Biomedical subjects

Ismo Räihä

Publications and source records attributed to Ismo Räihä.

8 recordsLinked to original sources

PubMed2006

Impaired glucose tolerance as a risk factor for stroke in a cohort of non-institutionalised people aged 70 years.

OBJECTIVE: to determine whether impaired glucose tolerance (IGT) is associated with an increased likelihood for ischaemic stroke. DESIGN: prospective cohort study. PARTICIPANTS: a sample of 1,032 non-institutionalised people aged 70 years in the Turku Elderly Study, Turku, Finland. MEASUREMENTS: the association between IGT (defined as plasma glucose level between 7.80 and 11.09 mmol/l 2 h after administration of 75 g of an oral glucose load) and diabetes mellitus (DM) (defined as the current use of insulin or an oral hypoglycaemic medication, a fasting plasma glucose level of >/=7 mmol/l or a plasma glucose level of >/=11.1 mmol/l 2 h after administration of an oral glucose load) with 12-year follow-up for the development of ischaemic stroke. RESULTS: a total of 742 (71.9%) subjects had normal glucose tolerance, 127 (12.3%) subjects had IGT and 163 (15.8%) had DM. Patients were examined in the year 1990 and followed up for stroke occurrence until death or until the end of 2002. Mean follow-up time was 9.6 years (SD +/-3.3 years). In total, 119 patients (11.5%) suffered a stroke during the follow-up. In logistic regression model, previous stroke, previous TIA, DM and atrial fibrillation were risk factors for stroke occurrence. CONCLUSION: stroke tended to happen more often in the IGT group than in the normal group, but the difference was not statistically significant. Statistically significant risk factors for stroke in elderly people are previous TIA or stroke, DM and atrial fibrillation.

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PubMed2006

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Journal Article↗

PubMed2005

Diabetes worsens the outcome of acute ischemic stroke.

OBJECTIVE: To characterize acute stroke events in diabetic patients in a population-based stroke register and to determine the influence of diabetes on the outcome of acute stroke. METHODS: Four thousand three hundred and ninety patients were recorded in the FINMONICA and FINSTROKE registers after their first ischemic stroke from 1990 to 1998. We followed mortality and stroke outcome for up to 4 weeks after the onset of acute stroke. RESULTS: Of the 4390 patients who had had an ischemic stroke, 43.6% were male and 25.1% (1103) had diabetes. Their mean age was 72.4 (S.D. 12.0) years and this was similar in patients with and without diabetes (72.9 years versus 72.3 years, p=0.18). Subjects with diabetes were more likely to be hypertensive (55% versus 38%, p<0.001) and have a history of myocardial infarction (20% versus 16%, p<0.001) than the non-diabetic stroke patients. Mortality at 4 weeks from the onset was higher in diabetic than in non-diabetic patients (20.0% versus 16.9% p=0.020). At day 28 after the stroke attack, diabetic patients were more likely to be disabled when compared with non-diabetic subjects (43.3% versus 33.5%, p<0.001). Using logistic regression analysis, adjusted for age-group, sex, previous medical history (MI, AF or TIA), diabetes was found to be a significant predictor of disability after stroke (OR=1.51, 95% CI 1.27-1.81). CONCLUSIONS: Diabetes, which affected one-fourth of the ischemic stroke patients on our register, was associated with a higher risk of death and disability after the onset of stroke. Preventing diabetes in the elderly population improves the short-term prognosis of acute ischemic stroke.

Acute Disease↗

PubMed2005

Binge drinking in midlife and dementia risk.

BACKGROUND: Studies examining the long-term effects of alcohol consumption on cognitive functioning have produced conflicting results. Our goal was to determine whether a long follow-up period combined with information about drinking patterns, in addition to total alcohol consumption, would provide new insights about the relationship of alcohol use with dementia risk. METHODS: A population-based cohort of 554 Finnish twins, who had provided data on alcohol consumption in questionnaires in 1975 and 1981, was followed for 25 years. Subjects were age 65 years or older at the time of dementia assessment in 1999-2001. Dementia risk was analyzed with respect to varying patterns of alcohol use by log-linear modeling, adjusted for age, sex, and education. RESULTS: By the end of follow-up, 103 participants had developed dementia. Binge drinking (ie, alcohol exceeding the amount of 5 bottles of beer or a bottle of wine on 1 occasion at least monthly), as reported in 1975, was associated with a relative risk of 3.2 (95% confidence interval=1.2-8.6) for dementia. Passing out at least twice as a result of excessive alcohol use during the previous year, as reported in 1981, was associated with a relative risk of 10.5 (2.4-46) for dementia in drinkers. CONCLUSIONS: Binge drinking in midlife is associated with an increased risk of dementia.

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PubMed2003

A 90-year-old monozygotic female twin pair discordant for Alzheimer's disease.

