Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Wednesday, August 3, 2016

Intensive CV Risk Management Doesn't Prevent Dementia

Well then your doctor will need to come up with something else.
Intense management of blood pressure, cholesterol, and other vascular risk factors had no significant impact on dementia, the open-label, cluster-randomized controlled PreDIVA trial showed.
The dementia incidence over about 6 years came out similar for patients who received intensive management and those on usual care (6.5% and 7%), Edo Richard, MD, of Radboud University Medical Center in The Netherlands, and colleagues, reported at the Alzheimer's Association International Conference and simultaneously online in The Lancet.
"The contrast between our groups was relatively small, probably because the level of healthcare in The Netherlands is very good already, so it's difficult to improve on an already high level of healthcare," Richard said during an oral presentation at the meeting in Toronto. "Potentially this intervention is more effective in countries with less developed healthcare systems(Like the US) or in middle-income countries."
Cardiovascular risk factors are associated with an increased risk of dementia, so Richard and colleagues decided to test whether an intensive intervention targeting several of these risk factors can prevent dementia in a general primary care population.
Overall, a total of 3,526 patients ages 70 to 78 at 26 healthcare practices were randomized to either a nurse-led, multidomain cardiovascular intervention or to usual care. The intervention targeted blood pressure, smoking, exercise, overweight, cholesterol, and glucose levels.
Patients were followed for a median of 6.7 years, and the primary outcome was the development of dementia. Secondary outcomes included stroke, MI, cognitive decline, dementia subtype, and mortality.
Richard said that many patients did end up dropping the intervention, but since this was a pragmatic trial, his team made every effort to follow up on all cases, and ultimately had outcomes for 98% of the population.
"The importance of a pragmatic outcome in a pragmatic trial in older people is that it hugely facilitates the interpretation of the results," Richard said.
Overall, they saw no difference in the primary endpoint, with 7% of those in the standard care developing dementia compared with 6.5% of those in the intensive vascular intervention group (hazard ratio 0.92, 95% CI 0.71 to 1.19).
They did see a mean 2 mm Hg reduction in blood pressure for those in the intervention, which is "very modest, but on a population level this could be relevant," Richard said, adding that those with the highest blood pressure at baseline garnered the most benefit.
There was no treatment effect on any of the other vascular risk factors.
In sensitivity analyses, there was a trend toward a benefit for the intervention in the per-protocol analysis, but it was of borderline significance (HR 0.78, 95% CI 0.58 to 1.04).
For the secondary outcome of dementia subtype, they saw a reduction in the risk of non-Alzheimer's dementia (HR 0.37, 95% CI 0.18 to 0.76) but this was based on a small number of cases, Richard warned.
There was also a trend toward a benefit of the intervention for those with untreated hypertension, and when they looked specifically at untreated patients who remained adherent, there was a significant reduction in dementia risk (HR 0.54, 95% CI 0.32 to 0.92) -- but again Richard noted that this was based on a small number of cases.
He concluded that their work shows that intensive vascular care in older patients "is safe. People were afraid it would be dangerous but we did not see any excess mortality or any excess hospitalizations in the intervention group compared with the control group."
"There was no significant effect on all-cause dementia, but we did see some interesting signals in the direction of a potential effect in adherent patients and in those with untreated hypertension, which could be used to guide development of future trials to prevent dementia," he said. "And it suggests an effect on non-Alzheimer's dementia, but we must interpret this with care."
Maria Carrillo, PhD, chief science officer of the Alzheimer's Association, said that despite the fact the study was negative on its primary outcome, its additional findings "suggest once again the benefits – for the head and the heart – of assessing, treating and managing heart health risk factors as we age."
The study was supported by the Dutch Ministry of Health.

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