Neuroepidemiology最新文献

{"title":"Incidence of First-Ever Stroke, Stroke Events, and Early Case Fatality Rate in China: Results from a National Population-Based Survey.","authors":"Haixin Sun, Siqi Ge, Bin Jiang, Xiaojuan Ru, Dongling Sun, Limin Wang, Mei Zhang, Wenzhi Wang","doi":"10.1159/000543474","DOIUrl":"10.1159/000543474","url":null,"abstract":"<p><strong>Background: </strong>In recent years, stroke has become the leading cause of death in the Chinese population, and the burden of stroke is huge. The aim of this study was to describe the epidemiological characteristics of population-based stroke incidence and case fatality rates in China, which are nationally representative.</p><p><strong>Methods: </strong>In 2013, a nationally representative household survey was conducted at 155 survey sites in 31 provinces. All stroke cases occurring within 1 year before the start of the survey period, including first-ever and recurrent strokes, were considered event cases. According to computed tomography, magnetic resonance imaging, and autopsy results, stroke was classified as ischemic, hemorrhagic, subarachnoid hemorrhagic, or difficult-to-classify stroke. The 7- and 30-day case fatality rates after stroke onset were investigated.</p><p><strong>Results: </strong>A total of 595,711 people were surveyed, with 2,164 diagnosed stroke events and 1,645 first-ever strokes. The age-standardized incidence of first-ever stroke and stroke event incidence in the Chinese population were 229.5 and 300.61 per 100,000 person-years, respectively. The world population age-standardized incidence of first-ever stroke and stroke events by the World Health Organization were 188.5 and 246.3 per 100,000 person-years, respectively. Among the 31 provinces, the top five incidence rates of first-ever stroke were recorded in Shaanxi, Heilongjiang, Ningxia, Henan, and Tianjin (518.0, 400.8, 389.5, 366.6, and 344.0 per 100,000 person-years, respectively). The top five incidence rates of stroke events were documented in Heilongjiang, Shaanxi, Henan, Tianjin, and Ningxia (672.7, 603.1, 580.2, 469.0, and 456.2 per 100,000 person-years, respectively). The 7- and 30-day case fatality rates were 14.3% and 17.8% for patients with first-ever stroke, respectively. Significant differences in the 30-day mortality rate of different stroke subtypes were recorded: 8.3% (95% confidence interval [CI], 8.2-8.5) for ischemic stroke, 44.4% (95% CI, 42.2-46.5) for cerebral hemorrhage, and 3.1% (95% CI, 3.0-3.3) for subarachnoid hemorrhage (p < 0.0001). Compared with the area of residence, the 30-day mortality rate of first-ever stroke in rural areas was 19.8% (95% CI, 19.3-20.3), which was higher than that in urban areas (14.9% [95% CI, 14.5-15.3]) (p = 0.011).</p><p><strong>Conclusion: </strong>In China, the incidences of first-ever stroke and stroke events are increasing, whereas the early case fatality rate is declining, which will inevitably lead to a higher stroke prevalence and a greater stroke burden. Therefore, the primary and secondary prevention strategies should be strengthened to reduce the incidence and burden of stroke.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-13"},"PeriodicalIF":3.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Psychiatric Disorders and Amyotrophic Lateral Sclerosis: A Prospective Cohort Study from the UK Biobank.","authors":"Yushan Tan, Tianmi Yang, Yangfan Cheng, Sirui Zhang, Yi Xiao, Jiyong Liu, Huifang Shang","doi":"10.1159/000543473","DOIUrl":"10.1159/000543473","url":null,"abstract":"<p><strong>Introduction: </strong>Psychiatric disorders have been reported to be associated with amyotrophic lateral sclerosis (ALS). However, evidence for the association remains inconsistent, and it is unclear whether specific categories of psychiatric disorders constitute risk factors for ALS. The study aimed to investigate the association between different categories of psychiatric disorders and the risk of ALS.</p><p><strong>Methods: </strong>We utilized data from the UK Biobank to conduct a population-based prospective cohort study. Cox proportional hazards models were employed to evaluate the association between a history of various psychiatric disorders including schizophrenia, bipolar disorder, depression, anxiety, stress-related disorders, and the risk of ALS. Analyses were adjusted for covariates including sociodemographic factors, lifestyle factors, and medical history.</p><p><strong>Results: </strong>Among the 484,065 participants initially included, 558 participants were diagnosed with ALS during a median follow-up of 13.63 years. With complete adjustment, previous schizophrenia (hazard ratio [HR] 6.32; 95% confidence interval [CI]: 2.60-15.36; p < 0.001) and depression (HR 1.37; 95% CI: 1.03-1.81; p = 0.03) were found to be significantly associated with ALS.