Diagnostic procedures in ischaemic stroke patients with dementia. a population-based study.

BACKGROUND: Dementia is a frequent condition in stroke patients. AIMS: To investigate the effect of dementia on access to diagnostic procedures in ischaemic stroke patients. METHODS: All cases of ischaemic stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Patients' characteristics were recorded, as was the use of brain computed tomography scans, brain magnetic resonance imaging, electrocardiogram, echocardiography, and Doppler ultrasonography of the cervical arteries. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Logistic regression models were used to evaluate the associations between dementia and the use of the diagnostic procedures. RESULTS: Of the 907 patients recorded, 104 were excluded because of death and inability to test cognition. Among the remaining 803 patients, 149 (18·5%) had dementia. Almost all of the patients underwent a brain computed tomography scan and an electrocardiogram during their stay. In contrast, the use of both Doppler ultrasonography of the cervical arteries (79·2% versus 90·2%, P < 0·001), echocardiography (32·9% versus 43·6%, P = 0·02), and brain magnetic resonance imaging (21·5% versus 34·4%, P < 0·001) were significantly lower in stroke patients with dementia than in those without. In multivariate logistic regression, dementia was associated with a lower use of both Doppler ultrasonography (odds ratio = 0·49; 95% confidence interval: 0·29-0·81, P = 0·005), echocardiography (odds ratio = 0·57; 95% confidence interval: 0·37-0·89, P = 0·012), brain magnetic resonance imaging (odds ratio = 0·55; 95% confidence interval: 0·34-0·89, P = 0·015), and a comprehensive assessment (odds ratio = 0·62; 95% confidence interval: 0·40-0·96, P = 0·033). CONCLUSION: Demented patients were less likely to undergo diagnostic procedures after ischaemic stroke. Further studies are needed to determine whether this lower utilization could account for the reported excess in recurrent events in these patients.

Effect of previous statin therapy on severity and outcome in ischemic stroke patients: a population-based study.

Although statin therapy has been shown to be effective in the prevention of ischemic stroke, its effect on stroke severity and early outcome is still controversial. We aimed to evaluate the association between statin use before onset and both initial severity and functional outcome in ischemic stroke patients. All cases of first-ever ischemic stroke that occurred in Dijon, France (151,000 inhabitants) between 2006 and 2011 were prospectively identified from the Dijon Stroke Registry. Vascular risk factors, clinical severity at onset assessed by the NIHSS score, stroke subtypes, prestroke statin use, and lipid profile were collected. Functional outcome was defined by a six-level categorical outcome using the modified Rankin scale. Analyses were performed using ordinal logistic regression models. Among the 953 patients with first-ever ischemic stroke, 127 (13.3 %) had previously been treated with statins. Initial stroke severity did not differ between statin users and non-users [median NIHSS score (interquartile range) 4.0 (7.0) versus 4.0 (9.0) p = 0.104]. In unadjusted analysis, statin use was associated with a lower risk of an unfavorable functional outcome at discharge (OR 0.69; 95 % CI 0.49-0.96; p = 0.026) that was no longer significant in multivariate analyses (OR 0.76; 95 % CI 0.53-1.09; p = 0.134). After adjustment for admission plasma LDL cholesterol levels, the non-significant association was still observed (OR 0.76; 95 % CI 0.49-1.18; p = 0.221). This population-based study showed that prestroke statin therapy did not affect initial clinical severity but was associated with a non-significant better early functional outcome after ischemic stroke.

Comparative effect of treadmill exercise on mature BDNF production in control versus stroke rats.

Physical exercise constitutes an innovative strategy to treat deficits associated with stroke through the promotion of BDNF-dependent neuroplasticity. However, there is no consensus on the optimal intensity/duration of exercise. In addition, whether previous stroke changes the effect of exercise on the brain is not known. Therefore, the present study compared the effects of a clinically-relevant form of exercise on cerebral BDNF levels and localization in control versus stroke rats. For this purpose, treadmill exercise (0.3 m/s, 30 min/day, for 7 consecutive days) was started in rats with a cortical ischemic stroke after complete maturation of the lesion or in control rats. Sedentary rats were run in parallel. Mature and proBDNF levels were measured on the day following the last boot of exercise using Western blotting analysis. Total BDNF levels were simultaneously measured using ELISA tests. As compared to the striatum and the hippocampus, the cortex was the most responsive region to exercise. In this region, exercise resulted in a comparable increase in the production of mature BDNF in intact and stroke rats but increased proBDNF levels only in intact rats. Importantly, levels of mature BDNF and synaptophysin were strongly correlated. These changes in BDNF metabolism coincided with the appearance of intense BDNF labeling in the endothelium of cortical vessels. Notably, ELISA tests failed to detect changes in BDNF forms. Our results suggest that control beings can be used to find conditions of exercise that will result in increased mBDNF levels in stroke beings. They also suggest cerebral endothelium as a potential source of BDNF after exercise and highlight the importance to specifically measure the mature form of BDNF to assess BDNF-dependent plasticity in relation with exercise.

