Publications by authors named "Shahram Oveisgharan"

54 Publications

Incident mobility disability, parkinsonism, and mortality in community-dwelling older adults.

PLoS One 2021 3;16(2):e0246206. Epub 2021 Feb 3.

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, United States of America.

Background: Mobility disability and parkinsonism are associated with decreased survival in older adults. This study examined the transition from no motor impairment to mobility disability and parkinsonism and their associations with death.

Methods: 867 community-dwelling older adults without mobility disability or parkinsonism at baseline were examined annually. Mobility disability was based on annual measured gait speed. Parkinsonism was based on the annual assessment of 26 items from the motor portion of the Unified Parkinson's Disease Rating Scale. A multistate Cox model simultaneously examined the incidences of mobility disability and parkinsonism and their associations with death.

Results: Average age at baseline was 75 years old and 318 (37%) died during 10 years of follow-up. Mobility disability was almost 2-fold more common than parkinsonism. Some participants developed mobility disability alone (42%), or parkinsonism alone (5%), while many developed both (41%). Individuals with mobility disability or parkinsonism alone had an increased risk of death, but their risk was less than the risk in individuals with both impairments. The risk of death did not depend on the order in which impairments occurred.

Conclusion: The varied patterns of transitions from no motor impairment to motor impairment highlights the heterogeneity of late-life motor impairment and its contribution to survival. Further studies are needed to elucidate the underlying biology of these different transitions and how they might impact survival.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246206PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857621PMC
February 2021

Variations in knowledge, awareness and treatment of hypertension and stroke risk by country income level.

Heart 2020 Dec 14. Epub 2020 Dec 14.

Dept of Medicine, Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Objective: Hypertension is the most important modifiable risk factor for stroke globally. We hypothesised that country-income level variations in knowledge, detection and treatment of hypertension may contribute to variations in the association of blood pressure with stroke.

Methods: We undertook a standardised case-control study in 32 countries (INTERSTROKE). Cases were patients with acute first stroke (n=13 462) who were matched by age, sex and site to controls (n=13 483). We evaluated the associations of knowledge, awareness and treatment of hypertension with risk of stroke and its subtypes and whether this varied by gross national income (GNI) of country. We estimated OR and population attributable risk (PAR) associated with treated and untreated hypertension.

Results: Hypertension was associated with a graded increase in OR by reducing GNI, ranging from OR 1.92 (99% CI 1.48 to 2.49) to OR 3.27 (2.72 to 3.93) for highest to lowest country-level GNI (p-heterogeneity<0.0001). Untreated hypertension was associated with a higher OR for stroke (OR 5.25; 4.53 to 6.10) than treated hypertension (OR 2.60; 2.32 to 2.91) and younger age of first stroke (61.4 vs 65.4 years; p<0.01). Untreated hypertension was associated with a greater risk of intracerebral haemorrhage (OR 6.95; 5.61 to 8.60) than ischaemic stroke (OR 4.76; 3.99 to 5.68). The PAR associated with untreated hypertension was higher in lower-income regions, PAR 36.3%, 26.3%, 19.8% to 10.4% by increasing GNI of countries. Lifetime non-measurement of blood pressure was associated with stroke (OR 1.80; 1.32 to 2.46).

Conclusions: Deficits in knowledge, detection and treatment of hypertension contribute to higher risk of stroke, younger age of onset and larger proportion of intracerebral haemorrhage in lower-income countries.
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http://dx.doi.org/10.1136/heartjnl-2019-316515DOI Listing
December 2020

Urinary Sodium and Potassium, and Risk of Ischaemic and Haemorrhagic Stroke (INTERSTROKE): a case-control study.

Am J Hypertens 2020 Nov 17. Epub 2020 Nov 17.

Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.

Background: Although low sodium intake (<2g/day) and high potassium intake (>3·5g/day) are proposed as public health interventions to reduce stroke risk, there is uncertainty about the benefit and feasibility of this combined recommendation on prevention of stroke and its subtypes.

Methods: We obtained random urine samples from 9,275 cases of acute first stroke and 9,726 matched controls (8,761 matched pairs for conditional analysis) from 27 countries and estimated the 24-hour sodium and potassium excretion, a surrogate for intake, using the Tanaka formula. Using multivariable conditional logistic regression, we determined the associations of estimated 24-hour urinary sodium and potassium excretion with stroke and its subtypes.

Results: The mean estimated 24-hour sodium and potassium urinary excretion was 3·29g/day and 1·57g/day, with 0·01% of participants having both low sodium (<2·0g/day) and high potassium excretion (>3·5g/day). There was a moderate positive correlation between sodium and potassium excretion (r=0·4435, P<0.001) and between sodium excretion and blood pressure (P<0.001). Compared with an estimated urinary sodium excretion of 2·8-3·5g/day (second quartile, reference), higher (>4·26g/day) (OR 1.81;95%CI,1.65-2.00) and lower (<2·8g/day) sodium excretion (OR 1.39;95%CI,1.26-1.53) were significantly associated with increased risk of stroke. The stroke risk associated with the highest quartile of sodium intake (sodium excretion >4·26g/day) was significantly greater (P<0.001) for intracerebral haemorrhage (ICH) (OR 2.38;95%CI,1.93-2.92) than for ischemic stroke (OR 1.67;95%CI,1.50-1.87), and greater for large vessel and small vessel ischemic stroke than for cardioembolic ischemic stroke. Urinary potassium was inversely and linearly associated with risk of stroke, and stronger for ischemic stroke than ICH (P=0.026). In an analysis of combined sodium and potassium excretion, the combination of high potassium intake (>1·58g/day) and moderate sodium intake (2.8-3.5 g/day) was associated with the lowest risk of stroke.

