Biomedical subjects

R Sulkava

Publications and source records attributed to R Sulkava.

At least 19 recordsLinked to original sources

PubMed2005

Neurologic symptoms are common during gestation and puerperium in CADASIL.

Based on a structured questionnaire and medical records, the authors found that 12 of 25 mothers with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with the R133C NOTCH3 mutation had had neurologic symptoms in 17 of their 43 pregnancies, most commonly hemiparesthesia (76%), hemiparesis (36%), aphasia (65%), and visual disorders (47%). In 82% of the patients, the symptoms were the first manifestation of CADASIL. The symptoms were most common during puerperium and in patients older than age 30.

Adult↗

PubMed2005

Cerebral amyloid angiopathy in a 95+ cohort: complement activation and apolipoprotein E (ApoE) genotype.

There is growing evidence that in Alzheimer's disease (AD) amyloid beta-protein (Abeta) triggers a chronic inflammatory reaction in cerebral amyloid plaques, including complement proteins. Abeta also accumulates cerebrovascularly in age- and AD-associated cerebral amyloid angiopathy (CAA). We investigated complement proteins in CAA in a population-based series using histological and immunohistochemical staining methods. The 74 subjects, aged 95 years or more, had undergone clinical neurological examination and apolipoprotein E (ApoE) genotyping. The brains had been studied for AD post-mortem, allowing us to relate the histopathological findings to clinical and genetic conditions. CAA with congophilic amyloid was found in 36/74 individuals (48.6%). The vascular amyloid deposits immunoreacted with antibodies to Abeta and complements 3d (C3d) and 9 (C9). The positivity in complement stains increased with growing severity of CAA (P = 0.001). The presence of CAA associated with ApoE epsilon4 (P = 0.0005) and overrepresentation of epsilon4 among those with moderate or severe vs. mild CAA (P = 0.03) was demonstrated. The presence of CAA associated with dementia (P = 0.01), which was contributed by both epsilon4+ (P = 0.02) and epsilon4- (P = 0.06) subjects. Our study shows that complement proteins are deposited in the affected vessels in Abeta-associated CAA. They may solely represent the cerebral Abeta- burden associated to inflammatory stimuli, or signal a contribution in the clearance of cerebral Abeta, thereby contributing to the events associated with evolution of clinical dementia. Our results demonstrate a strong association between CAA and ApoE epsilon4 as well as dementia and suggest that the contribution of CAA to dementia is largely independent of ApoE epsilon4.

Aged, 80 and over↗

PubMed2005

Capability for daily activities in old people with rheumatoid arthritis: a population based study.

OBJECTIVE: To describe the functional capacity for daily activities in old people with clinical rheumatoid arthritis (including juvenile rheumatoid arthritis (JRA)) in a population based cohort. METHODS: A cohort of 700 people was randomly collected from the population older than 75 years in a Finnish town. Altogether 601 persons (86%) participated. Data were collected from clinical records and by interview, clinical examination, and questionnaire. Ability to carry out activities of daily living (ADL) was assessed by the Barthel index, and the IADL (instrumental activities of daily living) by the Lawton and Brody questionnaire. RESULTS: 16 people had clinical rheumatoid arthritis (one with JRA). The prevalence was 16/601 (2.7% (95% confidence interval, 1.7% to 4.5%)). Eight patients with rheumatoid arthritis (50%) obtained the best possible ADL figures, while three (19%) had very poor results. Seven (44%) could not dress themselves without help. Three (19%) were unable to walk, and five (31%) could not climb stairs. Sex and age adjusted results showed no statistical difference (ADL and IADL) between patients with clinical rheumatoid arthritis and rest of the cohort. Four patients (25%) had dementia, which was associated with the poor functional capacity. CONCLUSIONS: The prevalence of the disease was unexceptional. The ability of old people with rheumatoid arthritis to carry out activities of daily living did not differ from the general population, but the disease may lead to severe disability on an individual level, especially when associated with dementia. It therefore remains a considerable challenge to the health care and social systems.

Activities of Daily Living↗

PubMed2003

Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older.

