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Tag: Neurology

  • Men using erectile dysfunction drugs less likely to develop Alzheimer’s disease

    Men using erectile dysfunction drugs less likely to develop Alzheimer’s disease

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    Drugs commonly used to treat erectile dysfunction may reduce the risk of Alzheimer’s disease, finds a new study led by UCL researchers.

    The authors of the new Neurology paper found that men prescribed erectile dysfunction drugs were 18% less likely to develop Alzheimer’s disease years later.

    The study included 269,725 men who were diagnosed with erectile dysfunction and who did not have any memory or thinking problems at the start of the study. Just over half (55%) were taking phosphodiesterase type 5 inhibitor drugs, including sildenafil (sold as Viagra), tadalafil (Cialis), vardenafil and avanafil, and were compared to those with erectile dysfunction but not prescribed the drugs.

    Erectile dysfunction drugs work by dilating blood vessels and were initially developed to treat hypertension and angina. They act on a cell signaling messenger that has also been investigated for its links to memory. These drugs are also able to cross the blood-brain barrier and may affect brain cell activity. Animal research has found phosphodiesterase type 5 inhibitors to have some neuroprotective benefits.

    For the current study, based on prescription records, the researchers found that men who were prescribed erectile dysfunction drugs were 18% less likely to develop Alzheimer’s disease later on (after the researchers adjusted the findings for potential confounding factors such as age, underlying health conditions, co-prescribed medications and smoking status), with an average follow-up time of 5.1 years. This association was strongest among men who had been issued the most prescriptions, suggesting that using the drug more regularly might have a greater impact on Alzheimer’s risk.

    Among the men prescribed erectile dysfunction drugs, 749 developed Alzheimer’s disease, which corresponds to a rate of 8.1 cases per 10,000 person-years. Person-years represent both the number of people in the study and the amount of time each person spends in the study. Among the men who were not prescribed the drugs, 370 developed Alzheimer’s disease, corresponding to 9.7 cases per 10,000 person-years.

    Although we’re making progress with the new treatments for Alzheimer’s disease that work to clear amyloid plaques in the brain for people with early stages of the disease, we desperately need treatments that can prevent or delay the development of Alzheimer’s disease.


    More research is needed to confirm these findings, learn more about the potential benefits and mechanisms of these drugs and look into the optimal dosage. A randomized, controlled trial with both male and female participants is warranted to determine whether these findings would apply to women as well.”


    Dr Ruth Brauer, Lead Author, UCL School of Pharmacy

    First author, PhD student Matthew Adesuyan (UCL School of Pharmacy) said: “While we cannot say based on our findings whether the drugs themselves were reducing people’s risk of Alzheimer’s disease, the results are encouraging and may point to a new way to reduce Alzheimer’s risk.”

    Source:

    University College London

    Journal reference:

    Adesuyan, M., et al. (2024) Phosphodiesterase Type 5 Inhibitors in Men With Erectile Dysfunction and the Risk of Alzheimer Disease A Cohort Study. Neurology. doi.org/10.1212/WNL.0000000000209131.

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  • Eleven stroke researchers to be recognized during the 2024 International Stroke Conference

    Eleven stroke researchers to be recognized during the 2024 International Stroke Conference

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    Eleven scientists leading the way in stroke research will be recognized during the American Stroke Association’s International Stroke Conference 2024 for their exceptional professional achievements. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    The illustrious group of awardees includes four groundbreaking scientists who have devoted their careers to stroke research and six scientists will be recognized for their notable new research. The awards include the Ralph L. Sacco Outstanding Stroke Research Mentor Award, which honors Ralph L. Sacco, M.D., M.S., FAHA, a past president of the American Heart Association and American Stroke Association, who passed away in January 2023.

    The 2024 honorees are:

    • Bernadette Boden-Albala, M.P.H., Dr.P.H., University of California, Irvine, who will receive the Edgar J. Kenton III Lecture Award.

    • Steven Warach, M.D., Ph.D., Dell Medical School at The University of Texas at Austin, who will receive the David G. Sherman Lecture Award.

    • James F. Meschia, M.D., FAHA, Mayo Clinic in Jacksonville, Florida, who will be honored with the William M. Feinberg Award for Excellence in Clinical Stroke.

    • Marc I. Chimowitz, M.B., Ch.B., Medical University of South Carolina, who will receive the Ralph L. Sacco Outstanding Stroke Research Mentor Award.