Conclusion: The association of sodium intake and stroke is J-shaped, with high sodium intake a stronger risk factor for intracerebral haemorrhage than ischemic stroke. Our data suggest that moderate sodium intake - rather than low sodium intake - combined with high potassium intake may be associated with the lowest risk of stroke and expected to be a more feasible combined dietary target.
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http://dx.doi.org/10.1093/ajh/hpaa176DOI Listing
November 2020

Association of Low Systolic Blood Pressure with Postmortem Amyloid-β and Tau.

J Alzheimers Dis 2020 ;78(4):1755-1764

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.

Background: Vascular mechanisms may contribute to the accumulation of AD pathology.

Objective: We examined whether the burden of vascular risk factors proximate to death is associated with amyloid-β and tau levels or modified their known association.

Methods: We examined the brains of 1, 585 participants from two longitudinal community-based studies of older adults. Amyloid-β and tau were quantified by postmortem examination. The burden of vascular risk factors was summarized by calculating the Framingham general cardiovascular risk score (FRS) proximate to death. Using linear regressions, we examined the association of the FRS with the amyloid-β and tau levels and examined if the FRS modified the association of the amyloid-β with tau.

Results: On average, participants were nearly 90 years old and two-thirds were women. The FRS was not associated with amyloid-β (Spearman r  = -0.00, p  = 0.918) or tau (r = 0.01, p = 0.701). However, the FRS as a whole (estimate = -0.022, SE = 0.008, p = 0.009), and specifically the systolic blood pressure (SBP) component (estimate = -0.033, SE = 0.012, p = 0.009), modified the association of the amyloid-β with tau. Further analysis showed that the association between amyloid-β and tau was stronger at lower levels of SBP.

Conclusion: Late-life vascular risk scores were not related to postmortem levels of amyloid-β or tau. However, lower levels of vascular risk scores and SBP were associated with a stronger association between amyloid-β and tau. These data suggest that vascular risk factors may modify the relation of AD pathology markers to one another.
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http://dx.doi.org/10.3233/JAD-200412DOI Listing
January 2020

Correlation between vitamin D level and coronary artery calcification.

J Res Med Sci 2020 22;25:51. Epub 2020 May 22.

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.

Background: Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC.

Materials And Methods: This was a cross-sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors.

Results: There was no association between CAC and Vitamin D levels (Spearman coefficient = -0.03, = 0.805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0.001, S. E. = 0.020, = 0.942).

Conclusion: We did not find the association between the serum level of Vitamin D and coronary artery calcification.
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http://dx.doi.org/10.4103/jrms.JRMS_1080_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377123PMC
May 2020

No difference in dementia prediction between apolipoprotein E4 and the ischemic score.

Alzheimers Dement 2020 11 30;16(11):1596-1599. Epub 2020 Jul 30.

Department of Clinical Neurological Sciences, University Hospital, University of Western Ontario, London, Ontario, Canada.

Introduction: Few biomarkers exist for early detection of vascular cognitive impairment. We examined whether the Hachinski Ischemic Scale (HIS) can predict dementia in elderly.

Methods: We leveraged data of the Canadian Study of Health and Aging. First, we examined the association of HIS with incident dementia. Next, we compared HIS to apolipoprotein E (APOE ɛ4) in prediction of dementia. We trained the HIS and APOE ɛ4 models in the training dataset and used the trained models for dementia prediction in the validation dataset.

Results: A higher HIS level was associated with a higher odds of dementia (odds ratio = 1.64, 95% confidence interval [CI]: 1.41 to 1.90, P < .001). Dementia discrimination of the HIS model was not different from the APOE ɛ4 model (area under the curve difference = 0.002, 95% CI: -0.024 to 0.029, P = .857). The calibration of the HIS model was 13.7 (P = .091) and of the APOE ɛ4 model was 13.3 (P = .100).

Discussion: HIS may be used as a simple, inexpensive test to identify older adults at risk of developing dementia.
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http://dx.doi.org/10.1002/alz.12139DOI Listing
November 2020

Person-specific contributions of brain pathologies to progressive parkinsonism in older adults.

J Gerontol A Biol Sci Med Sci 2020 Jul 28. Epub 2020 Jul 28.

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.

Objective: Mixed-brain pathologies are the most common cause of progressive parkinsonism in older adults. We tested the hypothesis that the impact of individual pathologies associated with progressive parkinsonism, differ among older adults.

Methods: Data was from 1089 decedents who had undergone annual clinical testing and autopsy. Parkinsonism was based on a modified United Parkinson's Disease Rating Scale. Linear mixed-effects models were employed, to investigate the combinations of nine pathologies related to progressive parkinsonism. Then we estimated the person-specific contributions of each pathology for progressive parkinsonism.

Results: The average participant showed three pathologies. Parkinson's disease (PD) and four cerebrovascular pathologies [macroinfarcts, atherosclerosis, arteriolosclerosis and cerebral amyloid angiopathy (CAA)] but not AD, TDP-43, hippocampal sclerosis and microinfarcts, were independently associated with progressive parkinsonism. These pathologies accounted for 13% of additional variance of progressive parkinsonism. Thirty-one different combinations of these five pathologies were observed to be associated with progressive parkinsonism observed. On average, PD and CAA accounted respectively for 66% and 65% of person-specific progression of parkinsonism, while macroinfarcts, atherosclerosis and arteriolosclerosis accounted for 41%-48%.

Conclusion: There is much greater heterogeneity in the comorbidity and relative impact of individual brain pathologies affecting progressive parkinsonism than previously recognized and this may account in part for its phenotypic heterogeneity in older adults.
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http://dx.doi.org/10.1093/gerona/glaa176DOI Listing
July 2020

Association of Early-Life Cognitive Enrichment With Alzheimer Disease Pathological Changes and Cognitive Decline.

