Do poststroke MRI findings predict the type of a subsequent stroke?
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Comment↗
Biomedical subjects
Clinton B Wright
Publications and source records attributed to Clinton B Wright.
Reported alcohol consumption and cognitive decline: The northern Manhattan study.
BACKGROUND: Moderate alcohol intake may slow cognitive decline, and both vascular and neurodegenerative mechanisms have been implicated. METHODS: We examined reported alcohol intake and cognitive decline in a community-based cohort of Hispanic, black and white individuals (n = 1,428). The role of the apolipoprotein E epsilon4 (APOE4) allele as a modifier was also studied. RESULTS AND CONCLUSIONS: Reported drinking was as follows: 300 participants (21%) were 'never' drinkers, 622 (44%) 'past' drinkers, 145 (10%) reported taking less than 1 drink weekly, 330 (23%) 1 drink weekly up to 2 daily and 31 (2%) more than 2 drinks daily. A positive relationship was seen between reported alcohol intake and cognition. Drinking less than 1 drink a week (p = 0.09), between 1 drink weekly up to 2 drinks daily (p = 0.001) and more than 2 drinks daily (p = 0.003) were associated with less cognitive decline on the modified Telephone Interview for Cognitive Status compared to never drinkers. This dose-response relationship was not modified by the presence of an APOE4 allele in a subsample.
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Extracranial internal carotid artery dissection with unusual gadolinium enhancement.
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Carotid Artery, Internal, Dissection↗
Dementia with cerebrovascular disease.
In this case study, we review the symptoms, cognitive testing, brain imaging, and brain pathology of a woman with dementia, for whom the neuropathological findings suggest a prominent contribution of cerebrovascular disease. Vascular dementia is the term commonly used for persons with dementia resulting from strokes, either clinically evident or subclinical "silent" events. "Mixed dementia" is the term used when there is an admixture of pathological findings related to Alzheimer's disease (AD) and cerebrovascular disease, as in this situation. In some cases of mixed dementia, the pathological involvement of AD may be the principal contributory cause of the cognitive symptoms, and in others, the vascular changes may give the greater contribution.
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Alcohol intake, carotid plaque, and cognition: the Northern Manhattan Study.
BACKGROUND AND PURPOSE: Moderate alcohol intake has been associated with better cognitive performance, implicating vascular and neurodegenerative processes. Few studies to clarify the importance of vascular disease have included direct measures of atherosclerosis or minority populations at higher risk of vascular disease and dementia. METHODS: The Northern Manhattan Study includes stroke-free community based Hispanic (54%), black (25%), and white (22%) participants. We performed a cross-sectional study of alcohol intake and performance on the Mini-Mental State Examination (MMSE) in subjects with sonographic measurement of maximal carotid plaque thickness and adjusted for sociodemographic and vascular risk factors. RESULTS: The median MMSE score was 27 (interquartile range 24 to 29; n=2215). Reported alcohol intake was divided into 5 groups: never (n=509), past (n=494), <1 drink/week (n=300), 1/week to < or =2 drinks/day (n=796), and >2 drinks/day (n=116). Drinking 1 drink weekly up to 2 daily was associated with better performance on the MMSE (odds ratio=1.19; 95% CI, 1.10 to 1.26) compared with nondrinkers in women (P< or =0.0001) but not in men, adjusting for sociodemographic and vascular risk factors. Maximal carotid plaque thickness (mean 1.1 mm; SD 1.2 mm) was not associated with alcohol intake and did not mediate the relationship between alcohol and cognition. CONCLUSIONS: Moderate alcohol consumption was independently associated with better cognitive performance in women from this multiethnic sample. Carotid plaque was not a mediator of this association suggesting alcohol may impact cognition through a separate vascular or degenerative pathway.
Black or African American↗
Ataxic hemiparesis from strategic frontal white matter infarction with crossed cerebellar diaschisis.
BACKGROUND: Ataxic hemiparesis is a classic lacunar syndrome that most often localizes to the pons. RESULTS: We report 3 patients who presented with left-sided ataxic hemiparesis and were found on imaging to have small right frontal subcortical white matter infarcts in similar locations by diffusion-weighted MRI. [99mTc]hexamethylpropylenamine oxime single-photon emission computed tomography (SPECT) scans in all 3 patients showed decreased metabolism in the contralateral cerebellar hemisphere, indicative of crossed cerebellar diaschisis (CCD). CONCLUSIONS: CCD is under-recognized in ataxic hemiparesis and may have implications for functional recovery after this type of ischemic stroke.
