Statins may reduce CV events in older patients with stroke

But shouldn't your doctor already been prescribing statins for better recovery since 2003? In my opinion I would say your doctor is incompetent if statins are not immediately prescribed. But I'm not medically trained so just ask your doctor to justify that lack of prescription. My doctor obviously did not extrapolate rat testing to humans and thus did nothing with statins for me in 2006.

1. Statins.

tested in rats from 2003

http://Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke  

Simvastatin Attenuates Stroke-induced Splenic Atrophy and Lung Susceptibility to Spontaneous Bacterial Infection in Mice

Or,

Simvastatin attenuates axonal injury after experimental traumatic brain injury and promotes neurite outgrowth of primary cortical neurons 

October 2012

tested in humans, March, 2011

http://www.medwirenews.com/39/91658/Stroke/Acute_statin_therapy_improves_survival_after_ischemic_stroke.html

And now lost even to the Wayback Machine

So I think this below is the actual research;

Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke April 2011

The latest here:

Statins may reduce CV events in older patients with stroke

Older patients with ischemic stroke who took statins for 2 years after discharge experienced fewer CV events after hospital discharge compared with those who took them for less than 2 years or not at all, researchers reported in Stroke.

Although statins are frequently initiated in patients aged 80 years and older after an ischemic stroke, evidence of their efficacy in CVD prevention for this population is sparse, so a new analysis was needed, the researchers wrote.

Source: Adobe Stock

Geert J. Lefeber, MD, from the department of geriatrics, University Medical Center Utrecht, and the division of pharmacoepidemiology and clinical pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands, and colleagues conducted a retrospective cohort study of 5,910 patients aged 65 years and older hospitalized for a first ischemic stroke from 1999 to 2016 who did not have statin prescriptions in the year before hospitalization.

The primary outcome was a composite of recurrent stroke, MI and CV mortality at 2 years. The primary analysis was for patients aged 80 years or older, but the researchers also analyzed patients aged 65 to 80 years to compare their results with current evidence on statin efficacy.

Among the 3,157 patients aged 80 years and older, compared with those who had a statin prescription of less than 2 years or none at all, those who had a statin prescription for 2 years had lower risk for the primary endpoint (adjusted HR = 0.8; 95% CI, 0.62-1.02) and all-cause mortality (aHR = 0.67; 95% CI, 0.57-0.8).

After correction for the mortality of 23.9% of the patients during the first 2 years, the number needed to treat to prevent one event was 64 for the primary outcome and 19 for all-cause mortality during a median follow-up of 3.9 years.

“To be able to decide whether benefits outweigh harm and which is the most appropriate dose and type of statin, more research is deemed necessary in the oldest old,” Lefeber and colleagues wrote.

 

Predicting neuroimaging eligibility for extended-window endovascular thrombectomy

 So did that salvageable penumbra get 100% salvaged? If you didn't measure that, you aren't doing your research correctly.

Predicting neuroimaging eligibility for extended-window endovascular thrombectomy

Adam de Havenon MD ¹ , Kole Mickolio MS ¹ , Steven O’Donnell MD ² , Greg Stoddard MS ³ , J. Scott McNally MD, PhD ⁴ , Matthew Alexander MD ⁴ , Philipp Taussky MD ⁵ , and Al-Wala Awad MD ⁵

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DOI link:

https://doi.org/10.3171/2020.8.JNS20386

Online Publication Date:

26 Feb 2021

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• ABSTRACT

OBJECTIVE

Endovascular thrombectomy (EVT) and tissue plasminogen activator (tPA) are effective ischemic stroke treatments in the initial treatment window. In the extended treatment window, these treatments may offer benefit, but CT and MR perfusion may be necessary to determine patient eligibility. Many hospitals do not have access to advanced imaging tools or EVT capability, and further patient care would require transfer to a facility with these capabilities. To assist transfer decisions, the authors developed risk indices that could identify patients eligible for extended-window EVT or tPA.

METHODS

The authors retrospectively identified stroke patients who had concurrent CTA and perfusion and evaluated three potential outcomes that would suggest a benefit from patient transfer. The first outcome was large-vessel occlusion (LVO) and target mismatch (TM) in patients 5–23 hours from last known normal (LKN). The second outcome was TM in patients 5–15 hours from LKN with known LVO. The third outcome was TM in patients 4.5–12 hours from LKN. The authors created multivariable models using backward stepping with an α-error criterion of 0.05 and assessed them using C statistics.

