Hugh Markus

Background and ObjectivesSleep disturbances are implicated as risk factors of both stroke and dementia. However, whether these associations are causal and whether treatment of sleep disorders could reduce stroke and dementia risk remain uncertain. We aimed to evaluate associations and ascertain causal relationships between sleep characteristics and stroke/dementia risk and MRI markers of small vessel disease (SVD).MethodsWe used data sets from a multicenter population-based study and summary statistics from genome-wide association studies (GWASs) of sleep characteristics and outcomes. We analyzed 502,383 UK Biobank participants with self-reported sleep measurements, including sleep duration, insomnia, chronotype, napping, daytime dozing, and snoring. In observational analyses, the primary outcomes were incident stroke, dementia, and their subtypes, alongside SVD markers. Hazard …

Internal carotid artery atherosclerosis is a major risk factor for stroke, accounting for 15–20% of ischaemic strokes. Revascularisation procedures—either carotid endarterectomy or carotid artery stenting—can reduce the risk of stroke for those with significant (>50%) luminal stenosis but particularly for those with more severe (70–99%) stenosis. However, advances in medical pharmacotherapy have implications for the relative benefit from surgery for symptomatic carotid atherosclerosis, as well as our approach to asymptomatic disease. This review considers the evidence underpinning the current medical and surgical management of symptomatic carotid atherosclerosis, the importance of factors beyond the degree of luminal stenosis, and developments in therapeutic strategies. We also discuss the importance of non-stenotic but high-risk carotid atherosclerotic plaques on the cause of stroke, and their implications for …

Aim To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals. Methods A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed. Results Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49 …

Thanks to our reviewers, and editorial board changes - Hugh Markus, 2024 Skip to main content Intended for healthcare professionals Sage Journals Home Search this journal Search all journals Enter search terms... SearchSearch Advanced search Enter search terms... SearchSearch Advanced search Search Access/ProfileAccess View access options View profile Create profile Cart Close Drawer MenuOpen Drawer MenuMenu Browse by discipline Select discipline: All disciplines All disciplines Health Sciences Life & Biomedical Sciences Materials Science & Engineering Social Sciences & Humanities Select subject: All subjects All subjects Allied Health Cardiology & Cardiovascular Medicine Dentistry Emergency Medicine & Critical Care Endocrinology & Metabolism Environmental Science General Medicine Geriatrics Infectious Diseases Medico-legal Neurology Nursing Nutrition Obstetrics & Gynecology …

International Journal of Stroke, 19 (4)(521 with ischemic stroke and 84 with intracerebral hemorrhage (ICH)). About 88.4% of the stroke survivors reported at least one adverse non-motor outcome, 66.3% two or more, and 45.8% three or more. The health domains most affected were anxiety (57.0%), fatigue (52.7%), impaired bladder function (50.2%), and reduced participation in social roles and activities (49.3%). They did not measure apathy. In adjusted analyses, stroke due to ICH (compared with ischemic stroke) and admission stroke severity were the strongest predictors of non-motor outcomes. The high incidence of fatigue, identified by Ozkan and colleagues as being present in half the stroke survivors, is consistent with the results of a systematic review reporting a prevalence of post-stroke in the range of 25% to 85%, with a pooled prevalence estimate on random effects metaanalysis of 50%. 12 Fatigue …

Background Stroke is often followed by vascular cognitive impairment and vascular dementia; these are the most feared complication of stroke. However, there is limited understanding of post-stroke cognitive impairment. Methods Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) is an observational cohort study of post-stroke cognition. Patients with haemorrhagic or ischaemic stroke, or transient ischaemic attack, were recruited within six weeks of stroke from hospitals across the UK. Consent was obtained from patients with capacity or from relatives/friends in those without capacity. The primary outcome is cognition and its severity assessed using a 7-level ordinal outcome. Final cognition will be compared in those with mild stroke/TIA (worst NIHSS <=7) versus severe stroke (NIHSS >7). Secondary outcomes will include function, mood and quality of life. Results We recruited 2441 patients from 50 hospitals. Of these, 2437 (99.8%) had a qualifying event of stroke or TIA. The mean age was 68.2 years (standard deviation 13.5), females 981 (40.3%), onset to recruitment 6 days [interquartile range 3-13] and diagnosis ICH 193 (7.9%), ischaemic stroke 2101 (86.2%), TIA 143 (5.9%). The distribution of cognition at baseline was: normal 1256 (51.6%), minor neurocognitive disorder-single domain 530 (21.8%), minor neurocognitive disorder-multi domain 320 (13.1%), major neurocognitive disorder-mild 237 (9.7%), major neurocognitive disorder-moderate 90 (3.7%) and major neurocognitive disorder-severe 3 (0.1%). We provide the statistical analysis plan in the appendix. Conclusion We provide baseline data and the SAP. Final follow …

A priority for the International Journal of Stroke (IJS) is to highlight the global burden of stroke. The worldwide epidemiology of stroke is regularly documented as part of the Global Burden of Disease initiative, 1 and more detailed analyses published in the IJS highlight how variable stroke risk is, with a particularly high risk in many lowerand middle-income countries (LMICs). 2, 3 We have also recently published in this journal detailed analyses of stroke risk in various countries and continents including Africa, India, China, and South America. 4–7 Together these show major disparities in stroke incidence and mortality and worryingly upward trends in incidence in many LMICs, but more positively highlight how stroke risk could be reduced with environmental and cardiovascular risk factor initiatives.It is equally important that we highlight global differences in provision of stroke services. Services for acute stroke …

BACKGROUND Recent studies, using diffusion tensor image analysis along the perivascular space (DTI-ALPS), suggest impaired perivascular space (PVS) function in cerebral small vessel disease, but they were cross-sectional, making inferences on causality difficult. We determined associations between impaired PVS, measured using DTI-ALPS and PVS volume, and cognition and incident dementia. METHODS In patients with lacunar stroke and confluent white matter hyperintensities, without dementia at baseline, recruited prospectively in a single center, magnetic resonance imaging was performed annually for 3 years, and cognitive assessments, including global, memory, executive function, and processing speed, were performed annually for 5 years. We determined associations between DTI-ALPS and PVS volume with cerebral small vessel disease imaging markers (white matter hyperintensity volume …