Parathyroid Hormone and Subclinical Cerebrovascular Disease: The Atherosclerosis Risk in Communities Brain Magnetic Resonance Imaging Study.
*Magnetic Resonance Imaging; Brain; Brain Diseases; Brain Diseases – Complications; brain MRI; Brain/*diagnostic imaging; cerebrovascular disease; Cerebrovascular Disorders; Cerebrovascular Disorders – Blood; Cerebrovascular Disorders/*blood/*diagnostic imaging; Cohort Studies; Computer Assisted; Computer-Assisted; Cross Sectional Studies; Cross-Sectional Studies; Female; Funding Source; Human; Humans; Image Processing; Leukoencephalopathies/complications/diagnostic imaging; Magnetic Resonance Imaging; Male; Middle Age; Middle Aged; Parathyroid hormone; Parathyroid Hormone/*blood; Parathyroid Hormones – Blood; Prospective Studies; subclinical brain infarcts; white matter hyperintensities
BACKGROUND: Elevated parathyroid hormone (PTH) levels have been associated with cardiovascular disease risk factors and events. We hypothesized that elevated PTH levels would also be associated with subclinical cerebrovascular disease. We examined the relationship between elevated PTH level and white matter hyperintensities (WMHs) and subclinical infarcts measured on brain magnetic resonance imaging (MRI). METHODS: PTH was measured at baseline (1993-1994) among participants free of prior clinical stroke who underwent a brain MRI at baseline (n = 1703) and a second brain MRI 10 years later (n = 948). PTH levels of 65 pg/mL or higher were considered elevated (n = 204). Participants who did not return for a follow-up MRI had, at baseline, higher PTH and a greater prevalence of cardiovascular risk factors (P \textless .05 for all); therefore, multiple imputation was used. The cross-sectional and prospective associations of PTH levels with WMH and MRI-defined infarcts (and their progression) were investigated using multivariable regression models. RESULTS: At baseline, the participants had a mean age of 62 years and were 60% female and 49% black. Cross-sectionally, after adjusting for demographic and lifestyle factors, elevated PTH level was associated with higher WMH score (beta = .19, 95% confidence interval [CI] .04-.35) and increased odds of prevalent infarcts (odds ratio 1.56, 95% CI 1.02-2.36). Results were attenuated after adjustment for potential mediators of this association (i.e., hypertension). No prospective associations were found between PTH and incident infarcts or change in estimated WMH volume, although estimates were imprecise. CONCLUSIONS: Although associated cross-sectionally, we did not confirm any association between elevated PTH level and progression of cerebrovascular changes on brain MRIs obtained 10 years apart. The relationship of PTH with subclinical brain disease warrants further study.
Korada Sai Krishna C; Zhao Di; Gottesman Rebecca F; Guallar Eliseo; Lutsey Pamela L; Alonso Alvaro; Sharrett A Richey; Post Wendy S; Reis Jared P; Mosley Thomas H; Michos Erin D
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
2016
2016-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jstrokecerebrovasdis.2015.12.029" target="_blank" rel="noreferrer noopener">10.1016/j.jstrokecerebrovasdis.2015.12.029</a>
MODELS AND SYSTEMS OF GERIATRIC CARE Developing a Stroke Unit Using the Acute Care for Elders Intervention and Model of Care.
BRAIN disease treatment; CEREBROVASCULAR disease; DISEASES in older people
The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes. [ABSTRACT FROM AUTHOR]
Allen Kyle R; Hazelett Susan E; Palmer Robert R; Jarjoura David G; Wickstrom Glenda C; Weinhardt Jan A; Lada Robert; Holder Carolyn M; Counsell Steven R
Journal of the American Geriatrics Society
2003
2003-11
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).