OBJECTIVE: To estimate the prevalence of dementia with Lewy bodies (DLB) according to the consensus criteria in a general population aged 75 years or older. METHODS: The "Kuopio 75+ study" is a population based health survey focused on the clinical epidemiology of dementia and functional capacity among elderly subjects aged 75 years or older. On 1 January 1998, a random sample of 700 subjects was drawn from a total population born before 1 January 1923, living in the city of Kuopio, northeast Finland (n = 4518). The study subjects underwent a structured interview and clinical examination. RESULTS: 601 elderly subjects (86% of the random sample) were examined. A dementia disorder was diagnosed in 137-a prevalence of 22.8% (95% confidence interval 19.4% to 26.2%). The prevalence of DLB was 5.0% (3.2% to 6.7%), comprising 22% of all demented subjects. Probable DLB was diagnosed in 20 subjects (3.3% (1.9% to 4.8%)), and possible DLB in 10 (1.7% (0.6% to 2.7%)). The prevalence of Alzheimer's disease was 10.6% (47% of all demented subjects), of vascular dementia, 5.3% (23%), and of other types of dementing disorders, 1.8% (8%). CONCLUSIONS: In a general population aged 75 years and older, the prevalence of a disorder fulfilling the diagnostic criteria of DLB is half that of Alzheimer's disease and the same as for vascular dementia.

Aged↗

PubMed2002

Randomized, double-blind, clinically controlled trial of intranasal calcitonin treatment in patients with hip fracture.

The objective of this study was to evaluate the short-term outcome of intranasal calcitonin treatment of elderly hip fracture patients on pain, bone loss, functional recovery, and length of hospital stay. In addition, we wanted to compare the effect of calcitonin with placebo on fusion of hip fractures treated with internal fixation using a screw or a nail. In a randomized, double-blind, clinically controlled trial, 260 independently living patients (aged 65 years or older) with acute hip fracture were randomly assigned to intranasal calcitonin 200 IU daily for 3 months or matching placebo nasal spray. Analyses were completed on an intention-to-treat basis. Three months after the operation, the median intensity of pain in visual analog scale was 0 mm (IQR 0.20) in the calcitonin group and 4 mm (IQR 0.33) in the placebo group (P = 0.15). The mean change in calcaneal bone mineral density from baseline to 3 months was not statistically significant between the groups -0.004 (95% CI -0.008 to -0.001) in the calcitonin group and -0.007 (95% CI -0.012 to -0.003) in the placebo group (P = 0.28). There were no significant differences in mortality, side effects, length of hospital stay, and functional recovery. Among patients with internal fixation using a screw or a nail (n = 99), fusion of the fracture was observed in an X-ray 3 months after the operation in 84% in the calcitonin group and in 63% in the placebo group (P = 0.029, difference 20% [95% CI 2 to 39]). We conclude that intranasal calcitonin might be useful for hip fracture patients but the clinical significance of this finding needs to be confirmed by studies with more participants, a longer treatment period, a longer follow-up, and perhaps a higher dose of calcitonin.

Activities of Daily Living↗

PubMed2002

Contribution of APOE promoter polymorphisms to Alzheimer's disease risk.

OBJECTIVE: To determine whether the effects of APOE promoter polymorphisms on AD are independent of the APOE-epsilon4 allele. BACKGROUND: Recently, the -491 A-->T and -219 G-->T polymorphisms located in the APOE promoter have been suggested to be risk factors for AD. However, the effects of these polymorphisms have not always been reproduced in case-control studies, possibly because of the strong linkage disequilibrium existing at this locus or the characteristics of the populations studied. METHODS: Data collection was performed from six independent samples (1,732 patients with AD and 1,926 control subjects) genotyped for APOE exon 4 and the two APOE promoter polymorphisms. The risks associated with the APOE polymorphisms for developing AD were estimated using logistic regression procedures and calculation of odds ratios with 95% CI adjusted by age, sex, and collection center. Independence of the APOE promoter polymorphisms was tested by stratification for APOE-epsilon4 and tertile design was used for age stratification. RESULTS: The independence of the -491 AA genotype was observed in the whole sample whereas the independence of the -219 TT genotype was observed only in the oldest population. CONCLUSION: The -491 and -219 APOE promoter polymorphisms incur risk for AD in addition to risk associated with the APOE-epsilon4 allele, with age accentuating the effect of the -219 TT genotype. Because these polymorphisms appear to influence apoE levels, these results suggest that APOE expression is an important determinant of AD pathogenesis.

Aged↗

PubMed2002

Effects of a group-based exercise program on the mood state of frail older women after discharge from hospital.

