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Silent cerebral infarction during immune TTP remission: prevalence, predictors, and impact on cognition.
Chaturvedi, Shruti; Yu, Jia; Brown, Jenna; Wei, Aria; Selvakumar, Sruthi; Gerber, Gloria F; Moliterno, Alison R; Streiff, Michael B; Kraus, Peggy; Logue, Claire M; Yui, Jennifer C; Naik, Rakhi P; Latif, Hira; Lanzkron, Sophie M; Braunstein, Evan M; Brodsky, Robert A; Gottesman, Rebecca F; Lin, Doris D.
Afiliação
  • Chaturvedi S; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Yu J; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Brown J; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Wei A; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Selvakumar S; Nova Southeastern University College of Allopathic Medicine, Davie, FL.
  • Gerber GF; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Moliterno AR; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Streiff MB; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Kraus P; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Logue CM; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Yui JC; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Naik RP; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Latif H; Division of Hematology and Oncology, MedStar Georgetown University Hospital Center, Washington, DC.
  • Lanzkron SM; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Braunstein EM; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Brodsky RA; Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Gottesman RF; Stroke, Cognition and Neuroepidemiology Section, National Institute of Neurological Disease and Stroke Intramural Research Program, Bethesda, MD.
  • Lin DD; Division of Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
Blood ; 142(4): 325-335, 2023 07 27.
Article em En | MEDLINE | ID: mdl-37216688
Immune thrombotic thrombocytopenic purpura (iTTP) survivors have increased risk of cardiovascular disease, including strokes, and report persistent cognitive difficulties during remission. We conducted this prospective study involving iTTP survivors during clinical remission to determine the prevalence of silent cerebral infarction (SCI), defined as magnetic resonance imaging (MRI) evidence of brain infarction without corresponding overt neurodeficits. We also tested the hypothesis that SCI is associated with cognitive impairment, assessed using the National Institutes of Health ToolBox Cognition Battery. For cognitive assessments, we used fully corrected T scores adjusted for age, sex, race, and education. Based on the diagnostic and statistical manual 5 criteria, we defined mild and major cognitive impairment as T scores with a 1 or 2 standard deviation (SD) and >2 SD below the mean on at least 1 test, respectively. Forty-two patients were enrolled, with 36 completing MRIs. SCI was present in 50% of the patients (18), of which 8 (44.4%) had prior overt stroke including during acute iTTP. Patients with SCI had higher rates of cognitive impairment (66.7% vs 27.7%; P = .026), including major cognitive impairment (50% vs 5.6%; P = .010). In separate logistic regression models, SCI was associated with any (mild or major) cognitive impairment (odds ratio [OR] 10.5 [95% confidence interval (95% CI), 1.45-76.63]; P = .020) and major cognitive impairment (OR 7.98 [95% CI, 1.11-57.27]; P = .039) after adjusting for history of stroke and Beck depression inventory scores. MRI evidence of brain infarction is common in iTTP survivors; the strong association of SCI with impaired cognition suggests that these silent infarcts are neither silent nor innocuous.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infarto Cerebral / Acidente Vascular Cerebral Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Blood Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infarto Cerebral / Acidente Vascular Cerebral Tipo de estudo: Etiology_studies / Guideline / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Blood Ano de publicação: 2023 Tipo de documento: Article