Search Results for: Malattia di Parkinson, stop al tremore con gli ultrasuoni

Stroke, Volume 56, Issue Suppl_1, Page AWP310-AWP310, February 1, 2025. Background:Vascular risk factors, particularly in midlife, are associated with an increased risk of dementia, and smoking has been inversely associated with Parkinson’s disease (PD) risk, but the role of these factors in PD-dementia (PDD) is less clear. This study explores whether midlife vascular risk factors are associated with risk of PDD in the community-based ARIC cohort.Methods:ARIC participants were evaluated for vascular risk factors (hypertension, diabetes, hypercholesterolemia, smoking, and obesity) in 1987-1989 (ages 44-64) and followed through 2016. PD cases were identified using participant medications, self-reported physician diagnosis, hospitalization and death surveillance, and PD diagnostic data provided by participants and physicians. Dementia was defined by in-person and phone-based cognitive assessment, informant interviews, and hospitalization codes. PDD was defined as having both a PD and dementia diagnosis, with the PD diagnosis occurring first. We excluded participants with missing covariates, on neuroleptic medications, or with PD or dementia at baseline. Adjusted Cox proportional hazards models examined the associations between midlife vascular risk factors (combined in one model) and incident PDD, PD/no dementia, and dementia/no PD, vs no PD/no dementia. We explored effect modification by race.Results:Of 13,875 participants (25% Black, 54% female), 179 developed PD at a mean age of 73.4 yo, 94 devleoped PDD at a mean age of 79.2 yo, and 1,791 developed dementia/no PD at a mean age of 79.7 yo. Midlife current smoking (HR 0.41, 95% CI 0.18-0.95, Figure) was signficantly associated with a lower risk of PDD; other vascular risk factors had nonsignficiant associations. Older age, APOEe4, male sex, and low education were significantly assoiated with an increased risk of PDD. Smoking, diabetes, hypertension, obesity, Black race, age, low education, male sex, and APOEe4 were associated with an increased risk of dementia/no PD. There was effect modification by race for smoking and obesity, which were significant risk factors for dementia/no PD in White but not Black participants (Table).Conclusions:Smoking in midlife was significantly associated with a lower rate of PDD vs no PD/no dementia. Other vascular risk factors were not associated with PDD, but demographic associations were similar to dementia. Future studies should evaluate these vascular risk factors over the life course and the mechanisms underlying these associations.

Stroke, Volume 56, Issue Suppl_1, Page ATP221-ATP221, February 1, 2025. Introduction:Cervical artery dissection (CAD) accounts for nearly 2% of all ischemic strokes but up to 25% of ischemic strokes in young adults. Dissection is likely precipitated by the interplay between risk factors (migraine, low body mass index), environmental triggers (cervical trauma or infection), and genetic connective tissue abnormalities (e.g. Ehlers-Danlos or Marfan’s disease). In this study, we delineate the prevalence of triggers and risk factors in a multicenter cohort of cervical artery dissection.Methods:This is a post-hoc analysis of the Antithrombotic for Stroke Prevention in Cervical Artery Dissection Study (STOP-CAD). We recorded information using the admission data on risk factors (migraine), triggers (upper respiratory infection, COVID-19, and minor cervical injury), and whether the patient had a known connective tissue disorder (CTD). We determined the prevalence of risk factors, triggers, and presence of CTD in patients with cervical artery dissection as well as the interplay between these factors in the pathogenesis of CAD.Results:We identified 4023 patients with CAD, the mean age was 47 years and 45% were women. A history of migraines was present in 16.6% (668) patients. At least one environmental trigger was present in 26.3% of patients (1061 patients), with minor cervical injury being the most common (22.2%, 892 patients), then upper respiratory infections (6.2%, 251 patients), and COVID-19 (1.2%, 49 patients). Among cervical injury, the most common was chiropractic manipulation (5.7%, 228 patients). Only 2% (83 patients) were known to have a CTD with Fibromuscular Dysplasia being the most common (0.6%, 23 patients). Among the entire STOP-CAD cohort, only 5 patients (0.1%) had evidence of at least one trigger, risk factor, or a known connection tissue disease. On the other hand, 61% of patients (2441 patients) had none of the three recorded.Conclusion:In patients with CAD, the absence of any risk factor, trigger, or known CTD is common and should not lead to dismissing a dissection diagnosis in patients with symptoms concerning for CAD.