BACKGROUND: Older people with somatic illnesses are at increased risk of depression. It is not known whether exercise alleviates depressive symptoms in frail, very old people recuperating from an acute illness. OBJECTIVE: To determine the effects of a group-based exercise training program on mood. METHODS: Sixty-eight women (mean age 83.0, SD 3.9 years) who were hospitalized due to an acute illness, and were mobility impaired at admission, were randomized into group-based 10-week strength training intervention (N=34) and home exercise control (N=34) groups. Twenty-four women in the training and 28 in the control group completed the follow-up. Measures of mood state with the Zung Self-Rating Depression Scale (ZSDS) were performed before and after the training intervention, and follow-up data was collected 3 and 9 months after the end of the intervention. RESULTS: After the intervention, there was a significant improvement in mood in the intervention group compared to the home exercise control group: -3.1 (SD 9.0) points vs +1.3 (SD 7.6) points (p=0.048) and the positive effect was still apparent three months after the intervention ceased: -2.6 (SD 7.7) points vs +3.5 (SD 9.7) points (p=0.015). Improvement of mood state at the first follow-up measurement was associated with the improvement in lower limb isometric muscle strength. CONCLUSIONS: Group-based exercise program organized in the context of a Finnish health care organization improved mood in frail older women recuperating from an acute illness.

Acute Disease↗

PubMed2002

Emotional reactions and life changes of caregivers of demented patients when home caregiving ends.

Many studies indicate that the cessation of caregiving of demented patients has positive effects on caregivers' lives but contradictory findings have also been reported. The aim of this study was to investigate how the caregivers of demented patients experienced the cessation of caregiving, how caregivers' lives changed after this event, and which factors predicted emotional reactions and life changes. Data were collected from 64 caregivers of demented patients, recruited from a previous controlled intervention study. The semi-structured telephone interviews sought (1) sociodemographic data, (2) emotional reactions the caregivers recalled from the point of cessation of caregiving, and (3) life changes experienced after that time point. At the point of cessation of caregiving, spouse caregivers had higher risk for loneliness, depressive feelings and sorrow than non-spouse caregivers. Feelings of relief were associated with non-spouses. Community care support obtained during the previous intervention study had protected the caregivers from loneliness, depressive feelings and sorrow. After the end of caregiving, spouse caregivers tended to experience more negative life changes. The increased number of leisure activities was associated with the support during community care.

Aged↗

PubMed2001

Prevalence of Alzheimer's disease in very elderly people: a prospective neuropathological study.

BACKGROUND: No previous autopsy-controlled, prospective, and population-based studies are available on the prevalence of AD in very elderly people. OBJECTIVE: To study the point prevalence of neuropathologically defined AD in a population of people at least 85 years of age, stratified according to their APOE genotype. METHODS: A population-based sample of 532 (of a total population of 601) elderly Finnish individuals, aged 85 years or more, were clinically tested for dementia in 1991 (with follow-up studies of the survivors in 1994, 1996, and 1999) and genotyped for APOE. An autopsy involving neuropathologic diagnosis of AD according to modified consensus criteria was performed in 118 of 198 deceased subjects who had been demented on April 1, 1991, and in 62 of 201 nondemented individuals. RESULTS: The prevalence of neuropathologically defined AD was 33%, whereas the prevalence of clinically diagnosed AD was 16%. There was a highly significant (p < 0.001) association between the APOE epsilon4 allele and AD: Sixty-three percent of APOE epsilon4 carriers and 20% of noncarriers had neuropathologic AD. The respective figures in subjects aged 90 years or more were 71 and 22%. CONCLUSIONS: The prevalence of neuropathologically defined AD is higher than that reported in most previous studies based on clinical diagnosis. The discrepancy between the neuropathologic and clinical diagnoses of AD in very elderly subjects may affect the results of population-based studies. The APOE genotype has a strong effect on the prevalence of neuropathologically defined AD, even after 90 years of age.

Aged↗

PubMed2001

Delirium in the non-demented oldest old in the general population: risk factors and prognosis.