</p><p><strong>Conclusion: </strong>This large prospective cohort study indicated the association between schizophrenia, depression, and a higher risk of subsequent ALS. These findings suggest potential implications for early process of global neurodegeneration in ALS, underlining the need for further research to explore the underlying mechanisms.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-13"},"PeriodicalIF":3.2,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Subtypes Mortality Attributable to Smoking in China: A Study Based on the Global Burden of Disease Database 2021.","authors":"Chunlong Xiao, Jing Wang, Zhao Cheng, Jie Gong, Chuanhua Yu","doi":"10.1159/000542605","DOIUrl":"https://doi.org/10.1159/000542605","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to analyze long-term trends in ischemic stroke (IS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) mortality from smoking in China from 1992 to 2021, to provide scientific advice on stroke prevention and treatment in China.</p><p><strong>Methods: </strong>The mortality data of smoking-related stroke and its subtypes in China during 1992-2021 were collected from the Global Burden of Disease 2021. Joinpoint regression model and Age-period-cohort (APC) model were used for trend analysis.</p><p><strong>Results: </strong>The age-standardized mortality rate of stroke and subtypes caused by smoking showed a decreasing trend in China from 1992 to 2021. The decline was greater for women than for men. According to APC model analysis, the age effect showed that ICH and IS showed an increasing trend, while SAH increased first and then decreased. The results of the cohort effect were similar to those of the period effect, with relative risk decreasing for all subtypes. The local drift showed that the stroke and subtypes in males showed a \"U\" shaped trend, a relatively stable trend for stroke and is in females, and a downward trend for SAH and ICH.</p><p><strong>Conclusions: </strong>Over the past 30 years, the burden of stroke and stroke subtype deaths attributable to smoking in China has decreased. However, future efforts should focus on preventing ICH. Strengthening tobacco control legislation, particularly targeting older men and young people, is crucial for further reducing smoking-related stroke risk.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.2,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Region of Birth Differences in Medication Adherence among Patients with Stroke or Transient Ischemic Attack.","authors":"Monique F Kilkenny, Lachlan L Dalli, Nadine E Andrew, David Ung, Joosup Kim, Vijaya Sundararajan, Dominique A Cadilhac, Amanda G Thrift, Mark R Nelson, Muideen T Olaiya","doi":"10.1159/000543317","DOIUrl":"10.1159/000543317","url":null,"abstract":"<p><strong>Background and purpose: </strong>Cultural and language barriers may affect quality of care, such as adherence to medications. We examined whether adherence to prevention medications within the year after stroke/transient ischemic attack (TIA) differed by the region of birth.</p><p><strong>Methods: </strong>An observational study of adults with stroke/TIA admitted to hospitals in the Australian Stroke Clinical Registry (Queensland, Victoria; 2012-2016; n = 45 hospitals). Data from the registry were linked with administrative data. Region of birth was categorized into 10 groups (Australia, Other Oceania, North-West Europe, Southern/Eastern Europe, North Africa/Middle East, South-East Asia, North-East Asia, Southern/Central Asia, Americas, Sub-Saharan Africa). Analysis was limited to those with a first-ever stroke/TIA who were dispensed an antihypertensive, lipid-lowering, or antithrombotic medication within 1-year post-discharge. Medication adherence was calculated based on the proportion of days covered until 1-year immediately post-discharge/death. Associations between region of birth and being adherent (PDC ≥80%) were determined using multivariable logistic regression (adjusted for age, sex, stroke type, ability to walk on admission, discharge destination, socioeconomic position, main language spoken, comorbidity score).</p><p><strong>Results: </strong>Among 24,236 eligible participants (median age 74 years, 44% female, 68% Australian-born), 54% were adherent to antihypertensive medications, 56% to lipid-lowering medications, and 49% to antithrombotic medications. Compared to Australian-born participants, those born in Other Oceania (4.0%) were less likely to be adherent to lipid-lowering medications (odds ratio [OR] 0.78, 95% CI: 0.67-0.90) and antithrombotic (OR 0.84, 95% CI: 0.72-0.97). Compared to Australian-born participants, those born in Southern and Central Asia (1.4%) were less likely to be adherent to lipid-lowering medications (OR: 0.76, 95% CI: 0.58-0.99) and antithrombotic (0.55, 95% CI: 0.40-0.76). No significant differences were found with other regions.