Stroke, Volume 56, Issue Suppl_1, Page ATP230-ATP230, February 1, 2025. Background:Cervical artery dissection (CAD) is a leading cause of stroke in young adults, accounting for up to 25% of strokes in this population. Despite its prevalence, there is considerable variability in the management of CAD due to the lack of large-scale randomized trials and inconsistent findings in existing literature. This study aims to assess global treatment practices for CAD and evaluate the consistency of clinical decision-making among stroke physicians using a structured survey.Methods:An international survey was distributed to stroke physicians and trainees, including those from the STOP-CAD and TREAT-CAD studies. The survey explored multiple aspects of CAD management, including patient characteristics influencing treatment choices, preferred antithrombotics, treatment duration, and criteria for stopping therapy. Six case-based scenarios were also included to evaluate initial treatment decisions, follow-up imaging practices, and medication duration. Responses were analyzed using Krippendorff’s alpha to quantify inter-rater reliability and assess the degree of consensus among respondents. The data was further analyzed in order to evaluate inter-rater reliability for the case scenarios.Results:The survey was completed by 102 stroke neurologists, revealing a moderate overall agreement with a Krippendorff’s alpha of 0.481. Detailed analysis indicated significant variability in responses across different aspects of CAD management, particularly regarding the choice of anticoagulants and treatment duration. While some areas showed higher levels of consensus, the overall variability highlights the lack of standardized practices. Table 1 presents Krippendorff’s alpha values for each of the six case scenarios, assessing overall agreement among respondents within each case. Table 2 provides Krippendorff’s alpha values for each of the five questions within each scenario, examining response consistency for each question across all scenarios.Conclusions:The observed variability in CAD management underscores the critical need for further research to establish optimal treatment strategies. While variability itself is not inherently problematic, it suggests that some clinicians may unknowingly provide suboptimal care due to inconsistent practices. This study highlights the importance of developing evidence-based guidelines to reduce uncertainty, ensure optimal care, and improve patient outcomes in CAD treatment.

Stroke, Volume 56, Issue Suppl_1, Page ADP54-ADP54, February 1, 2025. Background:Randomized trials and observational of patients with cervical artery dissection showed no significant difference in ischemic stroke risk with anticoagulation versus antiplatelet therapy. Occlusive dissection is a high-risk subgroup that may potentially benefit from anticoagulation. In this study, we aim to determine whether anticoagulation is effective in reducing ischemic stroke rates in patients with occlusive cervical artery dissection using subgroup data from the Cervical Artery Dissection in Stroke Study (CADISS), Biomarkers and Antithrombotic Treatment in Cervical Artery Dissection (TREAT-CAD), and Antithrombotic therapy for Stroke Prevention In Patients with Cervical Artery Dissection (STOP-CAD).Methods:We stratified patients across the antiplatelet versus anticoagulation groups in the TREAT-CAD, CADISS, and STOP-CAD studies by occlusion status (occlusive versus non-occlusive dissection). The outcome was ischemic stroke during follow up. We performed a meta-analysis for ischemic stroke with anticoagulation vs. antiplatelet using relative risks.Results:We identified a total of 1626 patients with occlusive cervical artery dissection. In patients with occlusive cervical artery dissection, the risk of ischemic stroke was 1.7% on anticoagulation vs. 6.3% on antiplatelet therapy (RR 0.33 95% CI 0.16-0.68, p

