong and her colleagues collected data on more than 48,000 men and women, average age 45, with no history of stroke or heart disease.

Among the participants were more than 24,000 meat eaters, about 7,500 pescatarians and more than 16,000 vegetarians and vegans.

During the 18 years of the study, nearly 3,000 people developed heart disease and more than 1,000 suffered a stroke. About 500 of the strokes were caused by blood clots in the brain (ischemic stroke) and 300 resulted from bleeding in the brain (hemorrhagic stroke).

The researchers accounted for factors such as medical history, smoking, use of dietary supplements, and physical activity, which can affect the risk for heart disease and stroke.

One U.S. dietitian noted that there are benefits to vegetarian diets — as long as you include vitamins that may be lacking.

“Vegans and strict vegetarians need to be mindful of obtaining certain nutrients, such as vitamin B12, vitamin D and omega-3 fatty acids from their diet and supplements,” said Samantha Heller, a senior clinical nutritionist at NYU Langone Medical Center in New York City.

Not getting enough of these nutrients may increase the risk of certain health problems, she said.

“That said, a more plant-based approach to eating helps reduce the risk of diseases such as cardiovascular disease, certain cancers and type 2 diabetes,” Heller said.

“You can’t go wrong cutting back on red and processed meats such as beef, pork and ham and adding lentils, chickpeas, tofu, broccoli, spinach or cauliflower to your meals,” Heller advised.

Source: HealthDay


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Rising Blood Pressure Puts Women At Greater Stroke Risk Than Men

As the severity of high blood pressure rises, the risk of stroke rises almost twice as quickly in women compared with men, according to a new study.

Published Tuesday in the journal Hypertension, the research raises the question of whether sex-specific guidelines may be needed for controlling high blood pressure.

High blood pressure is the most common modifiable risk factor for stroke, which is the third leading cause of death for women and the fifth leading cause for men.

For people under 60, high blood pressure is less prevalent in women than men, study authors said. But it becomes more prevalent in older women, who are less likely to keep their blood pressure under control as they age.

“Our findings basically suggest that the risk of stroke may increase with each level of hypertension, more so in women than men,” said Dr. Tracy Madsen, the study’s lead author. She is an assistant professor of emergency medicine at Alpert Medical School of Brown University in Providence, Rhode Island.

Madsen’s team looked at sex and racial differences in the level of hypertension severity and stroke risk in 26,461 men and women in the United States. More than half of participants were women, 40% were black, and the average age of men was 66, while for women it was 64.

The study included an oversampling of people living in the southeastern states of the so-called “stroke belt,” which includes Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee. People in the region have a 34% higher risk of stroke than their counterparts elsewhere in the country.

Researchers found that for every 10 mmHg increase in blood pressure, the risk of stroke widened between white women and men, and the risk of stroke across increasing levels of blood pressure was about twice as high in women than men. These sex differences did not hold true, however, among black men and women, even though this group experienced more severe hypertension than whites.

The dramatic contrast in stroke risk between men and women suggests a need for closer examination of how hypertension behaves in each group, Madsen said. Women have too often been underrepresented in clinical trials, despite their higher prevalence for stroke and stroke-related mortality.

“We need to see if this (gap) holds true in a prospective, randomized clinical trial and whether it would be helpful to have tighter blood pressure control for women,” she said.

Not everyone agrees these findings point to a potential need for sex-specific guidelines for treating hypertension.

That issue was evaluated when the American Heart Association and the American College of Cardiology developed new guidelines for controlling blood pressure in 2017, said Dr. Paul Whelton, who chaired the guideline writing committee. People are considered to have high blood pressure if their systolic, or top number, is 130 or higher or their diastolic, the bottom number, is 80 or higher.

“For treatment, there hasn’t been any convincing demonstration that there’s much of a difference between men and women,” said Whelton, a professor at Tulane University in New Orleans and the Show Chwan Health System Endowed Chair in Global Public Health.

He said the new study’s findings surprised him, but more research is needed before making any conclusions.

“The differences in this study are fairly substantial,” he said. “It raises a red flag, but for me, at least, I don’t think it has convincingly demonstrated an answer one way or another.”

Madsen’s team also looked at how the number of hypertensive medications a person was taking impacted their risk for stroke.

They found the more medications it took to maintain good blood pressure control, the higher that person’s stroke risk. That risk increased 23% for each additional class of medication. This held equally true for both men and women.

“This does not suggest that the medications themselves increase the risk of stroke,” Madsen said. “But someone who takes three medications to maintain a systolic blood pressure level of 140 mmHg has a higher stroke risk than someone who needs only one medication to reach that same level. It’s because their blood pressure is more difficult to control or resistant to treatment.”

Madsen said the study points to the need to gather more sex-specific data in future investigations.

“There are hidden sex differences in many disease processes that we really don’t even know about,” she said. “We may not have enough data to say that tomorrow we need to implement sex-specific guidelines for how we treat hypertension, but we also don’t have the data to say that our one-size-fits-all approach to stroke prevention is the right one.”

Source: HealthDay


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Stroke Survivors Need to Pay Attention to Bone Health

People who have had a stroke, and the doctors who treat them, have a lot to be concerned about: regaining mobility and function, controlling risk factors for a second stroke, guarding against depression that can result from a newly limited life.

There’s another potential consequence not on everyone’s list: osteoporosis.

“We don’t know as much about osteoporosis and stroke as we should,” said Dr. Mark Goldberg, a neurologist at the Peter O’Donnell Brain Institute in Dallas and professor at the UT Southwestern School of Medicine. “As stroke doctors, this is something we should be paying more attention to.”

Osteoporosis is a progressive disease, more often in women, in which bones become porous and fragile, increasing the risk of fractures. A stroke occurs when blood supply to part of the brain is blocked by a clot or a rupture, killing brain cells and impairing body function, even causing paralysis on one side of the body.