</p><p><strong>Conclusions: </strong>Disparities by the region of birth were observed in medication adherence after stroke/TIA for participants born in Asia and Oceania. Targeted education to improve medication adherence, specific to the needs of these groups, is warranted.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-6"},"PeriodicalIF":3.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Informal Care Time and Costs of Dementia Care in Benin (West Africa).","authors":"Angeladine Kenne Malaha, Clémence Thébaut, Dismand Stephan Houinato, Grégoire Magloire Gansou, Dieu Donné Gnonlonfoun, Thierry Adoukonou, Pierre-Marie Preux, Maëlenn Guerchet","doi":"10.1159/000538262","DOIUrl":"10.1159/000538262","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a growing global health challenge, with significant socioeconomic implications. This study examined the informal care duration and related costs along with the total cost of care for older individuals with dementia in Benin, West Africa, providing insights into a region with limited dementia research.</p><p><strong>Methods: </strong>We conducted a cost-of-illness study in Benin. Both hospital and community recruitments were used to enroll adults aged ≥60 years and their primary caregivers. Structured questionnaire and validated tools were used to collect the demographic, clinical, healthcare resource utilization data as well as informal care duration. Replacement costs approach was performed to valuate informal care time. Official exchange rates from the World Bank were used to convert costs from local currency to purchasing power parities dollars (PPP$).</p><p><strong>Results: </strong>Data from 135 individuals with varying dementia stages revealed that dementia places substantial caregiving demands, predominantly on women who provide up to 8 h of daily care. In 2021, the mean annual cost of dementia care was estimated to be PPP$ 2,399.66 ± 2,057.07. Informal care represented a significant portion of dementia expenses, up to 92% of the total care costs in this study.</p><p><strong>Discussion: </strong>Policy interventions are urgently needed to address the dementia care challenges in Benin, especially because economic transitions and educational advancements may reduce the availability of informal caregivers. This emphasizes the vital role of informal caregivers and underscores the need of implementing dementia policies to support families facing the evolving challenges of dementia care.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-11"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-Specific Differences in the Progression of Huntington's Disease Symptoms - A National Study in China.","authors":"Shanquan Chen, Huanyu Zhang, Jiazhou Yu, Xi Cao, Shuyang Zhang, Dong Dong","doi":"10.1159/000539131","DOIUrl":"10.1159/000539131","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Huntington's disease (HD) is a rare, inherited neurodegenerative disorder. Despite extensive research on symptom progression and sex differences in Western populations, little is known about these aspects within the Chinese context. The objective of this study was to investigate the temporal trends of symptoms in individuals with HD in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A nationwide cross-sectional study was conducted in Chinese individuals diagnosed with HD. Symptom progression over time, encompassing physical, psychiatric, and cognitive symptoms, was self-reported. We calculated the proportions of individuals who currently had each symptom by disease duration, and tested corresponding temporal trends by linear regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 269 individuals diagnosed with HD were included. Specific symptoms were found to progress more significantly in males compared to females over time, including psychotic symptoms (p = 0.007), urinary incontinence (p = 0.013), reduced concentration (p = 0.005), font alteration (p = 0.029), atypical facial expression (p = 0.037), and suicidal ideation (p = 0.047). In terms of cognitive and psychiatric symptoms, no significant temporal trends were identified in females, while males demonstrated significant increasing trends, with reduced concentration (p = 0.005) and psychotic symptoms (p = 0.007) standing out.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study emphasizes the existence of sex-specific symptom progression in HD within the Chinese population, underscoring the importance of considering sex in clinical practice. Further research should investigate the mechanisms behind these differences and explore tailored treatment options.