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BACKGROUND AND PURPOSE: Previous studies have suggested a decreased cancer risk among patients with Alzheimer's disease (AD). There remains a lack of data on the specific types of cancer and risk factors for developing cancer in AD. We evaluated the association between AD and cancer risk, and we examined specific types of cancer. METHODS: A population-based longitudinal study was conducted using the National Health Insurance Service-Senior cohort for 2002-2013. A total of 4,408 AD patients were included in the study, as were 19,150 matched controls. Potential associations between the risk of cancer and AD were analyzed using Cox proportional hazard regressions. RESULTS: Cancer developed in 12.3% of the AD group patients and in 18.5% of control group subjects. AD was associated with a reduced risk of cancer (hazard ratio [HR], 0.70; 95% confidence intervals, 0.64-0.78). The risk of head and neck cancers was significantly reduced (HR, 0.49), as were risks for cancers of the digestive tract, including stomach cancer (HR, 0.42), colorectal cancer (HR, 0.61), liver and biliary tract cancers (HR, 0.68), and pancreatic cancer (HR, 0.55). Lung and prostate cancer risks were also significantly lower for the AD group (HR, 0.52 and HR, 0.72, respectively). CONCLUSIONS: Our results showed an inverse association between AD and cancer. Further research involving a large number of patients in a hospital based-study is needed to address the biological associations between cancer development and dementia, including AD.
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Isolated middle cerebral artery (MCA) stenosis in young patients with no other medical condition may be a unique pathologic entity with a benign long-term course. Generally, moyamoya disease shows a progression of stenosis from internal cerebral artery (ICA) to other intracranial vessel. A 26-year-old woman was admitted for choreic movements of the right arm and leg. Brain magnetic resonance imaging showed no stroke. Conventional angiography revealed 48% stenosis of the left M1 without ICA stenosis. Single photon emission computed tomography revealed perfusion asymmetry after acetazolamide injection, suggesting decreased uptake in the left basal ganglia and the cerebral cortex. Her hemichorea was mildly decreased with risperidone. One year later, follow-up angiography showed complete occlusion of the left M1 with neovascularization suggestive of moyamoya disease. The patient underwent bypass surgery and her hemichorea disappeared. This may be an atypical presentation of moyamoya disease. The bypass surgery was an effective measure for restoring the vascular insufficiency and, resultantly, controlling her hemichorea.
RESUMO
BACKGROUND AND PURPOSE: Endarterectomy has been proved to be an effective stroke prevention procedure. However, there are still inconsistencies between the results of different preoperative evaluation methods, which may sometimes complicate treatment plans. This study measured the discrepancies between different angiographic grading methods and attempted to further assess the accuracy of the carotid duplex examination according to these different angiographic grading methods. METHODS: One hundred seventy-one preendarterectomy carotid duplex examinations and angiograms were reviewed. All angiograms were measured blindly by one of the authors using the North American Symptomatic Carotid Endarterectomy Trial (N), the European Carotid Surgery Trial (E), and the common carotid (C) methods. The measurement results were further converted into the area of stenosis indices (N2, E2, and C2, respectively). By using regression testing, all results could be compared. The duplex examination data were then compared with the results of different angiographic measurement methods to evaluate their accuracy. RESULTS: The measurement results of all angiographic grading methods were well correlated. Using different angiographic grading systems as the gold standard, duplex examination for screening endarterectomy candidates produced the following results: According to the N method, accuracy was 74%; according to the E method, accuracy was 90%; and according to the C method, the accuracy rate was 92%. According to N2, accuracy was 88%; according to E2, accuracy was 94%; and according to C2, the accuracy rate was 93%. CONCLUSIONS: The measurement results of all 3 commonly used angiographic grading methods were linearly correlated with one another. (It is important to note that none of those standards should be treated as the only gold standard.) In this study, the duplex criteria have a greater accuracy rate according to E or C rather than N. However, this study also demonstrated that the cut point of the Doppler criteria is the determinant factor for accuracy rather than which gold standard was compared. Through careful adjustment of the cutoff criteria, carotid duplex can be highly accurate, despite the use of different reference standards.