JAMA Neurol 2020 Jun 29. Epub 2020 Jun 29.

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.

Importance: Indicators of early-life cognitive enrichment (ELCE) have been associated with slower cognitive decline and decreased dementia in late life. However, the mechanisms underlying this association have not been elucidated.

Objective: To examine the association of ELCE with late-life Alzheimer disease (AD) and other common dementia-related pathological changes.

Design, Setting, And Participants: This clinical-pathological community-based cohort study, the Rush Memory and Aging Project, followed up participants before death for a mean (SD) of 7.0 (3.8) years with annual cognitive and clinical assessments. From January 1, 1997, through June 30, 2019, 2044 participants enrolled, of whom 1018 died. Postmortem data were leveraged from 813 participants. Data were analyzed from April 12, 2019, to February 20, 2020.

Exposures: Four indicators of ELCE (early-life socioeconomic status, availability of cognitive resources at 12 years of age, frequency of participation in cognitively stimulating activities, and early-life foreign language instruction) were obtained by self-report at the study baseline, from which a composite measure of ELCE was derived.

Main Outcomes And Measures: A continuous global AD pathology score derived from counts of diffuse plaques, neuritic plaques, and neurofibrillary tangles.

Results: The 813 participants included in the analysis had a mean (SD) age of 90.1 (6.3) years at the time of death, and 562 (69%) were women. In a linear regression model controlled for age at death, sex, and educational level, a higher level of ELCE was associated with a lower global AD pathology score (estimate, -0.057; standard error, 0.022; P = .01). However, ELCE was not associated with any other dementia-related pathological changes. In addition, a higher level of ELCE was associated with less cognitive decline (mean [SD], -0.13 [0.19] units per year; range, -1.74 to 0.85). An indirect effect through AD pathological changes constituted 20% of the association between ELCE and the rate of late-life cognitive decline, and 80% was a direct association.

Conclusions And Relevance: These findings suggest that ELCE was associated with better late-life cognitive health, in part through an association with fewer AD pathological changes.
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http://dx.doi.org/10.1001/jamaneurol.2020.1941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325069PMC
June 2020

Total daily physical activity, brain pathologies, and parkinsonism in older adults.

PLoS One 2020 29;15(4):e0232404. Epub 2020 Apr 29.

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, United States of America.

Objective: We examined the association of physical activity, postmortem brain pathologies, and parkinsonism proximate to death in older adults.

Methods: We studied the brains of 447 older decedents participating in a clinical-autopsy cohort study. We deployed a wrist worn activity monitor to record total daily physical activity during everyday living in the community-setting. Parkinsonism was assessed with 26 items of a modified motor portion of Unified Parkinson's Disease Rating Scale (UPDRS). We used linear regression models, controlling for age and sex, to examine the association of physical activity with parkinsonism with and without indices of Alzheimer's disease and related disorders (ADRD) pathologies. In separate models, we added interaction terms to examine if physical activity modified the associations of brain pathologies with parkinsonism.

Results: Mean age at death was 90.9 (SD, 6.2), mean severity of parkinsonism was 14.1 (SD, 9.2, Range 0-59.4), and 350 (77%) had evidence of more than one ADRD pathologies. Higher total daily physical activity was associated with less severe parkinsonism (Estimate, -0.315, S.E., 0.052, p<0.001). The association of more physical activity with less severe parkinsonism persisted after adding terms for ten brain pathologies (Estimate, -0.283, S.E., 0.052, p<0.001). The associations of brain pathologies with more severe parkinsonism did not vary with the level of physical activity.

Conclusion: The association of higher physical activity with less severe parkinsonism may be independent of the presence of ADRD brain pathologies. Further work is needed to identify mechanisms through which physical activity may maintain motor function in older adults.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232404PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190120PMC
July 2020

The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: A randomized double-blind clinical trial study.

Iran J Neurol 2019 Apr;18(2):57-63

Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. In a single-center randomized double-blind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the C point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients' mobility in daily activities.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755509PMC
April 2019

The Effect of Continuous Theta-Burst Transcranial Magnetic Stimulation Combined with Prism Adaptation on the Neglect Recovery in Stroke Patients.

J Stroke Cerebrovasc Dis 2019 Nov 6;28(11):104296. Epub 2019 Aug 6.

Department of Neurology, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.

Objectives: This study was designed to investigate the effect of prism adaptation (PA) combined with continuous theta-burst transcranial magnetic stimulation (cTBS) on the neglect recovery of stroke patients with unilateral neglect.

Methods: A total of 14 stroke patients with unilateral neglect were randomly assigned to 2 groups including an intervention group undergone PA combined with cTBS over the left intact parietal cortex and a control group. PA combined with sham cTBS was perfomed for 2 weeks in 10 daily sessions. Before and after the intervention, patients were evaluated for visuospatial neglect measured using the Star Cancellation Test (SCT), Line Bisection Task (LBT), Figure Copying Test, and Clock Drawing Task. Neurological function was evaluated using the Modified Rankin Scale (MRS).

Results: Both groups (PA alone and PA+ cTBS) showed improvement in their neglected symptoms (measured by SCT, LBT, Figure Copying Test, and Clock Drawing Task), and in their disability in the neurological function (measured by MRS) (P< .05).

Conclusions: The results of the present study showed that, transcranial magnetic stimulation did not increase the effect of PA on neglect symptoms in stroke patients.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.07.012DOI Listing
November 2019

Anthropometric indices predicting incident hypertension in an Iranian population: The Isfahan cohort study.