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Huntington's disease (HD) is a rare, inherited neurodegenerative disorder. Despite extensive research on symptom progression and sex differences in Western populations, little is known about these aspects within the Chinese context. The objective of this study was to investigate the temporal trends of symptoms in individuals with HD in China.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A nationwide cross-sectional study was conducted in Chinese individuals diagnosed with HD. Symptom progression over time, encompassing physical, psychiatric, and cognitive symptoms, was self-reported. We calculated the proportions of individuals who currently had each symptom by disease duration, and tested corresponding temporal trends by linear regression analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 269 individuals diagnosed with HD were included. Specific symptoms were found to progress more significantly in males compared to females over time, including psychotic symptoms (p = 0.007), urinary incontinence (p = 0.013), reduced concentration (p = 0.005), font alteration (p = 0.029), atypical facial expression (p = 0.037), and suicidal ideation (p = 0.047). In terms of cognitive and psychiatric sy","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"78-86"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11797925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Systemic Inflammatory Response Index and Neutrophil-to-High-Density Lipoprotein Ratio Mediated by Fasting Blood Glucose with 90-Day Prognosis in Acute Ischemic Stroke Patients.","authors":"Aimei Zhang, Yuan Zhu, Junqi Liao, Dan Wu, Xiaohui Yan, Jingyi Chen, Qiuhua He, Fantao Song, Li Li, Yunze Li, Zhaoyao Chen, Wenlei Li, Qin Yang, Zhuyuan Fang, Minghua Wu","doi":"10.1159/000539132","DOIUrl":"10.1159/000539132","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, monocyte count, HDL level, and fasting blood glucose level. Then, the SIRI and NHR values were calculated. Following this, the correlation among SIRI, NHR, and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. Lastly, mediation analysis was performed to examine the relationship between systematic inflammatory response and study outcomes mediated by FBG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;SIRI and NHR were both negatively correlated with clinical outcomes (p &lt; 0.05). Logistic regression analysis revealed that SIRI and NHR were independently associated with poor outcomes after adjusting for potential confounders. Subgroup analyses further validated these correlations. Meanwhile, mediation analysis corroborated that FBG partially mediated the associations between SIRI and a poor prognosis at 90 days (indirect effect estimate = 0.0038, bootstrap 95% CI 0.001-0.008; direct effect estimate = 0.1719, bootstrap 95% CI 0.1258-0.2179). Besides, FBG also played a mediating role between NHR and poor outcomes (indirect effect estimate = 0.0066, bootstrap 95% CI 0.002-0.120; direct effect estimate = 0.1308, bootstrap 95% CI 0.0934-0.1681).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study demonstrated that SIRI and NHR are positively associated with poor clinical and mortality outcomes at 90 days in AIS patients, which was partially mediated by FBG.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, ","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"31-42"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11797957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study.","authors":"Cheng-Di Chiu, You-Pen Chiu, Hei-Tung Yip, Hui-Ru Ji, Der-Yang Cho, Irene Han-Juo Cheng, Cho-Yi Chen","doi":"10.1159/000539001","DOIUrl":"10.1159/000539001","url":null,"abstract":"<p><strong>Introduction: </strong>Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs.</p><p><strong>Methods: </strong>This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded.</p><p><strong>Results: </strong>TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85-0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62-0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54-0.85 between 1 and 3 month).</p><p><strong>Conclusion: </strong>The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"43-56"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Much Does Dysphagia Cost? Understanding the Additional Costs of Dysphagia for New Zealand in Patients Hospitalised with Stroke.","authors":"Shnece Duncan, Andrea Menclova, Maggie-Lee Huckabee, Dominique A Cadilhac, Anna Ranta","doi":"10.1159/000539133","DOIUrl":"10.1159/000539133","url":null,"abstract":"<p><strong>Introduction: </strong>Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand.