2000 Fiscal Year Final Research Report Summary
LONGITUDINAL STUDY ON STROKE RECURRENCE AND DEVELOPMENT OF DEMENTIA
| Project/Area Number |
10670586
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Neurology
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| Research Institution | SHIMANE MEDICAL UNIVERSITY |
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Principal Investigator |
KOBAYASHI Shotai Shimane Medical University, Department of Internal Medicine III, Professor, 医学部, 教授 (00118811)
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| Co-Investigator(Kenkyū-buntansha) |
MASUDA Junichi Shimane Medical University, Department of Laboratory Medicine, Professor, 医学部, 教授 (70173747)
YAMAGUCHI Shuhei Shimane Medical University, Department of Internal Medicine III, Associate, 医学部, 助教授 (80135904)
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| Project Period (FY) |
1998 – 2000
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| Keywords | SILENT BRAIN INFARCTION / MRI / STROKE PATIENT / STROKE RECURRENCE / BLOOD PRESSURE / Dementia |
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| Research Abstract |
1) To investigate risk factors for cognitive decline in the subjects with silent cerebrovascular diseases, we performed MRI examination and cognitive function test every 3 years during 6years. The subjects were 31 elderly people (mean age were 72 years old) without past history of cerebral diseases including stroke. They were all independent in ADL.They received MRI 3 times at starting of examination, 3 years after and 6 years after. We compared MRI findings among 3 sets, and evaluated whether white matter lesion or silent infarct did increase or not. Sixteen subjects of these showed silent worsening on MRI, and they showed also decline in Okabe memory scale. Blood pressure elevated in this group comparing with non-worsening MRI group. Cerebral blood flow did not change during 6years. Latent decline of cognitive functions in normal elderly related to subclinical worsening of silent infarction or white matter lesions on MRI.And the risk factor for this decline is elevation of blood pres
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sure.
2) We studied the relationship between stroke recurrence and controlling of blood pressure in 135 patients with brain infarction. Stroke recurrence mostly occurred as 43.3% within 12 months from initial onset, and as 70% within 24 months. A tendency of J curve phenomenon in blood pressure groups was observed in the patients with lacunar infarction. Nadir of diastolic pressure was 80-85 mmHg, but significant difference was observed only with higher blood pressure group. We conclude incomplete control of hypertension is a risk factor for stroke recurrence.
3) To investigate genetic risk factors for stroke, we studied phenotype of Lp (a) and polymorphism of genotype in MTHFR which related to metabolism of homocystein in the 74 patients with symptomatic brain infarction and 214 controls. Multivariate logistic analysis revealed Lp (a) phenotype (OR 3.98) and MTHFR (OR 2.75) were significant risk factors for stroke. We also studied these polymorphism in the 147 subjects who received brain check-up in our SIHS.This results showed that Lp (a) was significant risk factor for silent brain infarction (OR 1.53).
4) Conclusion
These results indicate that hypertension is the greatest risk factor for stroke recurrence and decline of cognitive functions related to increase of silent cerebrovascular diseases. Phenotype of Lp (a) is also a risk factor for silent brain infarction. Less
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