Anatol J Cardiol 2019 06;22(1):33-43

Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences; Isfahan-Iran

Objective: The aim of the present study was to assess different obesity indices, as well as their best cut-off point, to predict the occurrence of hypertension (HTN) in an Iranian population.

Methods: In a population-based study, subjects aged 35 years and older were followed for 7 years. Blood pressure was measured at baseline and after the follow-up. Anthropometry indices included body mass index (BMI), body adiposity index (BAI), the waist-to-height ratio (WHtR), the waist-to-hip ratio (WHpR), and waist and hip circumferences (WC and HC). Logistic regression was employed to calculate the odds ratio (OR) and 95% confidence intervals (CI) per standard deviation (SD) increment. The operating characteristic analysis was used to derive the best cut-off value for each index.

Results: Among original 6504 participants, 2450 subjects who had no cardiovascular diseases (CVD) and HTN at baseline were revisited, and 542 (22.1%) new cases of HTN were detected. There were minimal differences between most indices in the adjusted models; however, the best HTN predictors were BMI (OR per SD 1.32; 95% CI 1.12-1.56) and almost equally WC (1.35; 1.13-1.60) in men and WC (1.20; 1.04-1.39) in women. As a binary predictor, BMI with a cut-off point of 24.9 kg/m2 in men (1.91; 1.40-2.62) and WC with a cut-off point of 98 cm in women (1.57; 1.17-2.10) were the best in adjusted models. WC, WHpR, and WHtR were significantly associated with an increased risk of HTN only in participants whose weight was normal (BMI, 18.5-24.9 kg/m2).

Conclusion: Therefore, BMI in men and WC in women were the best predictors of HTN, both as continuous and binary factors at their appropriate cut-off points.
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http://dx.doi.org/10.14744/AnatolJCardiol.2019.10594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683211PMC
June 2019

The association between the serum 25-hydroxyvitamin D level and cardiovascular events in individuals with and without metabolic syndrome.

ARYA Atheroscler 2018 Nov;14(6):254-259

Professor, Department of Cardiology, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Previous studies revealed that the level of 25-hydroxyvitamin D [25(OH)D] could be consider as one the risk factors for the occurrence of cardiovascular diseases (CVDs). This study aimed to evaluate the relationship between serum 25(OH)D level and CVD events in individuals with and without metabolic syndrome (MetS) in an Iranian population.

Methods: In this nested case-control study conducted as a part of the Isfahan Cohort Study (ISC), 55 patients with CVD events were selected as case group, and 55 sex- and age-matched individuals without CVD events as control group. These participants were divided into the two main groups based on the presence of MetS at baseline.

Results: The level of 25(OH)D in individuals with and without MetS was significantly lower among patients with CVD compared to those without CVD events at the baseline of study and after the follow-up (P = 0.036 and P = 0.039, respectively). The level of 25(OH)D significantly decreased risk of incidence of CVD events in individuals without MetS after adjusting for age, sex, nutrition, and exposure to sunlight [0.19 (0.05-0.73); P = 0.016]. There was not any significant relationship between the amount of 25(OH)D at the baseline and CVD events in individuals with MetS.

Conclusion: In individuals with MetS, the level of 25(OH)D is not related to CVD events; as MetS directly influence the pathophysiology of mechanisms which are responsible for CVD events, and maybe this effect obscure the effect of 25(OH)D.
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http://dx.doi.org/10.22122/arya.v14i6.1703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527149PMC
November 2018

Total Daily Physical Activity and the Risk of Parkinsonism in Community-Dwelling Older Adults.

J Gerontol A Biol Sci Med Sci 2020 03;75(4):702-711

Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois.

Background: Physical activity is a modifiable risk factor associated with health benefits. We hypothesized that a more active lifestyle in older adults is associated with a reduced risk of incident parkinsonism and a slower rate of its progression.

Methods: Total daily physical activity was recorded with an activity monitor in 889 community-dwelling older adults participating in the Rush Memory and Aging Project. Four parkinsonian signs were assessed with a modified motor portion of the Unified Parkinson's Disease Rating Scale and summarized as a categorical measure and continuous global parkinsonian score. We used Cox models to determine whether physical activity was associated with incident parkinsonism and linear mixed-effects models to examine if physical activity was associated with the rate of progressive parkinsonism.

Results: During an average follow-up of 4 years, 233 of 682 (34%) participants, without parkinsonism, developed incident parkinsonism. In Cox models controlling for age, sex, and education, a higher level of physical activity was associated with a reduced risk of developing parkinsonism (hazard ratio = 0.79; 95% CI = 0.70-0.88, p < .001). This association was not attenuated when controlling for cognition, depressive symptoms, Apolipoprotein E ℇ4 allele, and chronic health conditions. In a linear mixed-effects model including all participants (N = 889) which controlled for age, sex, and education, a 1 SD total daily physical activity was associated with a 20% slower rate of progression of parkinsonism.

Conclusion: Older adults with a more active lifestyle have a reduced risk for parkinsonism and a slower rate of its progression.
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http://dx.doi.org/10.1093/gerona/glz111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328202PMC
March 2020

A 10-year Isfahan cohort on cardiovascular disease as a master plan for a multi-generation non-communicable disease longitudinal study: methodology and challenges.

J Hum Hypertens 2019 11 1;33(11):807-816. Epub 2018 Nov 1.

Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.