RESULTS

The final predictors included the National Institutes of Health Stroke Scale (NIHSS), the Alberta Stroke Program Early CT Score (ASPECTS), and age. The prediction of the first outcome had a C statistic of 0.71 (n = 145), the second outcome had a C statistic of 0.85 (n = 56), and the third outcome had a C statistic of 0.86 (n = 54). With 1 point given for each predictor at different cutoffs, a score of 3 points had probabilities of true positive of 80%, 90%, and 94% for the first, second, and third outcomes, respectively.

CONCLUSIONS

Despite the limited sample size, compared with perfusion-based examinations, the clinical variables identified in this study accurately predicted which stroke patients would have salvageable penumbra (C statistic 71%–86%) in a range of clinical scenarios and treatment cutoffs. This prediction improved (C statistic 85%–86%) when utilized in patients with confirmed LVO or a less stringent tissue mismatch (TM < 1.2) cutoff. Larger patient registries should be used to validate and improve the predictive ability of these models.

 

Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

So rather than focus on getting survivors recovered, the focus was on cost. Solve the recovery problem first and then we can discuss cost. Survivors want solutions. GET THERE!

Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

 

This article was originally published here

BMJ Open. 2021 Feb 25;11(2):e039201. doi: 10.1136/bmjopen-2020-039201.

ABSTRACT

OBJECTIVE: To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual.

DESIGN: Economic evaluation within a comparative effectiveness research design.

SETTING: Primary care (2016-2017) and community settings (2011-2013) in the Netherlands.

PARTICIPANTS: Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation.

INTERVENTIONS: Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke.

PRIMARY AND SECONDARY OUTCOME MEASURES: Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale.

RESULTS: Health outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI -€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level.

CONCLUSIONS: Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

PMID:33632749 | DOI:10.1136/bmjopen-2020-039201

Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial

 This needs to be taken to that stroke leader so that followup research can be done that will result in EXACT STROKE PROTOCOLS. But whom am I kidding, nothing will be done; We have NO LEADERSHIP AND NO STROKE STRATEGY.

Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial

• Prof Mikael Mazighi, MD
• Prof Sebastien Richard, MD
• Bertrand Lapergue, MD
• Prof Igor Sibon, MD
• Prof Benjamin Gory, MD
• Jerome Berge, MD
• et al.
• Show all authors

Published:February 26, 2021DOI:https://doi.org/10.1016/S1474-4422(20)30483-X

Summary

Background

High systolic blood pressure after successful endovascular therapy for acute ischaemic stroke is associated with increased risk of intraparenchymal haemorrhage. However, no randomised controlled trials are available to guide optimal management. We therefore aimed to assess whether an intensive systolic blood pressure target resulted in reduced rates of intraparenchymal haemorrhage compared with a standard systolic blood pressure target.

Methods

We did a multicentre, open-label, randomised controlled trial at four academic hospital centres in France. Eligible individuals were adults (aged ≥18 years) with an acute ischaemic stroke due to a large-vessel occlusion that was successfully treated with endovascular therapy. Patients were randomly assigned (1:1) to either an intensive systolic blood pressure target group (100–129 mm Hg) or a standard care systolic blood pressure target group (130–185 mm Hg), by means of a central web-based procedure, stratified by centre and intravenous thrombolysis use before endovascular therapy. In both groups, the target systolic blood pressure had to be achieved within 1 h after randomisation and maintained for 24 h with intravenous blood pressure lowering treatments. The primary outcome was the rate of radiographic intraparenchymal haemorrhage at 24–36 h and the primary safety outcome was the occurrence of hypotension. Analyses were done on an intention-to-treat basis. BP-TARGET is registered with ClinicalTrials.gov, number NCT03160677, and the trial is closed at all participating sites.

Findings

Between June 21, 2017, and Sept 27, 2019, 324 patients were enrolled in the four participating stroke centres: 162 patients were randomly assigned to the intensive target group and 162 to the standard target group. Four (2%) of 162 patients were excluded from the intensive target group and two (1%) of 162 from the standard target group for withdrawal of consent or legal reasons. The mean systolic blood pressure during the first 24 h after reperfusion was 128 mm Hg (SD 11) in the intensive target group and 138 mm Hg (17) in the standard target group. The primary outcome was observed in 65 (42%) of 154 patients in the intensive target group and 68 (43%) of 157 in the standard target group on brain CT within 24–36 h after reperfusion] (adjusted odds ratio 0·96, 95% CI 0·60–1·51; p=0·84). Hypotensive events were not significantly different between both groups and occurred in 12 (8%) of 158 patients in the intensive target and five (3%) of 160 in the standard target group. Mortality within the first week after randomisation occurred in 11 (7%) of 158 patients in the intensive target group and in seven (4%) of 160 in the standard target group.

