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Andreas Terént

Publications and source records attributed to Andreas Terént.

At least 19 recordsLinked to original sources
PubMed2006

Metabolic risk factors for stroke and transient ischemic attacks in middle-aged men: a community-based study with long-term follow-up.

BACKGROUND AND PURPOSE: The impact of lipometabolic and glucometabolic disturbances on stroke incidence remains to be characterized in detail. We investigated relations of a comprehensive panel of baseline lipometabolic and glucometabolic variables to incident fatal and nonfatal stroke or transient ischemic attack (TIA), and stroke subtypes. METHODS: A community-based prospective study of 2313 middle-aged men invited to a health survey at age 50. RESULTS: During a follow-up of up to 32 years, 421 developed stroke or TIA. In Cox proportional hazards analyses adjusting for treatment with cardiovascular drugs at baseline, 1-standard deviation increases in body mass index, systolic and diastolic blood pressures, serum proinsulin, and lipoprotein(a) were associated with 11 to 35% increased risk for subsequent stroke/TIA. Electrocardiographic left ventricular hypertrophy and smoking were also associated with a higher risk for stroke/TIA. Essentially the same variables were related to brain infarction/TIA. Higher proportions of palmitic (16:0), palmitoleic (16:1), and oleic acid (18:1) in cholesterol esters were associated with an increased risk, whereas a higher proportion of linoleic acid (18:2 n-6) was protective against stroke/TIA. Further adjusting all models also for hypertension, diabetes, the metabolic syndrome, serum cholesterol, atrial fibrillation, cardiovascular disease, smoking, and physical activity, essentially the same pattern was observed. CONCLUSIONS: Indices of an unhealthy dietary fat intake and a high serum lipoprotein (a) level predicted fatal and nonfatal stroke/TIA independently of established risk factors in a community-based sample of middle-aged men followed for 32 years.

Aged↗
PubMed2006

Living setting and utilisation of ADL assistance one year after a stroke with special reference to gender differences.

PURPOSE: To examine living setting and need for ADL assistance before and one year after a first-ever stroke with special focus on gender differences. METHODS: One-year survivors from a population-based stroke study (n = 377) were studied with regard to place of living, need for ADL assistance and who provided the help. Stroke severity, cognitive impairment, post-stroke depression as well as risk factors were evaluated. RESULTS: Before the stroke 48 patients (13%) lived in special housing (service flats or nursing homes), and one year after the stroke, 50 of the survivors (20%) lived in such accommodations. Before the stroke, 80 (21%) of the patients needed help with their personal ADL, while 90 (36%) needed help after one year. The increased need was fulfilled by relatives. Female spouses more often helped their male counterparts, and they tended to accept a heavier burden. Age, living alone, stroke severity, cognitive impairment, pre-stroke ADL dependency and depression were predictors for special housing. CONCLUSIONS: In a time when more and more stroke survivors are cared for at home, it is important to pay attention to the situation of the caregivers. Female caregivers seem to be in an especially exposed position by accepting a heavier burden.

Activities of Daily Living↗
PubMed2005

Experimental treatment for focal hyperglycemic ischemic brain injury in the rat.

Hyperglycemia aggravates ischemic brain injury, possibly due to the activation of signaling pathways involving reactive oxygen species, Src and mitogen-activated protein kinases. The aim of this study was to investigate the effects of the spin trap agent alpha-phenyl-N-tert-butyl nitrone (PBN), the Src family kinase inhibitor PP2 and the MEK1-inhibitor U0126 on focal hyperglycemic ischemic brain injury. Temporary middle cerebral artery occlusion (90 min) was induced in four groups of rats (PBN, PP2, and U0126 vs. control). Neurological testing and tetrazolium red staining were performed after 1 day. PBN decreased the infarct volume by 70% compared with the control (P<0.05) and a tendency towards reduced infarcts was seen in the PP2 or U0126 groups. Furthermore, neurological testing was consistent with the volumetric analysis. In conclusion, PBN appears to be a potential neuroprotective agent in hyperglycemic, focal ischemic brain injury, while the efficacy of PP2 and U0126 could not be confirmed by the present data.

Animals↗
PubMed2005

Double-blind comparison of sertraline and placebo in stroke patients with minor depression and less severe major depression.