Stroke, Volume 56, Issue Suppl_1, Page ADP45-ADP45, February 1, 2025. Background:The 2021 American Heart Association guidelines recommend antiplatelet or anticoagulation therapy for 3-6 months following acute cervical artery dissection (CeAD), driven by results from two randomized clinical trials which failed to demonstrate superiority of anticoagulation over antiplatelet therapy. This secondary analysis of STrOke Prevention in Cervical Artery Dissection (STOP-CAD) examined changes in oral antithrombotic strategies of CeAD following publication of these trials.Methods:This is a pre-specified secondary analysis of a retrospective multinational observational cohort study evaluating outcomes related to antithrombotic treatment for acute CeAD (2015-2021). Adult patients with acute CeAD treated with oral antithrombotics (excluding vessel stenting) within 180 days of diagnosis were included. Anticoagulation (AC) was defined as direct oral anticoagulant therapy or vitamin K antagonist and antiplatelet (AP) was defined as single or dual oral antiplatelet therapy. The odds of oral anticoagulant use (over single or combination oral AP) therapy across each year were estimated using multivariable logistic regression and joinpoint regression.Results:From 4,023 STOP-CAD patients, 3,345 had complete data regarding oral antithrombotic agent initiation and met inclusion criteria. Baseline characteristics per year did not differ significantly. Beginning in 2017, there was a decrease in the rate of oral AC (OAC) use with and without AP. Low NIHSS at baseline and single vertebral artery involvement were significantly associated with lower rates of oral AC use with or without AP use. Meanwhile; female sex, presence of an infarct on imaging, and presence of a partially occlusive thrombus were significantly associated with higher rates of OAC use. In joinpoint regression, the percentage of patients on OAC decreased and the percentage of patients on oral AP therapy increased over time. In 2015, 33.9% of patients received AC with or without AP, 18.7% received AC without AP and 81.3% received AP only. In contrast, in 2022 19.1% of patients received AC with or without AP 6.75% received AC without AP, and 93.4% received AP only.Conclusions:Real-world clinical practices in the treatment of acute CeAD changed with a clearer understanding of the lack of definite benefit of OAC for all-comers with CeAD. While there may be certain subgroups for whom OAC is more effective than oral AP for CeAD, an increasing majority of patients receive AP over OAC.

Stroke, Volume 56, Issue Suppl_1, Page AWP218-AWP218, February 1, 2025. Background:Identifying patients likely to have significant hematoma expansion (HE) has been a challenge in clinical trials of intracerebral hemorrhage (ICH). Non-contrast CT (NCCT) markers of HE have been described. Time from symptom onset to CT affects the predictive value of these markers, with limited data in the ultra-early time period (33% or >6ml from baseline. Regression analyses were adjusted for treatment group and baseline hematoma volume.Results:There were 246 patients included in this analysis (median age 67 years, 38.8% female, median time from onset to imaging 75 min [IQR 59-88 min], 50.4% tranexamic acid), of whom 105 (42.7%) had HE on 24-hour imaging. Inter-rater agreement was excellent for all NCCT markers (kappa score >0.8). Most patients (85.7%) had ≥1 marker of HE. The most frequent marker was the swirl sign (74.3%) and the least frequent was the blend sign (7.3%) (Table 1). HE occurred more often in patients with any marker at baseline (45.5% vs 25.6%, p=0.03). The blend sign (15.2% vs 1.4%, p

Stroke, Ahead of Print. Background:The optimal endovascular management of cervical carotid dissection causing tandem occlusion remains uncertain. We investigated the impact of emergent carotid stenting during endovascular treatment (EVT) for acute ischemic stroke (AIS) in patients with tandem occlusion secondary to cervical carotid artery dissection.Methods:This was a secondary analysis of patients treated with EVT for AIS due to occlusive carotid artery dissection and tandem occlusion included in the retrospective international Antithrombotic Treatment for Stroke Prevention in Cervical Artery Dissection (STOP-CAD) study. We compared patients with and without emergent stenting. The primary efficacy and safety outcomes were 90-day functional independence (modified Rankin Scale 0-2) and symptomatic intracranial hemorrhage (sICH) within 24h after EVT. Procedural outcome was successful intracranial recanalization (mTICI 2b/3). We used mixed-effect logistic regression adjusting for site, age, and NIHSS. In additional analyses, we used inverse probability of treatment weighting and adjusted for ASPECTS.Results:Of the 4023 patients enrolled in STOP-CAD, 328 presented with anterior circulation AIS due to tandem occlusion and underwent EVT. The median age was 51 years (interquartile range 44-58), and 96 patients (29.3%) were female. One hundred fifty patients (45.7%) underwent emergent stenting. There was no significant association between stenting and 90-day functional independence (62.0% vs 59.7%; aOR 1.23, 95% CI 0.82-1.86, p=0.315) or sICH (7.3% vs 7.9%; aOR OR 0.95, 95% CI 0.41-2.2, p=0.913). Emergent carotid stenting was associated with successful intracranial recanalization (81.8% vs 76.6% aOR 2.62, 95% CI 1.52-4.5, p

