Variations in Risk Factors across Different Periods of Stroke and Transient Ischemic Attack Recurrence.

INTRODUCTION: Accurately discerning periods of heightened risk of stroke or transient ischemic attack (TIA) recurrence and managing modifiable risk factors are essential for minimizing overall recurrence risk. This study identified differences in the timing of stroke or TIA recurrence based on risk factors and patient characteristics to develop strategies for reducing recurrence in clinical practice. METHODS: We retrospectively selected patients with ischemic stroke or TIA at the Korea University Ansan Hospital Stroke Center between March 2014 and December 2021 using the prospective institutional database of the Korea University Stroke Registry. We collected demographic, clinical data and categorized participants by recurrence timing (early within or late after 3 months). Using multinomial logistic regression analysis, we examined variables associated with early and late recurrent stroke or TIAs. RESULTS: Among 3,646 patients, 255 experienced a recurrent stroke or TIA and 3,391 experienced their first stroke or TIA. Multinomial logistic regression analysis revealed significant associations between early recurrent stroke or TIA and diabetes mellitus (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.25-3.15), other determined etiologies in the Trial of Org 10172 in the Acute Stroke Treatment classification (OR 3.00, 95% CI 1.37-6.61), and white matter changes (OR 1.97, 95% CI 1.17-3.33). Late recurrence showed a significant correlation with TIA (OR 2.95, 95% CI 1.52-5.71) and cerebral microbleeds (OR 2.22, 95% CI 1.32-3.75). CONCLUSION: Substantial differences in factors contribute to stroke or TIA recurrence based on timing. Managing the risk of recurrence in clinical practice necessitates accurate identification of heightened risk periods and rigorous control of modifiable risk factors.

Correlation between overactive bladder symptom score and neuropsychological parameters in Alzheimer's disease patients with lower urinary tract symptom

ABSTRACT Purpose To examine an association between the overactive bladder symptom score (OABSS) and neuropsychological parameters. Moreover, we investigate the factors that affect each item in the questionnaire. Materials and Methods A total of 376 patients (males: 184; females: 192) with probable Alzheimer’s disease (AD) were recruited. Cognitive testing was conducted using the Mini Mental Status Examination (MMSE), Clinical Dementia Rating (CDR) scale, Global Deterioration Scale (GDS), and Barthel Activities of Daily Living (ADL). Lower urinary tract symptom (LUTS) was assessed using OABSS and voiding diary. Results The prevalence of overactive bladder (OAB) (defined as OABSS ≥3 with an urgency score of ≥2) in patients with AD was 72.6%. Among the OAB subjects, the most common severity of symptom was moderate (72.6%), followed by mild (21.2%), and severe (5.8%). It was found that OABSS had a very high correlation with aging (r=0.75; p<0.001). When compared with neuropsychological parameters, it was found that OABSS was highly correlated with the CDR scores (r=0.446; p<0.001). However, no significant correlation was found between the changes in OABSS scores and those in other neuropsychological parameters. Based on the individual symptom scores, urgency incontinence was highly correlated with the CDR scores (r=0.43; p<0.001). Conclusions OABSS is a useful tool in assessing AD patients with LUTS. There was a consistent positive association between OABSS severity, including urgency incontinence, and CDR scores.

The PHC-cog: a brief cognitive function screening test for the elderly.

BACKGROUND: Cognitive dysfunctions such as dementia have emerged as a leading public health problem among the elderly. Its early detection is important for the management of patients, and for the educational support of other family members. Although cognitive dysfunction screening tests are available, they have not been widely utilized in community or primary care settings. AIM: To validate the PHC-cog (Public Health Center Cognitive Dysfunction Test) and to assess it as a simple and brief method for massive screening of cognitive dysfunctions in the primary care setting. MATERIALS AND METHODS: The study comprised 137 community-dwelling patients with dementia and 134 age, sex, and education-matched controls. The PHC-cog was made combining patients' and informants' questionnaires to improve performance. The PHC-cog patient's section briefly assessed the patient's cognition. RESULTS: The PHC-cog Patient's Section had a sensitivity and specificity of 0.75 and 0.92, respectively. The PHC-cog Informants' Section had a sensitivity and specificity of 0.79 and 0.83, respectively. The total method of administering the PHC-cog had a sensitivity and specificity of 0.96 and 0.82, and the two-stage method had a sensitivity and specificity of 0.92 and 0.76, respectively. CONCLUSIONS: The PHC-cog test is a simple, accurate and reliable, performance-based tool in the screening for cognitive dysfunction. The PHC-cog test is quick, and easy-to-use, and will hopefully become widely used in the cognitive screening of the aging population in the primary public medical institutions of Korea.