Ischemic stroke hospitalizations decline in middle-aged, elderly, increases in young

ScienceDaily (Feb. 9, 2011) — The number of acute ischemic stroke hospitalizations among middle-aged and older men and women fell between 1994 and 2007, but sharply increased among those under age 35 -- including teens and children -- according to research presented at the American Stroke Association's International Stroke Conference 2011.

See Also:Health & MedicineStroke PreventionHeart DiseaseElder CareMind & BrainStrokeCaregivingBrain InjuryReferenceMulti-infarct dementiaStrokePeripheral visionCoronary heart disease

Analysts at the U.S. Centers for Disease Control and Prevention (CDC), reviewing hospitalization data by age and gender, identified declining rates of 51 percent in girls 0-4 years and 25 percent in men and 29 percent in women over 45.

However, the number of ischemic stroke hospitalizations increased 51 percent in males between ages 15 and 34 during the period studied. The rate increased 17 percent in females between 15 and 34.

Among children and teens, they found a 31 percent increase in boys between 5 to 14 years and a 36 percent increase among girls 5 to 14 years.

Among the younger middle-aged set, they found a 47 percent increase among men 35-44 and a 36 percent increase among women 35-44.

"I believe this is the first large study to report these findings, stratified by age and gender," said Xin Tong, M.P.H., a health statistician with the CDC's Division for Heart Disease and Stroke Prevention in Atlanta.

"We cannot link anything in particular to the trend in younger patients, but I believe the role of obesity and hypertension will prompt a big discussion. Unfortunately, right now we can't speculate on the causes."

The unit of analysis was hospitalization, so researchers couldn't draw any firm connections or determine what factors are driving the increase in ischemic stroke cases among the young. Ischemic stroke occurs when blood supply to the brain becomes obstructed, usually by a clot or narrowing of the arteries. The risk of long-term brain damage can be reduced significantly if patients receive the clot-busting tissue plasminogen activator (tPA) within three or four and a half hours after stroke onset.

Hospitals and physicians should be aware of the rising risk of stroke in young people, and the necessity to educate them about stroke symptoms, Tong said.

"Acute ischemic stroke is currently considered something that mostly happens to older people, but awareness of rising rates in the young is important or else tPA and other important stroke treatment may be unnecessarily delayed in younger patients," she said.

Tong said her group is pursuing additional investigation on this subject.

Co-authors are: Elena V. Kuklina, M.D., Ph.D.; Cathleen Gillespie, M.S.; and Mary G. George, M.D., M.S.P.H.

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Study links inflammation in brain to some memory decline

ScienceDaily (Apr. 15, 2011) — High levels of a protein associated with chronic, low-grade inflammation in the brain correlate with aspects of memory decline in otherwise cognitively normal older adults, according to a study led by scientists at the University of California, San Francisco.

See Also:Health & MedicineCrohn's DiseaseHealthy AgingNervous SystemMind & BrainDementiaIntelligenceNeuroscienceReferenceTemporal lobeInflammationAmnesiaOccipital lobe

The study is being reported in a poster session at the American Academy of Neurology annual meeting on April 13, 2011.

Inflammation is part of the body's natural immune response to tissue damage. However, chronic inflammation is associated with many diseases. In the brain, it is thought to play a role in aging and neurodegenerative diseases, such as Parkinson's and Alzheimer's. If further research determines that inflammation causes memory decline, anti-inflammatory drugs could prove useful in staving off the damage.

Studies in animals have shown that prolonged brain inflammation impairs function of the hippocampus, a region of the brain involved in storing and generating memory. It does so by disrupting the establishment of memories, a process known as long term potentiation.

The scientists in the study hypothesized that the presence of C-reactive protein (CRP), a marker of chronic low grade inflammation in the brain, would be associated with poorer memory creation and smaller medial-temporal lobes, which include the hippocampus.

They examined 76 women and men (mean age 71.8) with detectible levels of CRP in their blood, and 65 people (mean age 70.8) with undetectable levels. All participants were given a 16-word list learning task to measure verbal recall, and underwent magnetic resonance imaging, MRI, to measure volumes of regions of the medial temporal lobes, specifically the hippocampus, entorhinal cortex and parahippocampal cortex.

The results showed that adults with measureable levels of C reactive protein recalled fewer words and had smaller medial temporal lobes.

Scientists don't know if the inflammation indicated by the C reactive protein is the cause of the memory loss, if it reflects a response to some other disease process or if the two factors are unrelated. But if inflammation causes the cognitive decline, relatively simple treatments could help, said Joel H. Kramer, PsyD, UCSF clinical professor of neuropsychology and the director of the neuropsychology program at the UCSF Memory and Aging Center.

"Anti-inflammatory drugs available today could be used to treat low grade infections in the brain, and could be used more aggressively following surgery, which prompts a large inflammatory response," he said.

Kramer and his colleagues plan to monitor the participants until the end of their lives and to use additional inflammatory markers -- ones that tend to be more sensitive to acute changes than CRP.

"We think such a study will give us a better idea of what's driving the processes we've observed," he said. "If baseline levels of inflammatory markers predict change over time, we'd consider a clinical trial using anti-inflammatory drugs to treat inflammation."

Inflammation is just one of several possible factors that might be driving cognitive decline in normally aging adults, said Kramer. He and his colleagues are examining the possible impact of cardiovascular and stroke risk factors, as well. "We're also just starting to look at exercise, and want to study sleep," he said.

The study was funded by the National Institute on Aging.

Other co-authors of the study are Ralph Green and Joshua Miller, of UC Davis, and Reva Wilheim, Caroline Racine, Brianne Bettcher, Kristine Yaffe and Bruce Miller, of the UCSF Memory and Aging Center.

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