Interpretation

An intensive systolic blood pressure target of 100–129 mm Hg after successful endovascular therapy did not reduce radiographic intraparenchymal haemorrhage rates at 24–36 h as compared with a standard care systolic blood pressure target of 130–185 mm Hg. Notably, these results are applicable to patients with successful reperfusion and systolic blood pressures of more than 130 mm Hg at the end of procedure. Further studies are needed to understand the association between blood pressure and outcomes after reperfusion.

Funding

French Health Ministry.

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A Robot-based Gait Training System for Post-Stroke Rehabilitation

 Since this is just a design approach it would require followup with stroke leadership and strategy. That doesn't exist, so this research was totally useless.

A Robot-based Gait Training System for Post-Stroke Rehabilitation

 Sharon Banh 1, 

Emily Zheng 2, 

Alyssa Kubota 1, 

Laurel D. Riek 1
1 Computer Science and Engineering, University of California San Diego
2 Computing and Mathematical Sciences, California Institute of Technology

ABSTRACT

As the prevalence of stroke survivors increases, the demand for
rehabilitative services will rise. While there has been considerable
development in robotics to address this need, few systems consider
individual differences in ability, interests, and learning. Robots need
to provide personalized interactions and feedback to increase engagement, enhance human motor learning, and ultimately, improve
treatment outcomes. In this paper, we present 1) our design process
of an embodied, interactive robotic system for post-stroke rehabilitation, 2) design considerations for stroke rehabilitation technology
and 3) a prototype to explore how feedback mechanisms and modalities affect human motor learning. The objective of our work is to
improve motor rehabilitation outcomes and supplement healthcare
providers by reducing the physical and cognitive demands of administering rehabilitation. We hope our work inspires development
of human-centered robots to enhance recovery and improve quality
of life for stroke survivors.
ACM Reference Format:
Sharon Banh1
, Emily Zheng2
, Alyssa Kubota1
, Laurel D. Riek1
. 2021. A
Robot-based Gait Training System for Post-Stroke Rehabilitation. In Companion of the 2021 ACM/IEEE International Conference on Human-Robot
Interaction (HRI ’21 Companion), March 8–11, 2021, Boulder, CO, USA. ACM,
New York, NY, USA, 5 pages. https://doi.org/10.1145/3434074.3447212

Decision-Making on Referral to Primary Care Physiotherapy After Inpatient Stroke Rehabilitation

 So your stroke medical team has NO PROTOCOL to follow and thus is totally shooting in the dark about how to get you 100% recovered. YOU  have to change that trajectory, your stroke medical team has ignored that responsibility since their very first patient did not get 100% recovered. Their tyranny of low expectations is complete, that way they don't have to solve the very hard problem of 100% recovery.

Decision-Making on Referral to Primary Care Physiotherapy After Inpatient Stroke Rehabilitation

Author links open overlay panelMariekeGeerarsMSc, PT*†‡§

RoderickWondergemPhD, PT†‡¶¹Martijn F.PistersPhD, PT†‡¶²

https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105667Get rights and content

Under a Creative Commons license

open access

Highlights

•

Referral depends on personal and home environmental factors of the patient.

•

Referral frequency and policy vary between care settings and physiotherapists.

•

Movement behavior is considered important, but the approach is currently unknown.

•

There is no consensus if secondary prevention is a physiotherapists’ primary task.

Abstract

Objective

This study aimed to acquire insight into the decision-making processes of healthcare professionals concerning referral to primary care physiotherapy at the time of discharge from inpatient stroke rehabilitation.

Design

A generic qualitative study using an inductive thematic analysis was performed. Semi-structured interviews were conducted following an interview guide.

Setting

Secondary care centers in the Netherlands: neurology departments of nine hospitals and (geriatric) rehabilitation centers.

Participants

Nineteen healthcare professionals (physiotherapists, specialist in geriatric medicine, physiatrist, physician assistant) participated in the study. All were involved in the decision for referral to primary care physiotherapy.

Results

During the inpatient period, healthcare professionals gather information to form a complete picture of the stroke survivor as a basis for decision-making. The decision on referral is influenced by personal factors and home environment of the stroke survivor, organizational factors within the care setting, and the intuition and feeling of social responsibility of the individual healthcare professional.