A 10-year longitudinal population-based study entitled Isfahan Cohort Study (ICS) was conducted in 2001-2011 with cardiovascular disease (CVD) as the primary outcome. We considered ICS as a master plan for a multi-level non-communicable disease (NCD) study named Isfahan Cohort Study 2 (ICS2). ICS2 is a multi-generation 10-year cohort study with new goals and outcomes that have been started in 2013, recruiting a sub-sample of ICS (n = 1487) and a new recruited sample (n = 1355) aged 35 years and over, all living in urban and rural areas of two counties in central Iran. In addition, 2500 of participant's adult children were selected randomly, as well as 1000 of their grandchildren. The aim of ICS2 is to detect the incidence of some NCDs including CVD, cancers, and diabetes and to identify the impact of their behavioral, metabolic, environmental, and genetic risk factors. In addition, studying lifestyle behaviors in three generations in a hierarchical manner of parents, their children and grandchildren in ICS2 will improve our knowledge on other determinants such as epigenetics of NCDs.
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http://dx.doi.org/10.1038/s41371-018-0126-2DOI Listing
November 2019

Sex differences in Alzheimer's disease and common neuropathologies of aging.

Acta Neuropathol 2018 12 17;136(6):887-900. Epub 2018 Oct 17.

Rush Alzheimer's Disease Center, Rush University Medical Center, 1750 W Harrison, Suite 1000, Chicago, IL, USA.

Alzheimer's dementia is significantly more common in women than in men. However, few pathological studies have addressed sex difference in Alzheimer's disease (AD) and other brain pathologies. We leveraged postmortem data from 1453 persons who participated in one of two longitudinal community-based studies of older adults, the Religious Orders Study and the Rush Memory and Aging Project. Postmortem examination identified AD pathologies, neocortical Lewy bodies, DNA-binding protein 43 (TDP-43), hippocampal sclerosis, gross and micro infarcts, atherosclerosis, arteriolosclerosis, and cerebral amyloid angiopathy. Linear and logistic regressions examined the association of sex with each of the pathologic measures. Two-thirds of subjects were women (n = 971; 67%), with a mean age at death of 89.8 (SD = 6.6) years in women and 87.3 (SD = 6.6) in men. Adjusted for age and education, women had higher levels on a global measure of AD pathology (estimate = 0.102, SE = 0.022, p < 0.001), and tau tangle density in particular (estimate = 0.334, SE = 0.074, p < 0.001), and there was a borderline difference between women and men in amyloid-β load (estimate = 0.124, SE = 0.065, p = 0.056). In addition, compared to men, women were more likely to have more severe arteriolosclerosis (OR = 1.28, 95% CI:1.04-1.58, p = 0.018), and less likely to have gross infarcts (OR = 0.78, 95% CI:0.61-0.98, p = 0.037), although the association with gross infarct was attenuated after controlling for vascular risk factors. These data help elucidate the neuropathologic footprint of sex difference in AD and other common brain pathologies of aging.
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http://dx.doi.org/10.1007/s00401-018-1920-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279593PMC
December 2018

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study.

Lancet 2018 05 17;391(10134):2019-2027. Epub 2018 May 17.

Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.

Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels.

Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month.

Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14-1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12-1·72) irrespective of other patient and service characteristics.

Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes.

Funding: Chest, Heart and Stroke Scotland.
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http://dx.doi.org/10.1016/S0140-6736(18)30802-XDOI Listing
May 2018

Distinct Clinical and Genetic Findings in Iranian Patients With Glycogen Storage Disease Type 3.

J Clin Neuromuscul Dis 2018 Jun;19(4):203-210

Iranian Center of Neurological Research, Neuroscience Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Glycogen storage disease type 3 (GSD-III) is a rare inherited metabolic disorder caused by glycogen debranching enzyme deficiency. Various pathogenic mutations of the AGL gene lead to abnormal accumulation of glycogen in liver, skeletal, and cardiac muscles. Here, we report distinct clinical and genetic data of Iranian patients with GSD-III.

Methods: Clinical and laboratory data of 5 patients with GSD-III were recorded. Genetic investigation was performed to identify the causative mutations.

Results: Three patients had typical liver involvement in childhood and one was diagnosed 2 years after liver transplantation for cirrhosis of unknown etiology. Four patients had vacuolar myopathy with glycogen excess in muscle biopsy. All patients had novel homozygous mutations of the AGL gene namely c.378T>A, c.3295T>C, c.3777G>A, c.2002-2A>G, and c.1183C>T.

Conclusions: This is the first comprehensive report of patients with GSD-III in Iran with 2 uncommon clinical presentations and 5 novel mutations in the AGL gene.
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http://dx.doi.org/10.1097/CND.0000000000000212DOI Listing
June 2018

ε2ε4 genotype, incident AD and MCI, cognitive decline, and AD pathology in older adults.

Neurology 2018 06 11;90(24):e2127-e2134. Epub 2018 May 11.

From Rush Alzheimer's Disease Center (S.O., A.S.B., L.Y., J.F., C.G., J.A.S., D.A.B.) and Departments of Neurological Sciences (A.S.B., L.Y., J.A.S., D.A.B.) and Pathology (J.F., J.A.S.), Rush University Medical Center, Chicago, IL; Shariati Hospital (S.O.), Tehran University of Medical Sciences, Iran; Department of Geriatrics (J.F.), University of Sao Paulo Medical School, Brazil; University Hospital (V.H.), University of Western Ontario, London, Canada; Broad Institute (P.L.D.J.), Cambridge, MA; Center for Translational & Systems Neuroimmunology (P.L.D.J.), Department of Neurology, Columbia University Medical Center, New York, NY.

Objective: To examine the association of the ε2ε4 genotype with incident Alzheimer disease (AD), mild cognitive impairment (MCI), cognitive decline, and AD pathology in older adults.

Methods: We used data from 2,151 older adults of European ancestry who were free of dementia at baseline and underwent structured annual clinical evaluation in a longitudinal study for incident AD and MCI, and cognitive decline. Postmortem examination in decedents documented pathologic AD and quantified β-amyloid and neurofibrillary tangles. Participants were stratified into 4 groups based on genotyping: ε2ε4, ε4 (ε4ε4, ε4ε3), ε2 (ε2ε2, ε2ε3), with ε3ε3 carriers serving as the reference group. We used Cox proportional hazards models to examine the association of genotype with incident AD and MCI. Linear mixed-effect models were used to examine the association with cognitive decline. Logistic and linear regression models were used to examine AD pathology. All the models controlled for age, sex, and education.