BACKGROUND: Poststroke depression is a frequent condition and important to treat. The aim of this trial was to study the efficacy and tolerability of sertraline. METHOD: In 4 Swedish stroke centers, 123 patients (aged 70.7 +/- 9.9 years) were enrolled during the period September 1998 to January 2001 in a randomized, double-blind, placebo-controlled 26-week trial, at a mean of 128 +/- 97 days (range, 3-375 days) after stroke, if they fulfilled DSM-IV criteria of major depressive episode (N = 76) or minor depressive disorder (N = 47). The primary efficacy variable was a change in depression assessed by the Montgomery-Asberg Depression Rating Scale. The Emotional Distress Scale (EDS) was administered and the occurrence of emotionalism and quality of life (QoL) were assessed, as well as neurologic recovery. Efficacy analyses were intention-to-treat, short-term (week 6) and long-term (week 26). RESULTS: Of the 123 patients, 62 were treated with sertraline (50-100 mg/day) and 61 with placebo. Both groups improved substantially, with no differences between the treatments, either for major depressive episode or minor depressive disorder, or for short- or long-term antidepressant effect and neurologic outcome. EDS revealed a better outcome with sertraline at week 6 (p < .05). At week 26, the improvement in QoL was better in sertraline patients (p < .05) and there was a trend for emotionalism (p = .07). No serious side effects were seen. CONCLUSION: Poststroke depression as measured by a conventional depression rating scale improved over time irrespective of treatment. Positive effects specific to sertraline were identified in emotional distress, emotionalism, and QoL. The study indicates that poststroke emotional reactions comprise depression and other domains susceptible to pharmacologic therapy.

Aged↗
PubMed2004

Cerebrovascular mortality 10 years after stroke: a population-based study.

OBJECTIVES: Cerebrovascular mortality has declined in the general population of Sweden. The objective of the present study was to investigate causes of death among stroke patients in a long-term perspective. RESEARCH DESIGN AND METHODS: A population-based study was conducted of first-ever strokes in the municipality of Söderhamn, Sweden. Standardized mortality ratios were calculated for comparison with the general population. Three time periods (1975 to 1978, 1983 to 1986, and 1987 to 1990) were analyzed. All 1186 patients were followed up for at least 10 years. RESULTS: Cerebrovascular mortality was greatly increased (more than 10-fold) in comparison with the general population during all study periods. The mortality from ischemic heart disease and some other diseases was moderately raised (3- to 8-fold), whereas the mortality from malignant disorders was normal. CONCLUSIONS: Cerebrovascular disease was the predominant cause of death among Swedish stroke patients in the 1970s and the 1980s.

Cause of Death↗
PubMed2004

Self-reported depression and use of antidepressants after stroke: a national survey.

BACKGROUND AND PURPOSE: Depression after stroke is often described as underdiagnosed and undertreated. However, there are few data on self-reported depression and use of antidepressants in stroke patients at large. MATERIALS AND METHODS: In the Swedish national quality assessment register, Riks-Stroke, 15 747 stroke survivors are recorded. They were asked about depressive mood and antidepressant treatment 3 months after stroke. Age-specific prevalence of antidepressant use after stroke was calculated. RESULTS: At 3 months after stroke, 12.4% of male and 16.4% of female stroke survivors reported that they always or often felt depressed. In a multiple logistic regression model, female sex, age younger than 65 years, living alone, having had a recurrent stroke, being dependent on others, and institutional living 3 months after stroke were independent predictors of self-reported depression. Antidepressant medication was used by 22.5% of men and 28.1% of women who had had a stroke. Of patients using antidepressant drugs, 67.5% did not report depressive mood. However, 8.4% of the entire cohort reported depressive mood but no treatment with antidepressants. When compared with the general population, approximately twice as many of the stroke patients were using antidepressant treatment. CONCLUSIONS: In this national survey, 1 in 7 patients reported that they felt depressed and the use of antidepressant drugs after stroke was common. The widespread use of antidepressants challenges the contention that antidepressants are generally underused after stroke. However, the substantial proportion reporting depressive mood but not using treatment with antidepressants suggests that patient selection for treatment should be more precise.

Aged↗
PubMed2004

[Thrombolytic therapy in acute ischemic stroke. Critical analysis of current knowledge].

Thrombolysis is a highly promising treatment in acute ischaemic stroke. There is evidence of positive effects at least up to three hours and most probably up to six. The risk of intracranial haemorrhage is increased fourfold with thrombolysis; risk factors other than the treatment as such have not been identified for certain; the risk is not related to giving thrombolysis during the 0-3 as opposed to the 3-6 hour time window. There is a non-significant excess of deaths, ranging from a small reduction to a substantial excess. There is not enough evidence to answer several questions regarding the influence of patient- and stroke characteristics on effectsize; death; and risk of intracranial haemorrhage. Giving priority to new large randomized controlled trials is essential to achieve this knowledge.