Conclusions

After inpatient rehabilitation, many elements are considered that may influence referral to primary care physiotherapy. Presently, there is no consensus concerning referrals. The final decision depends on the individual physiotherapist and care setting. Healthcare professionals mentioned the importance of movement behavior, although there is no consensus if secondary prevention is a primary task of the physiotherapist. More research is needed to identify risk factors for functional decline in order to develop a referral policy that addresses primary care physiotherapy to the right group of stroke survivors.

• 
  

Key Words

Stroke/Rehabilitation

Decision-making

Physiotherapy

Primary health care

Patient discharge

Introduction

Worldwide, stroke is a leading cause of death and disability.¹ Although incidence rates are expected to increase over the next few decades, survival rates are expected to improve. Consequently, more stroke survivors will have to learn to live with the consequences(See the tyranny of low expectations in full display, only YOU can change that.). After acute stroke care or rehabilitation, returning home(Really? Have you asked them? I bet without  your bias in your questions it would be 100% recovery.) is one of the primary goals for stroke survivors.² In the Netherlands, 65 % of stroke survivors return home immediately after acute hospital care.³ The remaining 35% continue inpatient rehabilitation in a rehabilitation center (RC) or geriatric rehabilitation center (GRC) before returning home. Only 75% of this group returns home.⁴

One of the key disciplines involved in rehabilitation after a stroke is physiotherapy. Physiotherapy has been found to be beneficial to restoring and maintaining gait and mobility-related functions as well as improving activities of daily living (ADL).⁵ This is essential for social reintegration.⁶ Additionally, physiotherapy is beneficial in restoring motor functions and physical fitness⁷ and contributes to secondary disease prevention.⁸

Physiotherapy starts within the first few days post-stroke in acute care⁹ in the hospital and, if necessary, continues in a (geriatric) rehabilitation center or primary care. When patients are discharged from the hospital or rehabilitation setting, physiotherapy in primary care is taken into consideration to continue rehabilitation or to prevent functional decline. It is unclear on what basis referral to primary care takes place. In practice, some patients are referred, and others are not. Unfortunately, stroke survivors often feel abandoned from facility based care after discharge and have difficulties to re-engage in society.¹⁰

The stroke guidelines only give general instructions concerning stroke survivor and informal caregiver needs.11, 12, 13, 14 The recommendations on stopping or continuing physiotherapy are mainly based on consensus opinion and lack current evidence.

This entails the risk that people post-stroke are unnecessarily referred, or wrongly not referred. The Dutch Physiotherapy Guideline¹⁵ leaves the decision to stop or continue treatment in the hands of the physiotherapist. Within the population post-stroke, a considerable variation exists in the risk for decline in ADL on the long term.¹⁶ Factors that are associated with ADL decline are: ADL dependency, impaired motor function of the leg, insurance status, living alone, age ≥ 80, inactive state, impaired cognitive function, depression and fatigue. It is unclear if these and which other factors play a role in the decision to refer, and who takes the decision. The healthcare professionals that are involved in the decision-making, i.e. physiotherapists, physicians, and physician assistants, might have different considerations, intentions, and goals regarding patient referrals.

Currently, collaboration in networks between hospital, rehabilitation care and primary care needs improvement to support patient-centered care. One of the key elements to optimize this collaboration is communication.¹⁷ In literature and in practice, there is no consensus on the organization and content of primary care in the chronic phase. Greater insight into the decision-making process could help healthcare professionals to make more-educated decisions with the aim to address primary care therapy to the right group of patients. Armed with this knowledge, the future of the physiotherapy care provided to stroke survivors returning home could be optimized. This contributes to more sustainable outcomes for people with stroke and possibly to a reduction of secondary complaints. Therefore, this study aimed to explore healthcare professionals' decision-making processes in hospitals and (geriatric) rehabilitation centers in referring patients to primary care physiotherapy at the time of discharge.

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Paucity of Entorhinal Cortex Pathology of the Alzheimer’s Type in SuperAgers with Superior Memory Performance

This is so blasted simple. Contact the stroke leader who will update the stroke strategy with this request to solve for fewer entorhinal NFTs. Then you just get researchers to SOLVE THIS EXACT PROBLEM. Solve for preventing these entorhinal NFTs. You can't let researchers choose their own research, stroke will never be solved that way. We need a strategy and leaders to run that strategy to completion.