Results: Of the 2,151 participants included in this study, ε2ε4 accounted for 2.1%, ε3/4 and 4/4 21.8%, ε2/3 and 2/2 14.0%, and ε3ε3 62.1%. We did not observe a difference in the risk of AD for ε2ε4 compared to ε3ε3. In cases without cognitive impairment at baseline, ε2ε4 carriers had an increased risk of incident MCI (hazard ratio 2.13, 95% confidence interval 1.34-3.39, = 0.002) and a faster rate of cognitive decline (estimate -0.047, SE 0.018, = 0.008) compared to ε3ε3 carriers. In decedents (n = 1,100), ε2ε4 showed a 3-fold increased odds of pathologic AD and a higher β-amyloid load than ε3ε3.

Conclusion: ε2ε4 genotype in older adults is associated with risk of MCI, cognitive decline, and a greater burden of AD pathology, especially β-amyloid.
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http://dx.doi.org/10.1212/WNL.0000000000005677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5996834PMC
June 2018

Ten-year trend in stroke incidence and its subtypes in Isfahan, Iran during 2003-2013.

Iran J Neurol 2017 Oct;16(4):201-209

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

As there was no evidence of long-term studies on stroke trend, stroke subtypes and its relationships to stroke risk factors and demographic characteristics in Iran, we aimed to evaluate the 10-year trend of stroke incidence and stroke subtypes in Isfahan, Iran. In a hospital-based retrospective study, 24186 cases with the first-ever stroke were analyzed. We assessed the incidence trend of annual stroke and its subtypes [ischemic stroke (IS) subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH)] during the years 2003 to 2013 by sex, and studied the association of demographic and major stroke risk factors with incidence and mortality rate of stroke. The mean age was 69.46 ± 14.87 years, and 49.29% of patients were women. IS was the most frequent type among all the types of strokes (76.18%). Stroke and its subtypes had decreasing incidence trend during the study period, except for SAH that increased. In addition, stroke and its subtypes had decreasing mortality trend during the study period, except for SAH that did not change anymore. Stroke mortality and incidence rates were lower in urban inhabitants compared to residents of rural areas [odds ratio (OR) = 0.763, P < 0.001]. Despite the relatively high incidence of stroke over the study period, the incidence rate of stroke, especially ICH subtype, had a decreasing trend over the last decade in Isfahan. However, given the current young population in Iran, we can expect that the incidence of stroke would have an escalating trend in future.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937006PMC
October 2017

Risk and Age of Cardiovascular Event in Women with Metabolic Syndrome: Menopause Age in Focus.

Metab Syndr Relat Disord 2018 04 13;16(3):127-134. Epub 2018 Feb 13.

1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences , Isfahan, Iran .

Background: There is still a controversy about the causal relationship between menopause status and cardiovascular disease (CVD). The present study aimed to evaluate whether premature menopause would predict higher risk and lower the age of CVD occurrence and how this differs in women with metabolic syndrome (MetS).

Methods: Using a population-based Isfahan Cohort Study (ICS), 1154 postmenopause women were followed up from 2001 to 2013 for any CVD occurrence. Cox proportional hazards regression analyses were used to estimate the association between menopause age of (≤45, 46-50, 51-55, ≥56 years) and CVD incidence. The menopause age group of 46-50 years was considered as reference group.

Results: During 12 years follow-up, 235 CV events were recorded. The mean age of menopause (±standard deviation) was 48.06 ± 5.48 years. The age at menopause was not predictive of total CV events, in women with and without MetS. In women without MetS, a trend with increasing incidence of stroke was observed at menopause age of ≤45 years (age adjusted hazard ratio: 4.84, 95% confidence interval: 0.99-23.5, P = 0.05). Women with menopause age of ≤45 years suffered from CV events, 5.7 years earlier than women with menopause age of ≥56 years (P = 0.11); this difference was 5.3 years in women with MetS (P = 0.4).

Conclusion: This study showed that younger age at menopause is not predictive of the occurrence of CV events. It also revealed that age at menopause is not associated with earlier CV events in postmenopause women, with and without MetS.
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http://dx.doi.org/10.1089/met.2017.0096DOI Listing
April 2018

PARS risk charts: A 10-year study of risk assessment for cardiovascular diseases in Eastern Mediterranean Region.

PLoS One 2017 19;12(12):e0189389. Epub 2017 Dec 19.

Department of Automatic Control, Biomedical Engineering Research Center, Universitat Politècnica de Catalunya, BarcelonaTech (UPC), Barcelona, Spain.