Acute Disease↗
PubMed2004

["Save the brain"-network in the county of Uppsala for thrombolytic therapy in stroke].

"Save the brain" is a network for thrombolysis of stroke in the Uppsala County, Sweden. The network involves the ambulance services, the emergency ward, and the departments of medicine and neurology. The county has 298,655 inhabitants. During one year, 2001-2002, 184 "save the brain" transports were performed. After an initial clinical examination at the emergency ward, 67 of these patients (36%) were investigated with hyperacute CT. After a second clinical examination, 13 patients (19%) received intravenous thrombolysis. The time lag from onset of symptoms to thrombolysis varied from one and a half hour to four hours.

Adult↗
PubMed2004

Cost of stroke in Sweden: an incidence estimate.

OBJECTIVES: To estimate the excess cost of stroke in Sweden and the potential costs that could be avoided by preventing first-ever strokes. METHODS: We adopted the incidence approach for estimating the present value of both direct and indirect costs. Data on mortality, stroke recurrence, and inpatient care were estimated from a national register of patient data with a four-year follow-up period. To estimate costs for social services, we used survey data on living conditions before stroke onset and at three and at twenty-four months. Costs for outpatient visits, rehabilitation, drugs, and production losses due to premature death and early retirement were estimated on the basis of both published and nonpublished sources. Lifetime costs were based on life tables adjusted for excess mortality of stroke, and costs in year 4 were extrapolated to subsequent years. RESULTS: The present value direct cost for an average stroke patient is SEK513,800 (USdollars 56,024 or Euro60,825). The corresponding indirect cost is SEK125,110 (USdollars13,640 or Euro14,810). Almost 45 percent of the direct costs were attributable to social services. Women had higher costs than men, and costs for survivors increased with age due to social services. CONCLUSIONS: With an incidence of 213 first-ever strokes per 100,000 individuals, the total excess direct and indirect cost of stroke would be SEK12.3 billion (approximately US$1.3 billion or Euro1.5 billion). Hence, there are large potential cost offsets both in the health-care sector and in the social service sector if the incidence of first-ever stroke could be reduced.

Adult↗
PubMed2003

[Drug therapy after stroke should be evidence-based. Organizational, economic and ethical decisions direct the choice of treatment].

Five types of drug therapy can be considered after stroke: antiplatelet therapy, anticoagulation with heparin or warfarin, blood-pressure-lowering therapy with ACE-inhibitors and diuretics, and finally cholesterol-lowering with statins. Aspirin therapy is the best-documented treatment to avoid another stroke, both in the acute and the long-term perspective. Warfarin treatment is fairly well documented for stroke patients with atrial fibrillation. Heparin therapy increases the risk for serious haemorrhage. Blood-pressure-lowering with a combined ACE-inhibitor and diuretic regimen has been shown to reduce the recurrence rate in younger patients with hemorrhagic as well as ischemic stroke. Statin therapy could be offered to younger stroke patients with a history of coronary heart disease. The increased occurrence of malignant diseases during statin therapy in elderly patients in one study deserves further investigations.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2003

Characteristics of the National Institute of Health Stroke Scale: results from a population-based stroke cohort at baseline and after one year.

BACKGROUND: The National Institute of Health Stroke Scale (NIHSS) results at baseline and after 1 year have never before been accounted for within an unselected population-based stroke sample. Neither has it been shown which individual items in the scale are the most important ones for the outcome in terms of death or dependency after 1 year. METHODS: The subjects were all patients within a municipality who had their first-ever non-subarachnoidal stroke during 1 year (n = 377). Impairment was evaluated at baseline (within 24-48 h) and after 1 year with the 15-item version of the NIHSS. At the 1-year follow-up, the Modified Rankin Scale was used in order to determine which patients were dependent. Predictors of death and dependency were analysed in logistic regression models. The different NIHSS items, age and gender were used as independent variables. RESULTS: The median NIHSS score was 6 (interquartile range 3-12) at baseline and 1 (interquartile range 0-3) at the 1-year follow-up, when 33% of the patients had died. Of patients scoring less than 4 on baseline NIHSS, 75% were functionally independent after 1 year. Seventeen per cent were functionally dependent and 8% were dead. Independent predictors of death were: age, questions, commands, gaze, alertness and sensation. Independent predictors of dependency were: age, commands, alertness and motor leg. CONCLUSIONS: Baseline NIHSS predicts the outcome after 1 year at the group level. Age and any reduction of the level of consciousness on arrival were associated with bad outcome after 1 year.