    • Louise D. McCullough, M.D., P.H.D., McGovern Medical School at UTHealth Houston, who will be awarded the Thomas Willis Lecture Award.

    • ·Takuma Maeda, M.D., Ph.D., Barrow Neurological Institute in Phoenix, who will receive the Mordecai Y.T. Globus New Investigator Award, for a research abstract.

    • Raed Joundi, M.D., D.Phil., McMaster University in Hamilton, Ontario, Canada, who will receive the Vascular Cognitive Impairment Award for research being presented at the meeting.

    • Oriana Sanchez, M.D., University of Texas, Houston, who will receive this year’s Robert G. Siekert New Investigator Award in Stroke for a research abstract.

    • ·Mohammed Abdelsaid, R.P.H., Ph.D., Mercer University School of Medicine, Savannah, Georgia, who will receive the Stroke Basic Science Award for a research abstract.

    • Shumei Man, M.D., Ph.D., FAHA, Cleveland Clinic in Ohio, who will receive the Stroke Care in Emergency Medicine Award for research being presented at the meeting.

    • Susan Linder, P.T., D.P.T., Ph.D., Cleveland Clinic in Ohio, who will be awarded the Stroke Rehabilitation Award for a research abstract.

    Bernadette Boden-Albala, M.P.H., Dr.P.H., the winner of the Edgar J. Kenton III Lecture Award, is the director and founding dean of the University of California, Irvine’s Program in Public Health and future School of Population and Public Health. With more than two decades of research experience, Boden-Albala is an internationally recognized expert in the social epidemiology of chronic disease whose research has focused on eliminating health disparities through defining and intervening on social support, structural and institutional barriers to optimal health. Her areas of expertise include community-based participatory research, health equity, stroke and cardiometabolic health disparities. She has led numerous large, multi-site studies utilizing community-based participatory research methods in urban and rural communities across the United States and globally, as well as large community health assessment, evaluation, capacity building and workforce training projects. The Edgar J. Kenton III Lecture Award recognizes lifetime contributions to the investigation, management, mentorship and community service in the field of racial and ethnic stroke disparities or related disciplines. Boden-Abala will present her Edgar J. Kenton III lecture, “A Roadmap for Health Equity: Understanding the Importance of Community-Engaged Research,” at 10:18 a.m. MT, Tuesday, Feb. 6.

    Steven Warach, M.D., Ph.D., the recipient of the David G. Sherman Lecture Award, is a professor of neurology at Dell Medical School at The University of Texas at Austin, where he is executive director of the Seton Dell Medical School Stroke Institute and also serves as the regional stroke director for Ascension Texas. Warach is known for his seminal contributions in magnetic resonance imaging of stroke. He earned his Ph.D. in psychology-neuroscience from Michigan State University and M.D. from Harvard Medical School, where he completed his neurology residency. The Sherman Award honors David G. Sherman, M.D., a prominent stroke physician and an internationally recognized leader and researcher in stroke prevention and treatment. The award recognizes lifetime contributions to the investigation, management, mentorship and community service in the stroke field. Warach will present his lecture, “Improving Stroke Diagnosis and Treatment: A Journey Toward the End of Time,“ at 11:32 a.m. MT, Wednesday, Feb. 7.

    James F. Meschia, M.D., FAHA, the awardee of the William M. Feinberg Award for Excellence in Clinical Stroke, is professor of neurology and chair emeritus of the department of neurology at Mayo Clinic in Jacksonville, Florida. Meschia is certified by the American Board of Psychiatry and Neurology (ABPN) in neurology and vascular neurology. Meschia is a pioneer in the study of inherited risk factors for ischemic stroke and has had a longstanding commitment to providing the latest evidence for carotid revascularization as a means for stroke prevention. He was the inaugural medical director of the first Joint Commission-certified stroke center within the Mayo Clinic Foundation, and he has authored or co-authored over four hundred peer-reviewed publications. The William M. Feinberg Award for Excellence in Clinical Stroke is named for the prominent stroke clinician-researcher and American Heart Association volunteer who contributed to a more comprehensive understanding of the causes of stroke. The award recognizes significant contributions to the investigation and management of clinical research in stroke. Meschia’s lecture, “Asymptomatic Carotid Stenosis: Current and Future Considerations,” will be presented at 11:03 a.m. MT, Thursday, Feb. 8.