This study was designed to develop a risk assessment chart for the clinical management and prevention of the risk of cardiovascular disease (CVD) in Iranian population, which is vital for developing national prevention programs. The Isfahan Cohort Study (ICS) is a population-based prospective study of 6504 Iranian adults ≥35 years old, followed-up for ten years, from 2001 to 2010. Behavioral and cardiometabolic risk factors were examined every five years, while biennial follow-ups for the occurrence of the events was performed by phone calls or by verbal autopsy. Among these participants, 5432 (2784 women, 51.3%) were CVD free at baseline examination and had at least one follow-up. Cox proportional hazard regression was used to predict the risk of ischemic CVD events, including sudden cardiac death due to unstable angina, myocardial infarction, and stroke. The model fit statistics such as area under the receiver-operating characteristic (AUROC), calibration chi-square and the overall bias were used to assess the model performance. We also tested the Framingham model for comparison. Seven hundred and five CVD events occurred during 49452.8 person-years of follow-up. The event probabilities were calculated and presented color-coded on each gender-specific PARS chart. The AUROC and Harrell's C indices were 0.74 (95% CI, 0.72-0.76) and 0.73, respectively. In the calibration, the Nam-D'Agostino χ2 was 10.82 (p = 0.29). The overall bias of the proposed model was 95.60%. PARS model was also internally validated using cross-validation. The Android app and the Web-based risk assessment tool were also developed as to have an impact on public health. In comparison, the refitted and recalibrated Framingham models, estimated the CVD incidence with the overall bias of 149.60% and 128.23% for men, and 222.70% and 176.07% for women, respectively. In conclusion, the PARS risk assessment chart is a simple, accurate, and well-calibrated tool for predicting a 10-year risk of CVD occurrence in Iranian population and can be used in an attempt to develop national guidelines for the CVD management.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189389PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736201PMC
January 2018

Whole milk consumption and risk of cardiovascular disease and mortality: Isfahan Cohort Study.

Eur J Nutr 2019 Feb 18;58(1):163-171. Epub 2017 Nov 18.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The association between milk intake and cardiovascular disease (CVD) and mortality risk is still controversial but data from Middle-Eastern populations are scarce. We aimed to study these associations in an Iranian population.

Methods: We used the Isfahan Cohort Study, a population-based prospective study of 6504 adult Iranians. In this analysis, we included 5432 participants free of CVD at baseline with at least one follow-up. Data on whole milk intake and other dietary factors were collected by a food frequency questionnaire at baseline. Cox proportional hazard regression was used to predict risk of CVD events, comprising coronary heart disease (CHD) and stroke, and mortality according to frequency of whole milk intake with adjustment for other potential confounders.

Results: During a median 10.9 years of follow-up, we documented 705 new cases of CVD comprising 564 CHD and 141 stroke cases. Compared with non-consumers, less than daily intake of whole milk was significantly associated with lower risk of CVD (HR 0.80, 95% CI 0.65-0.97), CHD (HR 0.81, 95% CI 0.65-0.99), and a non-significant lower risk of stroke (HR 0.79, 95% CI 0.50-1.27). Daily intake of whole milk was not significantly associated with CVD (HR 1.25, 95% CI 0.89-1.75), CHD, and stroke, but was associated with higher risk of all-cause mortality (HR 1.54, 95% CI 1.04-2.29).

Conclusions: Less than daily intake of whole milk was associated with a statistically significant, although modest, lower risk of CVD compared with non-consumption, but this potential benefit may not extend to daily intake in this population.
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http://dx.doi.org/10.1007/s00394-017-1581-1DOI Listing
February 2019

Cardiovascular disease events and its predictors in women: Isfahan Cohort Study (ICS).

J Cardiovasc Thorac Res 2017 21;9(3):158-163. Epub 2017 Aug 21.

Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women. Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke. After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively). In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.
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http://dx.doi.org/10.15171/jcvtr.2017.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5670338PMC
August 2017

Enhancement of Motor Recovery through Left Dorsolateral Prefrontal Cortex Stimulation after Acute Ischemic Stroke.

J Stroke Cerebrovasc Dis 2018 Jan 8;27(1):185-191. Epub 2017 Sep 8.

Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Two previous studies, which investigated transcranial direct current stimulation (tDCS) use in motor recovery after acute ischemic stroke, did not show tDCS to be effective in this regard. We speculated that additional left dorsolateral prefrontal cortex (DLPFC) stimulation may enhance poststroke motor recovery.

Methods: In the present randomized clinical trial, 20 acute ischemic stroke patients were recruited. Patients received real motor cortex (M1) stimulation in both arms of the trial. The 2 arms differed in terms of real versus sham stimulation over the left DLPFC. The motor component of the Fugl-Meyer upper extremity assessment (FM) and Action Research Arm Test (ARAT) scores were used to assess primary outcomes, and nonlinear mixed effects models were used for data analyses.

Results: Primary outcome measures improved more and faster among the real stimulation group. During the first days of stimulations, the sham group's FM scores increased by 1.2 per day, while the real group's scores increased by 1.7 per day (P = .003). In the following days, FM improvement decelerated in both groups. Based on the derived models, a stroke patient with a baseline FM score of 15 improves to 32 in the sham stimulation group and to 41 in the real stimulation group within the first month after stroke. Models with ARAT scores yielded nearly similar results. No significant adverse effect was reported.

Conclusion: The current study results showed that left DLPFC stimulation in conjunction with M1 stimulation resulted in better motor recovery than M1 stimulation alone.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.026DOI Listing
January 2018

Mendelian Genes and Risk of Intracerebral Hemorrhage and Small-Vessel Ischemic Stroke in Sporadic Cases.

Stroke 2017 08 5;48(8):2263-2265. Epub 2017 Jul 5.

From the Population Health Research Institute, Hamilton, Ontario, Canada (M.C., S.Y., G.P.); HRB Clinical Research Facility, NUI Galway, University Hospital Galway, Ireland (M.O.); Vlaams Instituut voor Biotechnologie, Vesalius Research Center, Department of Neurology, University Hospitals KU Leuven, Belgium (V.T.); Philippine General Hospital, Manila (A.D.); Fundación Oftalmológica de Santander, Medical School, Universidad de Santander, Bucaramanga, Colombia (P.L.-J., D.G.-A.); Division of Cardiology, Uganda Heart Institute, Kampala (C.M.); 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (A.C., M.S.); Department of Pharmacology, Medical University of Warsaw, Poland (A.C., M.S.); and Iranian Center of Neurological Research, Tehran University of Medical Sciences, Iran (S.O.).