Paucity of Entorhinal Cortex Pathology of the Alzheimer’s Type in SuperAgers with Superior Memory Performance

Tamar Gefen, Allegra Kawles, Beth Makowski-Woidan, Janessa Engelmeyer, Ivan Ayala, Payam Abbassian, Hui Zhang, Sandra Weintraub, Margaret E Flanagan, Qinwen Mao ... Show more

Cerebral Cortex, bhaa409, https://doi.org/10.1093/cercor/bhaa409

Published:

17 February 2021

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Abstract

Advancing age is typically associated with declining memory capacity and increased risk of Alzheimer’s disease (AD). Markers of AD such as amyloid plaques (AP) and neurofibrillary tangles (NFTs) are commonly found in the brains of cognitively average elderly but in more limited distribution than in those at the mild cognitive impairment and dementia stages of AD. Cognitive SuperAgers are individuals over age 80 who show superior memory capacity, at a level consistent with individuals 20–30 years their junior. Using a stereological approach, the current study quantitated the presence of AD markers in the memory-associated entorhinal cortex (ERC) of seven SuperAgers compared with six age-matched cognitively average normal control individuals. Amyloid plaques and NFTs were visualized using Thioflavin-S histofluorescence, 6E10, and PHF-1 immunohistochemistry. Unbiased stereological analysis revealed significantly more NFTs in ERC in cognitively average normal controls compared with SuperAgers (P < 0.05) by a difference of ~3-fold. There were no significant differences in plaque density. To highlight relative magnitude, cases with typical amnestic dementia of AD showed nearly 100 times more entorhinal NFTs than SuperAgers. The results suggest that resistance to age-related neurofibrillary degeneration in the ERC may be one factor contributing to preserved memory in SuperAgers.

Alzheimer’s disease, entorhinal cortex, memory, stereology, SuperAgers

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Alzheimer's May Start Sooner for People With Anxiety, Depression History

This is a major reason YOUR DOCTOR IS REQUIRED TO HAVE PROTOCOLS that prevent your depression and anxiety post stroke. 100% recovery would be the best solution but your doctor doesn't have that or is even trying for that.

Post stroke anxiety(20% chance).

Post stroke depression(33% chance).

 

Alzheimer's May Start Sooner for People With Anxiety, Depression History

— Psychiatric disorders could have additive effects on AD pathophysiology, study suggests

by Judy George, Senior Staff Writer, MedPage Today February 24, 2021

A history of either anxiety or depression was inversely associated with the age when Alzheimer's disease started, a retrospective analysis suggested.

People with Alzheimer's disease who had a past diagnosis of anxiety were 3 years younger than other Alzheimer's patients when they developed the disease, reported Zachary Miller, MD, of the University of California San Francisco (UCSF), and co-authors.

Patients with a history of depression were 2 years younger at Alzheimer's onset, they said in an abstract released in advance of the 2021 American Academy of Neurology annual meeting.

The findings were based on 1,500 Alzheimer's disease patients from the UCSF Memory and Aging Center who were screened for past psychiatric disorders, including depression, anxiety, bipolar disorder, schizophrenia, and post-traumatic stress disorder (PTSD). Researchers evaluated typical Alzheimer's risk factors -- hypertension, hyperlipidemia, diabetes, education, and APOE4 status -- as well as novel Alzheimer's-associated factors like left handedness, learning disabilities, autoimmune diseases, and seizure history.

"We are continuing to delve deeper into these findings," Miller said. "We have reason to believe that we have validated our core results in a very large external database of Alzheimer's patients from the National Alzheimer's Coordinating Center, which we will hopefully be discussing in greater depth during our presentation" at the AAN annual meeting, he told MedPage Today.

It's "relatively well established that certain psychiatric conditions, especially depression and anxiety, are associated in some way with cognitive decline and possibly dementia," noted Claire Sexton, DPhil, director of scientific programs and outreach at the Alzheimer's Association in Chicago, who was not involved with the study.

"Questions remain, however, about whether the cognitive changes are leading to the psychiatric conditions, or the psychiatric conditions are contributing to the cognitive changes," Sexton told MedPage Today. "It is likely that both are to some extent true, but more research is needed to clarify these relationships."

Of the Alzheimer's patients in the UCSF study, 43.3% had a history of depression, 32.3% had anxiety, 1.2% had bipolar disorder, 1% had PTSD, and 0.4% had schizophrenia. Patients with depression or anxiety were significantly younger at age at Alzheimer's onset by 2.1 and 3.0 years, respectively, compared with those without (P<0.001).