BACKGROUND: The oldest old are prone to develop delirium. Studies into risk factors for delirium have been carried out predominantly in younger age groups. The aim of this population-based follow-up study was to investigate the risk factors for delirium requiring medical attention and subsequent prognosis in the non-demented general population aged > or = 85 years. METHOD: The study included the non-demented subjects in the population-based Vantaa 85+ study. After the 3-year observation period, 199 subjects (91% of those surviving) were re-examined and their medical records were evaluated for episodes of delirium. The subjects were followed up with respect to mortality for another 2 years. RESULTS: During the 3-year observational period, 20 subjects (10%) had been diagnosed as having had an episode of delirium. A Mini-Mental State Examination score of < 24 (odds ratio (OR) 3.44, confidence interval (CI = 95%) 1.27-9.32) and high systolic blood pressure (OR 3.08, CI 1.08-8.79) were identified as independent risk factors for delirium. The association between the delirium episode and a new diagnosis of dementia was significant ( p = 0.001). The mortality rate was greater among those subjects who experienced delirium than among subjects without this syndrome ( p = 0.008). CONCLUSIONS: Mild cognitive impairment and high systolic blood pressure were found to be risk factors for delirium requiring medical attention in the general non-demented population aged > or = 85 years. The study also highlights the significant association between delirium and a new dementia diagnosis in this age group.

Aged↗

PubMed2001

Relation of collagen type I alpha 1 (COLIA 1) and vitamin D receptor genotypes to bone mass, turnover, and fractures in early postmenopausal women and to hip fractures in elderly people.

Background: In a previous study, we showed an association between the vitamin D receptor (VDR) gene BsmI restriction fragment polymorphism and peak bone mass in young Finnish adults. Design: The previous finding prompted us to study the relationship of the same polymorphism, as well as of the polymorphism in the Sp1 binding site of the collagen type I alpha 1 (COLIA 1) gene, to bone mineral density (BMD). BMD was measured by dual-energy X-ray absorptiometry and adjusted for age, weight, height, and lifestyle factors. Also studied was the relationship of VDR and COLIA 1 genotypes to markers of bone turnover [serum osteocalcin, type I procollagen carboxy- (PICP), and aminoterminal (PINP) propeptide, and type I collagen carboxyterminal telopeptide (ICTP)] and bone fractures in 513 early postmenopausal women (1-5 years postmenopausal), as well as hip fractures in 172 very old people. Results: The BB, Bb, and bb genotypes of the VDR gene, as well as the SS, Ss, and ss genotypes of the COLIA 1 gene, were distributed similarly among 402 early postmenopausal women with osteopenia in the lumbar spine and among 111 women with normal BMD (P=0.12 for VDR, P=0.53 for COLIA 1). There was no relation between the VDR and COLIA 1 genotypes and lumbar spine BMD among osteopenic women, among normal women, or in the combined study population. Among the women with vertebral osteopenia, the femoral neck BMD did not associate significantly with the VDR or COLIA 1 polymorphisms. The frequencies of the different VDR and COLIA 1 genotypes were similar among women with or without a history of a low-energy fracture. There was a borderline association between the VDR genotype and serum osteocalcin concentrations, with the Bb genotype associated with the highest median level (P=0.037). In a population-based sample of very old individuals (>85 years), the frequencies of the different VDR and COLIA 1 genotypes were similar among those with (n=64) and without (n=108) a history of hip fracture. Conclusion: The present data suggest that, in the Finnish population, the VDR and COLIA 1 genotypes do not determine the bone mass of early postmenopausal women or their bone turnover rate. The polymorphisms are not associated with risk of hip fractures in elderly people or with low-energy fractures in early postmenopausal women.

Journal Article↗

PubMed2001

Systematic intervention for supporting community care of elderly people after a delirium episode.

OBJECTIVE: To investigate the effects of a systematic intervention with a case manager concept and rehabilitation periods compared to standard aftercare in elderly community-dwelling patients discharged from the hospital after a delirium episode. DESIGN: Before/after intervention cohort study with 3-year follow-up. SETTINGS: Acute geriatric wards of a city hospital and a private rehabilitation center. SUBJECTS AND METHODS: The intervention group consisted of 51 community-dwelling people over 65 years of age without severe underlying disorders, who were consequently admitted as emergency cases to the hospital because of a delirious state or who were delirious immediately after admission. The intervention included continuous support and counseling by a nurse specialist and rehabilitation periods at a rehabilitation center. The control group consisted of 51 age- and gender-matched patients admitted to the same hospital for delirium fulfilling the same inclusion and exclusion criteria during preceding years. The main outcome measures were duration of community care, the use of long-term institutional care, the use of short-term hospitalizations during the follow-up, and the death of the patients. RESULTS: Delirium even in the healthy community-dwelling subjects indicated a poor prognosis. After 3 years, 18 patients (35%) from the intervention group and 9 patients (18%) from the controls were in community care. The mean duration of community care was 671 days in the intervention group and 503 days in the control group, p = .025. A reduction of 19 years was achieved in the cumulative time spent in long-term institutionalized care. The use of short-duration hospitalization was similar in both groups. CONCLUSION: The institutionalization of elderly patients after a delirious state could be delayed using rehabilitation periods and systematic intervention with the case manager concept.