    Marc I. Chimowitz, M.B., Ch.B., the recipient of the Ralph L. Sacco Outstanding Stroke Research Mentor Award is professor emeritus of neurology at the Medical University of South Carolina in Charleston, South Carolina. His main career interests are in improving treatments for patients with intracranial arterial atherosclerosis and helping to mentor the next generation of clinical and translational scientists.The Ralph L. Sacco Outstanding Stroke Research Mentor Award recognizes outstanding achievements in mentoring future generations of stroke researchers in the field of cerebrovascular disease. Chimowitz will present his lecture, “Mentoring Clinical Stroke Researchers in Challenging Times,” at 11:34 a.m. MT, Thursday, Feb. 8.

    Louise D. McCullough, M.D., P.H.D., FAHA, the winner of the Thomas Willis Lecture Award, is the Roy M. and Phyllis Gough Huffington Distinguished Chair of Neurology at McGovern Medical School; chief of neurology at Memorial Hermann Hospital-Texas Medical Center and co-director of UTHealth Neurosciences, all in Houston. McCullough is a physician-scientist and a practicing vascular neurologist with clinical expertise in sex/gender disparities, the microbiome, stroke and aging, and acute stroke treatments. A renowned investigator, she is well recognized for her work in cerebral vascular disease and is known for her research identifying sex differences in cell death pathways during stroke, which have now been shown to be a major factor in the response to ischemic insult. The Thomas Willis Award recognizes contributions to the investigation and management of stroke basic science. McCullough’s lecture, “Aging, Sex, and Stroke: The Three Amigos of Brain Misadventures,” will be presented at 11:03 a.m. MT, Friday, Feb. 9.

    Takuma Maeda, M.D., Ph.D., the Mordecai Y.T. Globus New Investigator Award in Stroke awardee, is a postdoctoral fellow at Barrow Aneurysm & AVM Research Center (BARRC) at the Barrow Neurological Institute in Phoenix. This award recognizes Globus’ major contributions to research in cerebrovascular disease and his outstanding contributions to the elucidation of the role of neurotransmitters in ischemia and trauma; the interactions among multiple neurotransmitters; mechanisms of hypothermic neuroprotection; and the role of oxygen radical mechanisms and nitric oxide in brain injury. Maeda’s award-winning presentation, Abstract 15, “Pharmacological Activation of Efferocytosis Prevents Intracranial Aneurysm Rupture,” will be presented at 7:30 a.m. MT, Wednesday, Feb. 7.

    Raed Joundi, M.D., D.Phil., is the Vascular Cognitive Impairment Award recipient. He is an assistant professor at McMaster University, an adjunct scientist at the Institute for Clinical Evaluative Sciences (ICES) and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences, all in Hamilton, Ontario, Canada. The Vascular Cognitive Impairment Award encourages investigators to undertake or continue research or clinical work in the field of vascular cognitive impairment and submit an abstract to the International Stroke Conference. Joundi’ s award-winning presentation, Abstract 67, “Risk and Time-Course of Post-Stroke Dementia: A Population-Wide Cohort Study, 2002-2022,” will be presented at 7:30 a.m. MT, Thursday, Feb. 8.

    Oriana Sanchez, M.D, the winner of the Robert G. Siekert New Investigator Award in Stroke, is currently completing a vascular neurology fellowship in the department of neurology at the University of Texas in Houston. The Siekert New Investigator Award in Stroke recognizes Robert G. Siekert, M.D., who was the founding chairman of the American Heart Association’s International Conference on Stroke and Cerebral Circulation, now known as the International Stroke Conference. The award encourages new investigators to undertake or continue stroke-related research. Sanchez’s award-winning presentation, Abstract 1, “Overcoming Clinical Trial Enrollment Challenges by Monitoring EMS Radio Transmissions: Pre-Hospital Screening of Acute Ischemic Stroke Patients,” will be presented at 7:30 a.m. MT, Wednesday, Feb. 7.

    Mohammed Abdelsaid, R.P.H., Ph.D., the recipient of the Stroke Basic Science Award, is an assistant professor at Mercer University School of Medicine in Savannah, Georgia. The Stroke Basic Science Award recognizes outstanding basic or translational science that is laboratory-based. Abdelsaid’s winning presentation, Abstract 17, “SARS-CoV-2 Spike Protein Exacerbates Thromboembolic Cerebrovascular Complications in Humanized ACE2 Mouse Model,” will be presented at 7:54 a.m. MT, Wednesday, Feb. 7.