Stroke, Ahead of Print. Background:There is limited data on ultra-early hematoma growth dynamics and its clinical relevance in primary intracerebral hemorrhage (ICH). We aimed to estimate the incidence of hematoma expansion (HE) within the hyperacute period of ICH, describe hematoma dynamics over time, investigate the associations between ultra-early HE and clinical outcomes after ICH, and assess the effect of tranexamic acid on ultra-early HE.Methods:We performed a planned secondary analysis of the STOP-MSU international multicenter randomized controlled trial. Repeat CT imaging ~1 hour after treatment commencement was encouraged. Patients who underwent re-imaging up to 3 hours from baseline imaging were included in this descriptive study. Hematoma expansion was defined as either a ≥33% or ≥6 ml increase from baseline hematoma volume.Results:We included 105 patients who had 1-hour imaging (median age 66years, 40% female, 53% tranexamic acid). Median time from onset to baseline imaging was 74min (IQR 56-87min), and between baseline and 1-hour imaging was 95min (IQR 74-132min). Forty-one patients (39%) had ultra-early HE. These patients had larger baseline hematoma volumes (15.9ml vs 9.1ml, p=0.03) compared to those with no early HE. Hematoma growth rate significantly reduced over time compared to the onset-to-baseline imaging period (clustered median regression p

Al lavoro un team del Giovanni XXIII di Bergamo e del Bambino Gesù

Latini, seguitola vicenda con le istituzioni regionali

Netta posizione del presidente dell’Opi Ancona, Conti

Objective
Prior research has identified that people with Parkinson’s reporting lower levels of self-efficacy exhibit worsening motor and non-motor symptomology, reduced quality of life, and self-management. Our key objective was to conduct a scoping review examining the impact of digital health technologies on self-efficacy in people with Parkinson’s.

Design
A scoping review using Arksey and O’Malley’s (2005) framework was undertaken.

Data sources
MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, IEEE Xplore, and Google Scholar principally for grey literature were searched from 1 January 2008 to the 24th of July 2024.

Eligibility criteria for selecting studies
Primary studies which incorporated digital health technologies, measured self-efficacy and had a sample population of people with Parkinson’s were searched.

Data extraction and synthesis
Following identification of potentially eligible records, two independent reviewers undertook title and abstract screening, followed by full-text screening. Data was extracted using our earlier published data extraction sheet which incorporated the Practical Reviews in Self-Management Support (PRISMS) taxonomy, and the template for intervention description and replication (TIDieR) checklist. Data was extracted from a Microsoft Excel spreadsheet and synthesised by describing themes, demographic data and numerical data.

Results
From 33 165 unique records following screening and independent review by two reviewers, 11 eligible records were found. Of these five elevated self-efficacy to a statistically significant level, five did not and one lowered self-efficacy. Of the studies which raised self-efficacy to a statistically significant level, all adopted a multimodal approach with a variety of devices. Thematically, these devices were focused on physical activity, falls/falls prevention, or both. The level of heterogeneity precluded comparisons between studies.

Conclusions
This scoping review identified significant knowledge and evidence gaps in the literature, and the limited number of eligible studies make these findings not generalisable. Future self-management research might benefit from also considering self-efficacy.

This Medial News article discusses recent research showing that current COVID-19 vaccines fail to elicit enough of a mucosal immune response to prevent infection.

Studio guidato dalle Molinette di Torino. Ruolo rare mutazioni

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