Aged↗

PubMed2001

Does apolipoprotein E influence learning and memory in the nondemented oldest old?

The objective of this study was to analyze the relationship of the apolipoprotein E (apoE) epsilon4 and epsilon2 alleles to learning and memory performances in the nondemented oldest old. Forty-six nondemented persons aged 85 years or over from a randomly selected group of 128 subjects in Vantaa, Finland, were studied. ApoE genotyping was performed using the minisequencing technique. A structured clinical examination and interview were carried out. The test variables studied were learning and memory scores (from the Fuld Object-Memory Evaluation), verbal fluency, and conceptualization (the Similarities subtest of the WAIS-R). We compared apoE-epsilon4 carriers to noncarriers and apoE-epsilon2 carriers to noncarriers. No statistically significant differences were found in any of the test variables. The results failed to confirm the hypotheses that poor cognitive performance is associated with the apoE-epsilon4 allele and good performance with the apoE-epsilon2 allele in the oldest old. This suggests that the apoE alleles do not have a detectable relationship to learning and memory in nondemented very elderly people.

Aged↗

PubMed2001

Effects of supporting community-living demented patients and their caregivers: a randomized trial.

OBJECTIVES: To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case management. DESIGN: Randomized controlled intervention study with 2-year follow-up. SETTING: Demented patients entitled to payments from the Social Insurance Institution for community care, in five municipalities in eastern Finland. PARTICIPANTS: One hundred demented patients, age 65 and older, living at home with the primary support of informal caregivers, allocated at random to the intervention (n = 53) or control group (n = 47). INTERVENTION: Intervention patients and their caregivers were provided with a 2-year intervention program of systematic, comprehensive support by a dementia family care coordinator. MEASUREMENTS: Time to institutionalization (period in community care) from enrollment of patients in the study to their placement in long-term institutional care. RESULTS: During the first months, the rate of institutionalization was significantly lower in the intervention group than in the control group (P = .042), but the benefit of the intervention decreased with time (P = .028). Estimated probability of staying in community care up to 6, 12, and 24 months was 0.98, 0.92, and 0.63 in the intervention group and 0.91, 0.81, and 0.68 in the control group, respectively. Results also suggest that the intervention used in the study might be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care. CONCLUSIONS: The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator. However, by the end of the 2-year intervention, the number of patients institutionalized was similar in the intervention and control group. It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers. On the basis of our experiences, we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care.

Aged↗

PubMed2001

Prevalence of subjective dry mouth and burning mouth in hospitalized elderly patients and outpatients in relation to saliva, medication, and systemic diseases.

OBJECTIVE: The purpose of this study was to investigate the prevalence of self-reported symptoms of dry mouth and burning mouth in the frail elderly. We expected to find the studied symptoms more frequently in the frail elderly than in those who were healthier. STUDY DESIGN: We examined 175 home-living elderly patients (mean age with SD, 82 +/- 5.7 years) hospitalized because of sudden worsening of their general health. For comparison, 252 elderly outpatients (mean age with SD, 77 +/- 5.7 years) from the same community were studied. The subjects' medical diagnoses and prescribed drugs used daily were recorded, their oral health examined, and saliva samples taken for analyses of flow rates, yeasts, and a variety of biochemical factors. RESULTS: The results showed that 63% of the hospitalized patients and 57% of the outpatients complained of dry mouth. The respective percentages of burning mouth were 13% in the hospitalized and 18% in the outpatients. The dentate status affected the feeling of dry mouth and burning mouth, but there were no consequent differences in concentrations of salivary biochemical constituents, yeast counts, and buffering capacity between patients with or without the symptoms except that hospitalized patients complaining of dry mouth more often had low salivary buffering than those without the symptom. Dry mouth was also more prevalent among the hospitalized patients who used several drugs daily, whereas no such association was found with the burning-mouth symptom. Use of analgesics appeared to safeguard against both the symptoms. Dry mouth and burning mouth were seldom reported simultaneously, although low salivary flow rate was a common finding in patients with burning mouth. The strongest explanatory factors for burning mouth were psychiatric disease among the outpatients (OR 8.7, CI 1.4-54.1, P <.05) and use of psychiatric drugs among the hospitalized (OR 4.2, CI 0.9-20.0, P =.07). For dry mouth, the strongest explanatory factors were respiratory disease in the outpatients (OR 2.0, CI 1.0-3.8, P <.05) and low salivary flow rate in the hospitalized elderly (OR 3.7, CI 1.4-10, P <.05). In all patients (n = 427), use of psychiatric drugs was the strongest explanatory factor for dry mouth (OR 2.1, CI 1.2-3.5, P <.01), whereas analgesic medication was found to protect against burning mouth (OR 0.5, CI 0.3-0.9, P <.05). CONCLUSION: The subjective feelings of dry mouth and burning mouth appeared to be a complex issue among the elderly population studied. The 2 symptoms were seldom reported at the same time. The appearance of symptoms did not directly correlate with general health, except in the case of psychiatric diseases and medications, which should be taken into account.