</p><p><strong>Methods: </strong>Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between May 1, 2018, and October 30, 2018, including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a speech language therapist review. Patients that required a nasogastric feeding tube in hospital were classified as \"severe.\" Optimal linear propensity score matching was utilised to provide a group of patients to compare with stroke and dysphagia. All costs were converted to 2021NZD.</p><p><strong>Results: </strong>Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age: 78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12 months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95% CI: 0.028-0.100), and severe dysphagia by 0.12 index points (95% CI: 0.03-0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was NZD 24,200 on average per patient. This estimate includes the additional hospitalisation costs (NZD 16,100), community rehabilitation services (NZD 570), hospital level aged residential care (NZD 4,030), and reduced HRQoL (NZD 3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was NZD 34,000 per patient.</p><p><strong>Conclusion: </strong>We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"57-67"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity Moderates the Relationship between Cardiovascular Disease Risk Burden and Cognition in Older Adults.","authors":"Sandra T Nguyen, Jing Guo, Suhang Song, Dolly Reyes-Dumeyer, Danurys Sanchez, Adam M Brickman, Jennifer J Manly, Nicole Schupf, Rafael A Lantigua, Richard P Mayeux, Yian Gu","doi":"10.1159/000536354","DOIUrl":"10.1159/000536354","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Older individuals with a higher cardiovascular disease (CVD) burden have a higher risk for accelerated cognitive decline and dementia. Physical activity (PA) is an inexpensive and accessible preventive measure to CVD, cognitive impairment, and dementia. The current study examined (1) whether PA moderates the relationship between CVD burden and cognition and (2) whether the moderating effect of PA differs by race/ethnicity groups and by APOE-ɛ4 status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our cross-sectional study included participants from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, community-based, longitudinal study on aging and dementia among individuals aged 65 years and older who reside in northern Manhattan. All participants underwent an interview and a neuropsychological assessment for global cognition, memory, language, visuospatial, and speed functioning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2,122 older individuals without dementia, having a higher CVD burden was associated with worse cognitive scores for global, language, speed, and visuospatial cognitive functions. PA mitigated the relationship between CVD burden and visuospatial function. Furthermore, PA mitigated the association of CVD burden with global cognition, language, and visuospatial functions in APOE-ɛ4 carriers but not in non-carriers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion/conclusion: &lt;/strong&gt;Our study suggests that PA may mitigate the negative association between CVD and cognition, especially in APOE-ɛ4 carriers. The moderating effect of PA did not differ by race/ethnicity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Older individuals with a higher cardiovascular disease (CVD) burden have a higher risk for accelerated cognitive decline and dementia. Physical activity (PA) is an inexpensive and accessible preventive measure to CVD, cognitive impairment, and dementia. The current study examined (1) whether PA moderates the relationship between CVD burden and cognition and (2) whether the moderating effect of PA differs by race/ethnicity groups and by APOE-ɛ4 status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our cross-sectional study included participants from the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, community-based, longitudinal study on aging and dementia among individuals aged 65 years and older who reside in northern Manhattan. All participants underwent an interview and a neuropsychological assessment for global cognition, memory, language, visuospatial, and speed functioning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2,122 older individuals without dementia, having a higher CVD burden was associated with worse cognitive scores for global, language, speed, and visuospatial cognitive functions. PA mitigated the relationship between CVD burden and visuospatial function. Furthermore, PA mitigated the association of CVD burden with global cognition, language, and visuospatial functions in APOE-ɛ4 carriers but not ","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"20-30"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11424774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}