The two maladies are intertwined, and not in a good way. Studies indicate stroke survivors who lose some of their balance and mobility are more likely to fall, and those with osteoporosis have a greater danger of breaking bones.

A Canadian study, for example, concluded stroke patients were 47% more likely than people without a history of stroke to suffer a fracture, a particularly perilous consequence for older people.

“Even if it’s just a small fall, they’re just much more likely to break their hip or shoulder,” Goldberg said. “This is a significant cause of disability.”

Becoming sedentary can make osteoporosis worse. Physical activity is a key factor in maintaining healthy bones, Goldberg said, “and by not moving around, people are likely to lose bone mass. So, after a stroke you’re (more likely to develop) osteoporosis.”

Despite that, other post-stroke problems seem to take priority.

“When people come for follow-up, they’re asked about blood pressure or heart issues,” said Dr. Angela Cheung, an internal medicine specialist and founding director of University Health Network Osteoporosis Program in Toronto. “Bone health is really on the bottom of the list.”

Cheung co-authored a study of more than 16,000 stroke survivors in Canada over 65, examining whether they were screened or treated for osteoporosis in the first year after the stroke.

The results, published earlier this year in the journal Stroke, showed only 5.1% had bone mineral density testing. About 15% were prescribed medication for osteoporosis.

Cheung said the study highlights the need for making osteoporosis assessment standard after a stroke.

“At the least we need to ask, have you fallen, and have you had a fracture, and then incorporate this in our follow-up care,” she said. “This needs to be on everyone’s radar.”

Goldberg agreed. “People who have had a stroke have a lot of problems that need attention,” he said. “All of a sudden you’re in a different world, and patients and their families are often overwhelmed.”

According to research, about one in five people who have a stroke will have another one within five years.

Neurologists, Goldberg said, tend to be focused on preventing a second stroke by controlling such risk factors as high blood pressure, diabetes, high cholesterol and an irregular heartbeat.

“This may be part of the reason that the osteoporosis facet of care hasn’t received enough attention,” he said. “But there are good ways to screen for it, and treatments for people at risk.”

Stroke and osteoporosis have another thing in common: an excellent reason to avoid cigarettes.

“Smoking is a risk factor for osteoporosis and for stroke,” he said. “So that’s a double whammy.”

Source: HealthDay

Blood Pressure Control Is Key to Avoid a Second Stroke

Serena Gordon wrote . . . . . . . . .

If you’ve already had one stroke, your risk for another is much higher. But new research found that well-controlled blood pressure can reduce that risk by about 20%.

The study authors suggested maintaining a blood pressure of 130/80 mm Hg or less.

“Intensive blood pressure control of at least less than 130/80 mm Hg is recommended for secondary stroke prevention,” said Dr. Kazuo Kitagawa, the study’s lead author. Kitagawa is a professor and chair of neurology at Tokyo Women’s Medical University in Japan.

While 120/80 mm Hg or lower might be an even better target, Kitagawa noted that only about one-third of people in the current study were able to achieve a level that low, despite being on an average of almost three blood pressure-lowering drugs.

He said that patients often worry that their blood pressure might drop too low, and there are side effects that can be associated with aggressive blood pressure reduction.

The new research was published online July 29 in JAMA Neurology.

The author of an editorial accompanying the study, Dr. Craig Anderson, said lowering blood pressure “is relatively straight forward.” But to effectively control blood pressure, doctors often need to prescribe multiple medications, though not all doctors will do so, he said. Anderson is a professor of neurology at the University of New South Wales in Sydney, Australia.

“Perhaps doctors have a tendency to be conservative in their use of antihypertensive medications, particularly in older, frailer people, because of the genuine concern about causing side effects, such as a fall from dizziness leading to a hip fracture,” he noted.

Anderson said the most common side effects of blood pressure-lowering drugs are mild, such as dizziness, ankle swelling and fatigue. These can often be avoided by modifying the drug dosage, he said. More serious, though less common, side effects include falls, fainting and impaired kidney function. Anderson said these side effects can usually be avoided with careful monitoring of a patient.

But as this study illustrates, there are also benefits with blood pressure-lowering drugs. Anderson said while doctors don’t know exactly how lower blood pressure reduces the risk of stroke, “presumably, it reduces stress on the walls of blood vessels, which lessens the chance of thickening and blockage and rupturing of them.”

Both Kitagawa and Anderson said lifestyle changes — maintaining a healthy weight, eating healthy foods, exercising regularly, reducing stress and reducing salt intake — also play an important role in reducing the risk of a second stroke.

The current study included nearly 1,300 stroke survivors. The study volunteers were recruited from 140 hospitals in Japan. They were enrolled between 2010 and 2016.

The participants were randomly assigned to one of two groups: standard control of pressure to 140/90, or an intensive control group that aimed for 120/80 or lower.

The study was stopped early due to slow enrollment and funding issues.

The baseline blood pressure for both groups was 145/84 mm Hg. During the shortened follow-up period, the standard group’s blood pressure dropped to 133/78 and the intensive group’s was reduced to 127/77.

Ninety-one people had a second stroke. The intensive group appeared to have a lower risk of an additional stroke, but the findings weren’t statistically significant, the study authors said.

However, the researchers pooled their findings with the results of three previous studies on blood pressure reduction and secondary stroke prevention, and found a drop in risk of 22% for intensive control.

“This research reinforces the importance of good blood pressure control in people who have survived a stroke,” Anderson said.

He added that it’s important that people remember to take their blood pressure medications as prescribed. Anderson said many people forget to take them regularly, so he suggested using mobile apps on your phone if you need help remembering to take your medications.

Source: HealthDay