Background And Purpose: Mendelian strokes are rare genetic disorders characterized by early-onset small-vessel stroke. Although extensively studied among families with syndromic features, whether these genes affect risk among sporadic cases is unknown.

Methods: We sequenced 8 genes responsible for Mendelian stroke in a case-control study of sporadic stroke cases (≤70 years). Participants included 1251 primary stroke cases of small-vessel pathology (637 intracerebral hemorrhage and 614 small-vessel ischemic stroke cases) and 1716 controls from the INTERSTROKE study (Study of the Importance of Conventional and Emerging Risk Factors of Stroke in Different Regions and Ethnic Groups of the World).

Results: Overall, the prevalence of canonical disease-causing mutations was 0.56% in cases and 0.23% in controls (odds ratio=1.89; 95% confidence interval, 0.54-7.57; =0.33). CADASIL (Cerebral Autosomal Dominant Arteriopathies with Subcortical Infarcts and Leukoencephalopathies) mutations were more frequent among cases (0.48%) than controls (0.23%) but were not significantly associated with stroke risk (odds ratio=2.03; 95% confidence interval, 0.58-8.02; =0.27). Next, we included all rare nonsynonymous mutations to investigate whether other types of mutations may contribute to stroke risk. Overall, 13.5% of cases and 14.2% of controls were carriers of at least one rare nonsynonymous mutation among the 8 Mendelian stroke genes. Mutation carriers were not at elevated risk of stroke (odds ratio=0.93; 95% confidence interval, 0.75-1.16; =0.55).

Conclusions: In the absence of syndromic features and family history of stroke, screening for Mendelian mutations among small-vessel stroke patients is unlikely to have high diagnostic utility.
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http://dx.doi.org/10.1161/STROKEAHA.117.017322DOI Listing
August 2017

Determinants of Incident Metabolic Syndrome in a Middle Eastern Population: Isfahan Cohort Study.

Metab Syndr Relat Disord 2017 09 5;15(7):354-362. Epub 2017 Jul 5.

1 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences , Isfahan, Iran .

Background: To identify the associated risk factors with development of metabolic syndrome (MetS) in a longitudinal prospective cohort study in an Iranian population.

Methods: A total of 1994 participants, aged ≥35 years, free of MetS, diabetes, and cardiovascular disease at baseline were followed up for 7 years. Physical examination, laboratory studies, and interview about lifestyle factors were performed, and MetS was defined based on harmonized definition at both time points. Logistic regression was used to calculate odds ratio (OR) and corresponding 95% confidence interval (CI).

Results: MetS occurred in 27% of subjects with an incidence rate of 39.2 and 46.6 per 1000 person-year in men and women, respectively (P = 0.04). Among the components of MetS, triglyceride (TG) alone (OR 2.59, 95% CI 1.78-3.78) or in combination with waist circumference (WC; OR 5.01, 95% CI 3.59-7.01) was the strongest predictor of incident MetS compared to those free of components. In multivariable analysis, all components were associated with higher risk except fasting plasma glucose in both genders and high-density lipoprotein cholesterol in men. Impaired glucose tolerance was associated with two (95% CI 1.11-3.65) times increased risk in women. The multivariable adjusted OR (95% CI) of overweight and obesity was 1.68 (1.13-2.50) and 2.88 (1.73-4.78) in women and 2.46 (1.74-3.46) and 2.47 (1.38-4.43) in men, respectively. Unhealthy diet [1.57 (1.02-2.41)] and weekly Cola consumption [1.50 (1.05, 2.14)] increased the risk in women only.

Conclusions: TG and WC components showed the highest predictive values for MetS incidence, while general obesity was independently associated with it.
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http://dx.doi.org/10.1089/met.2016.0156DOI Listing
September 2017

Atherosclerosis and vascular cognitive impairment neuropathological guideline.

Brain 2017 02 21;140(2):e12. Epub 2016 Dec 21.

Department of Clinical Neurological Sciences, University Hospital, University of Western Ontario, London, ON, Canada.

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http://dx.doi.org/10.1093/brain/aww304DOI Listing
February 2017

Impaired arterial smooth muscle cell vasodilatory function in methamphetamine users.

J Neurol Sci 2016 Nov 17;370:107-111. Epub 2016 Sep 17.

Iranian Center of Neurological Research, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: Methamphetamine use is a strong risk factor for stroke. This study was designed to evaluate arterial function and structure in methamphetamine users ultrasonographically.

Methods: In a cross-sectional study, 20 methamphetamine users and 21 controls, aged between 20 and 40years, were enrolled. Common carotid artery intima-media thickness (CCA-IMT) marker of early atherogenesis, flow-mediated dilatation (FMD) determinants of endothelium-dependent vasodilation, and nitroglycerine-mediated dilatation (NMD) independent marker of vasodilation were measured in two groups.

Results: There were no significant differences between the two groups regarding demographic and metabolic characteristics. The mean (±SD) CCA-IMT in methamphetamine users was 0.58±0.09mm, versus 0.59±0.07mm in the controls (p=0.84). Likewise, FMD% was not significantly different between the two groups [7.6±6.1% in methamphetamine users vs. 8.2±5.1% in the controls; p=0.72], nor were peak flow and shear rate after hyperemia. However, NMD% was considerably decreased in the methamphetamine users [8.5±7.8% in methamphetamine users vs. 13.4±6.2% in controls; p=0.03].

Conclusion: According to our results, NMD is reduced among otherwise healthy methamphetamine users, which represents smooth muscle dysfunction in this group. This may contribute to the high risk of stroke among methamphetamine users.
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http://dx.doi.org/10.1016/j.jns.2016.09.027DOI Listing
November 2016