The present study describes PET, MRI, and neuropsychological findings in 90-year-old monozygotic female twins, who have remained discordant for probable Alzheimer's disease (AD) for at least 7 years. These findings were compared with those of healthy persons composing the reference group (seven women, three men; the mean+/-S.D. age: 73.3+/-3.3 years). Twins' life histories were remarkably similar, except for continuous NSAID use of the unaffected twin for decades. The regional cerebral glucose metabolic rates (rCMRgluc) and all but two CERAD test scores of the affected twin were more than 2 S.D. below the mean values of the reference group. These values were normal in the unaffected twin. The affected twin had moderate hippocampal and temporoparietal atrophy, whereas the hippocampi were intact, and cortical atrophy was mild in the unaffected twin. These findings indicate that the twins were discordant for AD, even though they had reached the age in which the prevalence of AD is high among women. Our results further address the influence of environmental factors on the onset of AD, especially the possible protective effect of anti-inflammatory medication.

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PubMed2003

Diagnosing cognitive impairment and dementia in primary health care -- a more active approach is needed.

OBJECTIVE: to determine the documentation rate of dementia in primary health care, the clinical characteristics of patients with documented and undocumented dementia, and the diagnostic evaluations made in cognitive impairment. DESIGN: cross-sectional population-based study with a retrospective review of medical history. SETTING: primary health care in the municipality of Lieto, Southwestern Finland. SUBJECTS: all the inhabitants aged 64 and over in Lieto. Participation rate 82%, numbers = 1260. MEASUREMENTS: assessment of dementia according to DSM-IV criteria, and severity according to Clinical Dementia Rating. Possible documentation of dementia and evaluations done were reviewed from primary health care medical records. RESULTS: 112 patients with dementia were found. The sensitivity of the general practitioners' judgment of dementia was 48.2% and the specificity 99.6%. The documentation rate of dementia was 73% in severe, 46% in moderate and 33% in mild dementia. A greater proportion of the patients with undocumented dementia were male (P = 0.003), lived at home (P = 0.003), coped better with the instrumental activities of daily living (P = 0.006), had more depression (P = 0.029) and milder dementia (P = 0.005) than patients with documented dementia. Thyroid stimulating hormone was measured in 51% of the patients with suspected memory impairment or dementia, B12 vitamin in 20%, and serum calcium in 18%. Twenty-eight per cent of the patients had been tested for cognitive function, 68% for depressive symptoms, and 88% for social abilities. Forty-two per cent of patients were referred to a specialist, 32% of patients who were over 75 years. CONCLUSIONS: less than half of the patients with dementia had their diagnosis documented in primary care medical records. Documentation increased in more advanced dementia. The diagnostic evaluations for reversible causes of dementia were insufficient in primary care, and they were done at a late phase of cognitive impairment.

Activities of Daily Living↗

PubMed2003

Regional cerebral glucose metabolism in monozygotic twins discordant for Alzheimer's disease.

We investigated regional cerebral glucose metabolic rates (rCMRgluc) with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose (FDG) in 7 monozygotic twin pairs discordant for Alzheimer's disease (AD). Ten healthy volunteers with comparable mean age and educational level served as controls. In the hippocampus, the mean +/- SD rCMRgluc were 0.20 +/- 0.03 micromol/ml/min for the demented twins, 0.21 +/- 0.03 micromol/ml/min for their non-demented co-twins, and 0.23 +/- 0.02 micromol/ml/min for the controls. The mean hippocampal rCMRgluc was reduced in the demented twins (p = 0.006), compared with the controls. In the lateral temporal cortex, the mean +/- SD rCMRgluc were 0.27 +/- 0.05, 0.28 +/- 0.04, and 0.32 +/- 0.02 micromol/ml/min, respectively. These mean rates were reduced both in the demented (p = 0.02) and the non-demented (p = 0.01) twins, compared with the controls. In conclusion, in the demented twins, the reduction of rCMRgluc was detected in the hippocampus and lateral temporal cortex, i.e. the 2 brain areas which show early changes in pathological and imaging studies in AD. Their non-demented co-twins showed milder reductions, which may be an indication of genetic susceptibility for dementia, and an early sign of a dementing illness in them.

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PubMed2002

Characteristics of two telephone screens for cognitive impairment.

We studied 56 subjects, 30 patients with a clinical diagnosis of Alzheimer's disease (AD) and 26 healthy controls, using two telephone screens for cognitive impairment, a self-report interview referred to as the TELE and the Telephone Interview for Cognitive Status (TICS). The sensitivity and specificity of the TELE to differentiate AD patients from healthy controls was 90.0 and 88.5% and those of the TICS were 86.7 and 88.5%, respectively. When receiver operator characteristic curves were constructed, the area under the curve for the TELE was 96.0% (SE 2.4%) and for the TICS 90.3% (SE 4.2%). Pearson's correlation between the TELE and the Mini-Mental State Examination (MMSE) was 0.87 (p < 0.0001) and between the TICS and the MMSE 0.86 (p < 0.0001). The correlation between the TELE and the sum of the boxes of the Clinical Dementia Rating scale (CDR-SB) was -0.71 (p < 0.0001) and -0.75 between the TICS and the CDR-SB (p < 0.0001). These results indicate that both screens are sensitive and specific instruments for differentiating AD patients from healthy controls and have a strong correlation with face-to-face measures of cognitive function.

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