    Shumei Man M.D., Ph.D., FAHA, the Stroke Care in Emergency Medicine Award awardee, is a neurologist at the Cleveland Clinic and stroke center director of Cleveland Clinic Fairview Hospital in Ohio. The Stroke Care in Emergency Medicine Award encourages investigators to undertake or continue research in the emergent phase of acute stroke treatment and submit an abstract to the International Stroke Conference. Man’s winning presentation, Abstract 43, “Race-Ethnic Specific Trends in Stroke Thrombolysis Care Metrics in Relation to U.S. Target: Stroke Nationwide Quality Improvement Program 2003-2021,” will be presented at 2:00 p.m. MT, Wednesday, Feb. 7.

    Susan Linder P.T., D.P.T., Ph.D., the Stroke Rehabilitation Award recipient, is director of clinical research for the department of physical medicine and rehabilitation at the Cleveland Clinic in Ohio. The Stroke Rehabilitation Award encourages investigators to undertake or continue research and/or clinical work in the field of stroke rehabilitation. Linder’s winning presentation, Abstract TMP28, “Forced-Rate Aerobic Cycling Enhances Motor Recovery in Persons With Chronic Stroke: A Randomized Clinical Trial,” will be presented at 6:15 p.m. MT, Thursday, Feb. 8.

    Source:

    American Heart Association

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  • Stroke and neck artery tear increase heart attack risk in the first year

    Stroke and neck artery tear increase heart attack risk in the first year

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    Heart attack risk almost doubles in the first year after a stroke or when combined with a tear in a neck artery wall, however, a tear without a stroke does not seem to raise heart attack risk, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    Our findings may aid physicians in assessing and managing cardiovascular risk after these events.”

    Liqi Shu, M.D., clinical fellow in neurology, Warren Alpert Medical School of Brown University in Providence, Rhode Island

    Aortic dissection is a tear in the wall of the aorta, the large artery that receives blood directly from the heart, and is known to increase heart attack risk. Tears in the walls of the carotid or vertebral arteries, which extend out from the aorta and carry blood through the neck to the brain, are called carotid or vertebral artery dissections. These dissections can result in stroke, and stroke is known to be associated with heart attack. It was unclear whether carotid or vertebral artery dissection itself increases heart attack risk prior to this study.

    The researchers analyzed health information for more than 800,000 adults (average age of 63 years; 62% women) hospitalized in New York (between 2011 and 2017) or Florida (between 2011-2019). The patients with no history of recent major head or neck trauma were separated into four groups based on diagnoses: acute ischemic stroke; cervical artery dissection; both; or a reference group of patients with transient ischemic attack known as a “warning stroke,” temporary loss of short-term memory (transient global amnesia) or migraine.

    After adjusting for heart attack risk factors, the study found:

    • Patients who had carotid or vertebral artery dissection without stroke had the same risk of having a heart attack within a year as those in the reference group.
    • Patients with stroke, either with or without carotid or vertebral artery dissection, were almost twice as likely to have a heart attack within a year, in comparison to patients in the reference group.

    “Before, it was just a guess, but now we know that carotid or vertebral artery dissection not causing a stroke does not raise the risk of a heart attack, and it makes sense that clinicians should focus predominantly on stroke prevention in this subgroup of patients,” Shu said.

    Study background:

    • Participants with a recent history of major head or neck trauma were excluded. Head or neck trauma may lead to traumatic carotid dissection, which is different from this study’s focus on spontaneous dissection.
    • The analysis controlled for several heart attack risk factors, including age, Type 1 or Type 2 diabetes, heart failure, coronary artery disease, high cholesterol and high blood pressure.
    • Almost 20,000 of the participants experienced a heart attack within one year of their initial hospitalization, and the risk of heart attack was compared among the diagnostic groups.
    • Among the study group of 823,634 participants, 65.4% were white, 16.2% were Black or African American, and 12.2% were Hispanic or Latino adults. 

    While this study is based on hospitalization data only in New York and Florida, it’s important to note that these states collectively represent a substantial portion of the U.S. population, accounting for over 10% of the total. These two states also provide a good representation of diverse demographic groups, adding strength to the findings. However, caution should still be exercised when generalizing these results to people living in other geographic areas. In addition, this retrospective analysis (looks back in time to analyze data) might not have accounted for all factors influencing heart attack risk such as medication usage, which was not included in the databases.