Aged↗
PubMed2003

Sex differences in management and outcome after stroke: a Swedish national perspective.

BACKGROUND AND PURPOSE: It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective. METHODS: In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses. RESULTS: Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4). CONCLUSIONS: Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.

Aged↗
PubMed2003

Trends in stroke incidence and 10-year survival in Söderhamn, Sweden, 1975-2001.

BACKGROUND AND PURPOSE: Stroke mortality rates have declined in many countries. Stroke incidence rates have also declined, but not to the same extent and not always in parallel with stroke mortality. The aim of the present study was to investigate trends in stroke incidence and long-term survival in a Swedish population. METHODS: A population-based survey of the incidence of first-ever stroke was performed prospectively in the periods 1975 to 1977, 1983 to 1986, and 1987 to 1990. Case fatality ratios and survival rates were followed to 2001. RESULTS: Crude incidence rates increased between 1975 to 1977 and 1983 to 1986, but age- and sex-adjusted incidence rates were stable during the whole period of 1975 to 1990. The incidence of intracerebral hemorrhage decreased by approximately two thirds, whereas the incidence of mild brain infarction almost doubled. The case fatality ratio at 28 days did not change, but the 10-year survival ratio increased from 13% to 35%. Mean survival time increased significantly among patients with intracerebral hemorrhage and brain infarction but not among patients with subarachnoidal hemorrhage or stroke of undetermined origin. CONCLUSIONS: Stroke incidence and short-term case fatality did not change between 1975 and 1990 in the Söderhamn population. Long-term survival after stroke, on the other hand, has continued to improve to 2001. The implication of these changes is that the burden of stroke is likely to increase unless strokes are becoming less severe.

Adolescent↗
PubMed2003

A model for costs of stroke services.

In industrialised countries, stroke is one of the most common causes of death and handicap, and the costs for stroke services are high. However, rational planning of stroke services and estimation of the costs of their provision are complex, even when generic pathways for stroke diagnosis and treatment are well understood. The reason is the chronic nature of cerebro-vascular disease and the cumulative effect of disabling brain injury. In this paper we describe development of a computer model for estimating the costs of stroke services, intended for use by planners and purchasers of stroke care services. The model operates by incrementing patients' experience of stroke events and their outcomes in annual steps, and is calibrated using Swedish data. We demonstrate the cost consequences by simulating three different policy changes. The model facilitates comparisons between stroke prevention, treatment and rehabilitation, and we conclude that by combining the three policy options it is possible to reduce the costs for stroke services markedly.

Adult↗
PubMed2003

Riks-stroke - a Swedish national quality register for stroke care.

BACKGROUND: Riks-Stroke, the Swedish national quality register on stroke care, provides unique opportunities to evaluate stroke units in routine clinical care. METHODS: Basic patient characteristics, process indicators and outcome variables are recorded in all 85 hospitals admitting acute stroke patients. A 3-month follow-up is included. RESULTS: There are wide variations between hospitals in the proportion of patients admitted to a stroke unit, in secondary prevention and in the proportion of patients in institutional care at 3 months. Even after adjustment for available prognostic indicators, case fatality is lower and functional outcome is better in patients treated in stroke units than in patients treated in general wards. CONCLUSION: Riks-Stroke shows that outcome is consistently better in patients treated in a stroke unit than in general wards, not only in randomised trials but also in routine stroke care.

Health Services↗
PubMed2002

[Early thrombolysis indicated in threatened cerebral infarction. A study of 60 patients treated at Akademiska sjukhuset in Uppsala].

Results of the routine use of tissue plasminogen activator (tPA) within 3 hours of an acute ischemic stroke have been reported from the United States, Canada and Germany. Published reports from other countries and from centers using tPA within a wider timeframe are limited. 60 patients in a Swedish University Hospital were treated with i.v. tPA within 6 hours of onset of acute ischemic stroke symptoms. Two patients suffered more extensive parenchymal intracerebral hemorrhages, of which one required surgery and one died. At 3 months, 47% were independent, 35% dependent and 18% deceased. Due to the relatively low number of patients in this series, data should be cautiously interpreted, but the results are comparable to those of large randomized controlled trials and published phase 4 studies. The risk of tPA treatment after 3-6 hours does not seem to be significantly increased as compared to treatment within 3 hours.

Acute Disease↗