Reductions in age at Alzheimer's onset doubled with each additional psychiatric diagnosis: a history of one psychiatric disorder was linked to Alzheimer's starting 1.5 years earlier, two psychiatric disorders to 3.3 years earlier, and three or more psychiatric disorders to 7.3 years earlier (P<0.001).

People with depression or anxiety history were more likely to be women and had fewer typical Alzheimer's disease risk factors. The group with past depression diagnoses also had a significantly higher prevalence of autoimmune diseases (P=0.01). The anxiety cohort was more likely to have a history of seizures (P=0.002).

The findings suggest that psychiatric disorders "each possess unique and additive effects on Alzheimer's disease pathophysiology," the researchers observed.

"While this association between depression and autoimmune disease, and seizures and anxiety is quite preliminary, we hypothesize that the presentation of depression in some people could possibly reflect a greater burden of neuroinflammation," Miller said. "The presence of anxiety might indicate a greater degree of neuronal hyperexcitability, where the networks in the brain are overstimulated, potentially opening up new therapeutic targets for dementia prevention."

A limitation of the study is that data were obtained from a tertiary specialty memory care center by retrospective chart review.

Last Updated February 24, 2021

• Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow

Disclosures

The study was supported by the NIH's National Institute on Aging.

Primary Source

American Academy of Neurology

Source Reference: Eijansantos E, et al "History of psychiatric disease inversely correlates with age of onset in Alzheimer's disease" AAN 2021.

 

Quality of Life and Disability-free Survival in the Elderly: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

My quality of life is great even though I will be disabled for half my life; age 50-100. I blame the stroke medical world primarily for my lack of recovery and specifically my doctor for not doing a damn thing when all his previous patients did not recover. Acceptance of failure to recover is endemic in the stroke medical world. 

Quality of Life and Disability-free Survival in the Elderly: The Locomotive Syndrome and Health Outcome in Aizu Cohort Study

Show all authors

Cheng-Tzu Hsieh, Hajime Yamazaki, MD, PhD, Jui Wang, MS, ...

First Published October 30, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/0898264320970323

Article information

Abstract

Objectives: 

The Short Form 12 Survey (SF-12) three-component model is used to compute health-related quality of life (QoL): it includes physical, mental, and role-social QoL. We asked whether the SF-12 three-component model is associated with disability-free survival. 

Methods: 

People ≥65 years old were included (n = 2634). SF-12 scores were assessed at baseline. The outcome was a composite of loss of independence (LoI) and death. LoI was defined using Japan’s long-term care insurance categories. Hazard ratios (HRs) for LoI or death were estimated using Cox proportional hazards models.  

Results: 

Better physical QoL was inversely associated with LoI or death (adjusted HR per 10-point increase: .88 [95% CI: .81–.96]), but mental QoL was not. Better role-social QoL was inversely associated with LoI or death only among participants with higher than average physical QoL (adjusted HR per 10-point increase: .79 [95% CI: .65–.96], p for interaction = .04).  

Discussion: 

Physical QoL was associated with disability-free survival, and role-social QoL was associated with disability-free survival among those with better physical QoL.

Keywords SF-12, quality of life, loss of independence, death, cohort

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Personality, Retirement, and Cognitive Impairment: Moderating and Mediating Associations

I think I'm good on conscientiousness and lower neuroticism and nothing here will change my stance on retirement.

 Personality, Retirement, and Cognitive Impairment: Moderating and Mediating Associations

Jason E. Strickhouser, PhD, Angelina R. Sutin, PhD

First Published October 25, 2020 Research Article Find in PubMed 

https://doi.org/10.1177/0898264320969080

Article information

Abstract

Objectives: 

Five-factor model (FFM) personality traits, including higher conscientiousness and lower neuroticism, are associated with lower risk of dementia and cognitive impairment. In this research, we test whether retirement status moderates and/or mediates the relation between personality and cognitive impairment.  

Method: 

We used data from the Health and Retirement Study (N = 9899), a longitudinal study of Americans over the age of 50 years, to examine moderating and mediating associations between personality traits and retirement status on risk of dementia and cognitive impairment not dementia (CIND) over an 8–10 year follow-up.  

Results: 

Personality and retirement each had strong, independent associations with risk of dementia and CIND. There were not, however, strong or consistent, moderating or mediating associations between personality and retirement predicting impairment risk.  

Discussion: Overall, these results indicate that personality and retirement are independent risk factors for incident cognitive impairment. Mechanisms other than retirement are likely to explain this association.

Keywords personality, retirement, dementia, cognitive impairment, longitudinal

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