    According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, stroke accounted for approximately 1 of every 21 deaths in the United States in 2021.

    Source:

    American Heart Association

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  • Living in poor neighborhoods linked to worse stroke recovery

    Living in poor neighborhoods linked to worse stroke recovery

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    Stroke survivors living in areas with poor economic conditions were twice as likely to have a poor recovery compared to survivors living in areas with better conditions, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

    This research was inspired by the people I work with daily. Although stroke patients from differing socioeconomic backgrounds often have similar functional status at discharge, outcomes can vary dramatically a year later. As a clinical research associate, I get to interact with them far beyond the completion of their urgent treatment, which sparked my interest in exploring the long-term outcomes for these patients.”


    Leah Kleinberg, B.A., postgraduate clinical research associate in the Falcone Lab in the department of neurology at Yale School of Medicine in New Haven, Connecticut

    Kleinberg and her colleagues found a significant correlation between functional outcomes after a stroke and the socioeconomic factors noted by census blocks.

    “The magnitude of this impact is what was most surprising. We did not expect a large disparity in outcomes, yet we found patients in the most economically disadvantaged areas were twice as likely to have unfavorable outcomes compared to patients in areas with less unemployment, better housing quality and higher income and education levels,” she said.

    In this study, researchers used data from Yale’s Longitudinal Study of Acute Brain Injury and Area Deprivation Index (ADI) rates for the 2020 U.S. Census blocks to compare outcomes among stroke survivors by socioeconomic disadvantage factors. The ADI evaluates a neighborhood on levels of income, education, employment and housing quality and is specific to each zip code. It was developed by the U.S. Health Resources & Services Administration to inform health care delivery and policy for disadvantaged areas.

    This analysis found:

    • Among 2,164 people with ischemic (clot-caused) stroke, the one-year unadjusted risk of poor outcomes was 35%, 40% and 46% for patients residing in neighborhoods with low, intermediate and high deprivation, respectively.

    • After considering the inability of the ADI to specifically measure each level of deprivation, researchers determined that those living in intermediate and high deprivation areas had 44% and 107% greater risk, respectively, of unfavorable outcomes, compared to patients living in neighborhoods with low deprivation levels.

    • The patients in the poor outcomes category were unable to look after their own affairs without assistance and required some help in daily activities. In the good outcomes category, patients could live independently, though some might have had residual symptoms or disability.

    “We hope this study will help promote awareness of how social determinants of health are as important as clinical variables and health information when trying to identify patients who are particularly high risk for poor long-term outcomes,” she said.

    Study details:

    • The Yale Longitudinal Study follows stroke survivors admitted to the Yale Health System, collecting outcome data at 3 months, 6 months and then yearly after hospital discharge. Zip code data was available for 2,164 patients enrolled in the Yale Longitudinal Study between 2018 and 2021. The average age was 69; 48% were women; 7.5% were Black adults and 7.7% were Hispanic adults.

    • Stroke outcomes were determined by trained assessors using the modified Rankin Scale, which measures disability severity after stroke on a scale of 0-6, from no disability (able to carry out all daily living tasks and duties without assistance) to severe disability (bed-ridden, incontinent, requiring constant nursing care and attention).

    Study limitations are that the Area Deprivation Index relies on geographic blocks and does not evaluate each household separately. Also, due to the observational nature of the study, the findings can only note associations and cannot determine cause and effect.

    When considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death, behind diseases of the heart, cancer, COVID-19 and unintentional injuries/accidents, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. The Association also recognizes that considering the role of social determinants of health is essential in improving the cardiovascular health of all Americans.

    “Access to quality care, nutritious foods, stable housing or other basic health needs are crucial for people recovering from stroke,” said Elizabeth A. Jackson, M.D., M.P.H., FAHA, immediate past chair of the Association’s Committee on Social Determinants of Health and a professor and director of the Cardiovascular Outcomes and Effectiveness Research Program at the University of Alabama at Birmingham, who was not involved in the research. “Unfortunately, these data are not surprising, rather, they support prior evidence suggesting health disparities are disproportionately experienced in areas where higher degrees of social vulnerability exist.”

    Source:

    American Heart Association

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