Aged↗

PubMed2001

Poor performance in the mini-mental state examination due to causes other than dementia.

OBJECTIVE: The aim of this study was to examine the extent to which causes other than dementia contribute to poor performance on the Mini-Mental State Examination (MMSE). DESIGN: Cross-sectional population-based study. SETTING: Municipality of Lieto, Finland. SUBJECTS: The study population consisted of all individuals residing in Lieto and born in or before 1926. A total of 1196 individuals, 93% of those eligible, participated. MAIN OUTCOME MEASURES: The MMSE was implemented following interviews and clinical examinations. Whenever an individual was unable to complete any individual item on the MMSE, the nurse recorded causes and assessed whether poor performance was mainly caused by dementia or other reasons. RESULTS: Poor test performance due to causes other than dementia was recorded in 122 (10.2%) individuals (4% of those in the 64-74 years group, 15% in the 75-84 years group and 42% in the group of 85 years of age or older). The most common causes were poor vision and hearing, deficient schooling and consequences of stroke. CONCLUSION: Ten percent of the elderly population had symptoms contributing to poor performance on the MMSE. Physicians should therefore consider and record co-morbidity in the testing situation, especially in very old individuals.

Aged↗

PubMed2001

Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland.

OBJECTIVES: To evaluate the impact of rheumatoid arthritis (RA) on the incidence of hip fractures. METHODS: All patients with acute hip fractures admitted to Jyväskylä Central Hospital in 1991-93 (n=517) were selected from the hospital discharge register. Medical records of these patients were studied retrospectively for RA fulfilling the American Rheumatism Association criteria. The prevalence of RA in patients with hip fractures was compared with the prevalence rates of RA obtained from the nearby city of Tampere. RESULTS: 29 (5.6%; 95% CI 3.8 to 8.0) of the patients with hip fracture in Jyväskylä Central Hospital had RA. The age and sex adjusted risk of hip fractures was increased by RA (risk ratio 3.26; 95% CI 2.26 to 4.70). CONCLUSIONS: Patients with RA are at increased risk of osteoporotic hip fractures.

Acute Disease↗

PubMed2001

Association of lipoprotein lipase Ser447Ter polymorphism with brain infarction: a population-based neuropathological study.

BACKGROUND: Variants of the lipoprotein lipase (LPL) gene have been shown to influence serum lipid levels, risk of coronary heart disease and, as found recently, risk of clinical ischaemic cerebrovascular disease. Here we tested for an association between brain infarction and two common polymorphisms of the LPL gene, Ser447Ter and Asn291 Ser. METHOD: To avoid ascertainment and selection bias involved in many association studies, we compared the distribution of these polymorphisms in neuropathologically verified patients (n = 119) vs controls (n = 133) derived from a prospective, population-based study (the Vantaa 85+ study). RESULTS: The LPL Ter447 variant was negatively associated with neuropathologically verified brain infarcts (P = 0.006), and even more strongly with small brain infarcts (P = 0.004). In addition, we found that the Ter447 variant was associated with higher serum HDL chblesterol (P = 0.004) and lower triglyceride levels (P= 0.003), and that it was negatively associated with pathologically verified severe coronary artery disease (P=0.001) in the Vantaa 85+ study sample. The Asn291Ser polymorphism was not significantly associated with brain infarction. CONCLUSION: The Ter447 variant of LPL is associated with decreased risk of brain infarction and coronary artery disease in our very elderly population.

Aged↗