COX-2 rs20417 Polymorphism Is Associated with Stroke and White Matter Disease.

BACKGROUND: To investigate the effect of COX-2 polymorphism and its product, prostaglandin E2 (PGE2), on stroke risk in an endemic area for Chagas disease. In a separate cohort, to investigate the effect of COX-2 polymorphisms on the total burden of cerebral white matter disease. METHODS: Cases were outpatients with ischemic stroke; controls were stroke-free subjects from 2 outpatient clinics (heart failure and caregivers of a movement disorders clinic). We extracted DNA from total blood to investigate the rs20417 COX-2 polymorphism. Serologic tests (Enzime-linked immunosorbent assay) were performed to confirm Trypanosoma cruzi infection and to quantify PGE2 levels. In the Boston cohort, white matter hyperintensity volume (WMHv) was quantified on the admission brain magnetic resonance images of subjects with ischemic stroke, who also donated DNA for the COX-2 gene region analysis. RESULTS: We studied 44 patients with stroke and 96 controls (46 with heart failure and 50 caregivers) in the Brazilian cohort; and 788 stroke patients (302 cardioembolic and 486 noncardioembolic) in the Boston cohort. In the Brazilian cohort, rs20417 polymorphism was associated with both stroke (P = 5 × 10(-6)) and decreased PGE2 levels (P = 4 × 10(-5)); similarly, Chagas was associated with stroke (P = 4 × 10(-3)) and decreased PGE2 levels (P = 7 × 10(-3)). In the Boston cohort, rs20417 polymorphism was associated with increased WMHv among noncardioembolic (P = .037), but not among cardioembolic stroke patients. CONCLUSIONS: Variation in COX-2 gene is associated with both symptomatic and silent brain cerebrovascular disease. This candidate gene region should be tested in population-based samples.

Risk factors associated with falls in adult patients after stroke living in the community: baseline data from a stroke cohort in Brazil.

BACKGROUND: Individuals with stroke have a high risk of falling, and their fall predictors may differ from those of other populations. PURPOSE: To estimate fall frequency and identify factors related to fall occurrence in a sample of patients with stroke residing in the community. METHODS: Clinical data were collected from 150 consecutive stroke patients with independent gait, and the following scales were applied: modified Barthel Index (mBI), Timed Up & Go Test (TUG), and National Institutes of Health Stroke Scale (NIHSS). Univariate analysis was performed; variables with possible association (P < .1) were included in a logistic regression model. Receiver operating characteristic curves were used to identify the best cutoff point for TUG. RESULTS: Falls occurred in 37% of patients. In multivariate analysis, right hemisphere injury (odds ratio [OR], 2.621; 95% CI, 1.196-5.740; P = .016), time in TUG (OR, 1.035 for every increase in 1 second; 95% CI, 1.003-1.069; P = .034), and longer time since stroke onset (OR, 1.012 for every month increase; 95% CI, 1.002-1.021; P = .015) remained predictors. When we grouped individuals according to affected cerebral hemisphere, both hemispheres had similar accuracy, but TUG cutoff point was lower in individuals with right- versus left-hemisphere lesions. CONCLUSIONS: Patients with poor TUG performance, longer times since stroke onset, and right-hemisphere injury have particularly high fall rates, and TUG cutoff points for fall prediction vary according to cerebral hemisphere.

Past smoking and current dopamine agonist use show an independent and dose-dependent association with impulse control disorders in Parkinson's disease.

BACKGROUND: Previous studies have described the association between dopamine replacement therapy in Parkinson's disease and impulse control disorders. METHODS: A case-control study was performed to establish the prevalence of four of these behaviors in Brazilian patients with Parkinson's disease on stable dopamine replacement therapy and the possible associated risk factors. We investigated 152 patients and 212 healthy controls for pathological gambling, compulsive sexual behavior and compulsive buying and eating. RESULTS: Overall, patients had more impulsive control disorders than controls (18.4% vs. 4.2%, P < 0.001). Impulse control disorders were more common in younger patients (P = 0.008) and in those taking dopamine agonist (P < 0.001) and levodopa (P = 0.02). Higher Unified Parkinson's Disease Rating Scale motor score (P = 0.03) and past smoking (P = 0.02) were also associated in the univariate analysis. Variables independently associated with impulse control disorders were history of smoking (odds ratio = 1.059 for each year of smoking, P = 0.010) and current use of pramipexole (odds ratio = 2.551 for each increase in 1 mg, P < 0.001). CONCLUSIONS: Dopaminergic stimulation and previous exposure to smoking are independently associated with impulse control disorders in a dose-dependent manner.