The deleterious effect of admission hyperglycemia on survival and functional outcome in patients with intracerebral hemorrhage.

BACKGROUND AND PURPOSE: We aimed to evaluate the association between blood glucose (BG) levels at admission and both functional outcome at discharge and 1-month mortality after intracerebral hemorrhage (ICH). METHODS: All cases of first-ever ICH were identified from the population-based Stroke Registry of Dijon, France from 1985 to 2009. Clinical and radiological information was recorded. BG was measured at admission. Multivariate analyses were performed using logistic and Cox regression models. Multiple imputation was used as a sensitivity analysis. RESULTS: We recorded 465 first-ever ICH. BG at admission was obtained in 416 patients (89.5%) with a median value of 6.92 mmol/L. In multivariate analyses, BG in the highest tertile (≥8.6 mmol/L) was an independent predictor of functional handicap (odds ratio, 2.51; 95% CI, 1.43-4.40; P=0.01) and 1-month mortality (hazard ratio, 2.51; 95% CI, 1.23-2.43; P=0.002). The results were consistent with those obtained from multiple imputation analyses. CONCLUSIONS: Admission hyperglycemia is associated with poor functional recovery at discharge and 1-month mortality after ICH. These results suggest a need for trials that evaluate strategies to lower BG in acute ICH.

Evaluation of the possible impact of a care network for stroke and transient ischemic attack on rates of recurrence.

We aimed to demonstrate that a stroke network is able to reduce the proportion of recurrent cerebrovascular events. In 2003, we set up a care network with the aim to reduce the proportion of stroke recurrence. For the statistical analysis, recurrent cerebrovascular events observed from 1985 to 2002 within the population of Dijon made it possible to model trends using Poisson logistic regression. From 1985 to 2002, we recorded 172 recurrent cerebrovascular events which were used to model trends before the creation of the care network. Within the period 2003-2007, we observed 162 recurrent cerebrovascular events compared with 196.7 expected cerebrovascular events with a significant standardized incidence rate of 0.82 (0.70-0.96; p = 0.01). After eliminating the role of some environmental factors, the possible hypothesis for the fall in recurrent stokes is probably the positive effect of the stroke care network.

Age-period-cohort analysis of stroke incidence in Dijon from 1985 to 2005.

BACKGROUND AND PURPOSE: Variations in stroke incidence could be explained by changes in vascular and environmental factors that affect the risk of stroke and changes in risk factors that are present in early life. The aim of this study was to identify and measure the effects of 3 interrelated factors, age, calendar period of stroke onset, and birth year cohort, on the incidence rates of stroke from 1985 through 2005. METHODS: Age-period-cohort models were used to analyze stroke incidence in Dijon from 1985 to 2005 from a population-based registry that collects data on all stroke patients whatever the type of management, in the public hospital, private hospitals, or at home, in the population of Dijon (150,000 inhabitants). RESULTS: For ischemic stroke, the incidence rose with time in men depending not only on age, but also on the period and cohort effects (P = 0.017). For women, the incidence only depended on age (P < 0.001; incidence rate ratio, 1.085; 95% CI, 1.081 to 1.089). For hemorrhagic stroke, the rise in the incidence with time depended only on age in men, whereas in women, it depended on age, period, and cohort effects (P = 0.019). CONCLUSIONS: Age, birth cohort, and calendar period contain relevant information to define and explain trends in stroke incidence rates over a long period.

Transient ischaemic attack mimics revealing focal subarachnoid haemorrhage.

We describe here 7 elderly patients with a transient neurological deficit due to a focal subarachnoid haemorrhage, identified from the Dijon Stroke Registry over 4 years. These 7 patients presented a clinical pattern marked by focal paraesthesia, with several stereotyped focal episodes (5 of the 7 cases), lasting less than 30 min (6 of the 7 cases), and associated with a cognitive decline (4 of the 7 cases). Headache was present in only 1 case. Neuroimaging revealed focal haemorrhage present in a cortical sulcus contralateral to the symptoms. No vascular lesions nor epileptic mechanisms nor ischemic lesions were observed. This syndrome could be explained by a spreading depression, and the focal subarachnoid haemorrhage could reflect possible cerebral amyloid angiopathy, suggested by the cognitive decline present in more than 50% of our series. Our observations suggest that focal subarachnoid haemorrhage may be diagnosed by MRI in the absence of acute headache and it may be revealed by transient focal and repetitive sensory perturbations. In medical practice, it is important to evoke this diagnosis in the elderly to avoid inappropriate treatment.