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Bi-hemispheric anterior cerebral artery with drop attacks and limb shaking TIAs.
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Total homocysteine is associated with white matter hyperintensity volume: the Northern Manhattan Study.
BACKGROUND: Total homocysteine (tHcy) has been implicated as a risk factor for stroke and dementia, but the mechanism is unclear. White matter hyperintensities may be a risk factor for both, but studies of the relationship between tHcy and quantitative measures of white matter hyperintensity volume (WMHV) are lacking, especially in minority populations. METHODS: A community-based sample of 259 subjects with baseline tHcy levels underwent pixel-based quantitative measurement of WMHV. We examined the relationship between tHcy and WMHV adjusting for age, sociodemographics, vascular risk factors, and B12 deficiency. RESULTS: Higher levels of tHcy were associated with WMHV adjusting for sociodemographics and vascular risk factors. CONCLUSIONS: These cross-sectional data provide evidence that tHcy is a risk factor for white matter damage.
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Ischemic stroke subtype incidence among whites, blacks, and Hispanics: the Northern Manhattan Study.
BACKGROUND: Stroke incidence is greater in blacks than in whites; data on Hispanics are limited. Comparing subtype-specific ischemic stroke incidence rates may help to explain race-ethnic differences in stroke risk. The aim of this population-based study was to determine ischemic stroke subtype incidence rates for whites, blacks, and Hispanics living in one community. METHODS AND RESULTS: A comprehensive stroke surveillance system incorporating multiple overlapping strategies was used to identify all cases of first ischemic stroke occurring between July 1, 1993, and June 30, 1997, in northern Manhattan. Ischemic stroke subtypes were determined according to a modified NINDS scheme, and age-adjusted, race-specific incidence rates calculated. The annual age-adjusted incidence of first ischemic stroke per 100,000 was 88 (95% CI, 75 to 101) in whites, 149 (95% CI, 132 to 165) in Hispanics, and 191 (95% CI, 160 to 221) in blacks. Among blacks compared with whites, the relative rate of intracranial atherosclerotic stroke was 5.85 (95% CI, 1.82 to 18.73); extracranial atherosclerotic stroke, 3.18 (95% CI, 1.42 to 7.13); lacunar stroke, 3.09 (95% CI, 1.86 to 5.11); and cardioembolic stroke, 1.58 (95% CI, 0.99 to 2.52). Among Hispanics compared with whites, the relative rate of intracranial atherosclerotic stroke was 5.00 (95% CI, 1.69 to 14.76); extracranial atherosclerotic stroke, 1.71 (95% CI, 0.80 to 3.63); lacunar stroke, 2.32 (95% CI, 1.48 to 3.63); and cardioembolic stroke, 1.42 (95% CI, 0.97 to 2.09). CONCLUSIONS: The high ischemic stroke incidence among blacks and Hispanics compared with whites is due to higher rates of all ischemic stroke subtypes.
Black or African American↗
Interleukin-6 is associated with cognitive function: the Northern Manhattan Study.
BACKGROUND AND PURPOSE: Inflammation has been linked to cognitive decline and dementia but the mechanism is not clear and few studies have included Hispanic and black subjects that may be at increased risk of these disorders. METHODS: We performed a cross-sectional analysis of the association between inflammatory marker levels and cognition in the stroke-free population-based cohort of the Northern Manhattan Study. Mini Mental State Exam (MMSE) scores were the continuous outcome and we adjusted for sociodemographic and vascular risk factors as well as subclinical atherosclerosis. RESULTS: Of the inflammatory markers, only interleukin (IL)-6 levels were associated with the MMSE. In univariate analysis age, hypertension, diabetes, smoking, moderate alcohol use, total homocysteine, carotid intima media thickness, and body mass index were positively associated with IL-6 levels. Hispanics compared to whites, those with less than a high school education, hypertension, cardiac disease, and total homocysteine were associated with lower MMSE scores. In a multivariate linear regression model, IL-6 was negatively associated with MMSE score adjusting for sociodemographic and vascular risk factors. CONCLUSIONS: IL-6 levels were negatively associated with performance on the MMSE in this multiethnic cohort. Adjusting for vascular disease and subclinical atherosclerosis did not attenuate the association, suggesting a direct effect on the brain.
Journal Article↗