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Matti Viitanen

Publications and source records attributed to Matti Viitanen.

34 records · Page 2Linked to original sources
PubMed2004

Positron emission tomography examination of cerebral blood flow and glucose metabolism in young CADASIL patients.

BACKGROUND AND PURPOSE: CADASIL causes repeated ischemic strokes leading to subcortical vascular dementia. The purpose of this study was to assess whether cerebral blood flow (CBF) and regional cerebral metabolic rates of glucose (rCMR(gluc)) in CADASIL patients are affected in early adulthood. METHODS: CBF and rCMR(gluc) were examined with positron emission tomography in correlation with magnetic resonance imaging (MRI) in 14 adult (19 to 41 years) CADASIL patients with the Notch3 R133C mutation. Seven patients had experienced transient ischemic attack and 3 had experienced > or =1 strokes. RESULTS: The mean CBF in the CADASIL patients was significantly lower in both frontal (P=0.019) and occipital (P=0.009) white matter (WM) than those in the controls. CBF decreased significantly with increased severity of the disease. The patients had lower mean rCMR(gluc) values than the controls, although differences were not statistically significant. Sum scores of semiquantitative MRI rating scale (Scheltens) correlated significantly with WM CBF but not with rCMR(gluc). CONCLUSIONS: In CADASIL, there is an early and significant decrease in the CBF of WM associated with simultaneous MRI changes. These are obviously caused by the arteriopathy in long penetrating arteries and indicate early tissue damage, also expressed as impaired rCMR(gluc) in the WM.

Adult↗
PubMed2004

Drug use and increased HbA1c levels in non-diabetic very elderly persons: the Kungsholmen project.

OBJECTIVE: To examine the association between the use of drugs with potential hyperglycemic effects and increased HbA1c levels in a very elderly population. METHODS: This was a cross-sectional study of older subjects age 81 years and over from the second follow-up (1994-1996) of the Kungsholmen project, a population-based study of elderly in an urban area of Stockholm, Sweden. The study population consisted of 578 subjects, with a mean age of 86.7 years, without known diabetes mellitus. Glucose levels were assessed using HbA1c. Information on drug use was based on personal interviews. Diagnoses of diabetes mellitus, hypertension, and congestive heart failure were obtained from personal or relative interviews, assessment by the examining physician, and from the computerized inpatient register. Measures of other factors that may influence glucose homeostasis included body mass index, s-K(+), s-Ca(2+), thyroid stimulating hormone, and sedimentation rate. RESULTS: High HbA1c levels (>5.3%) indicating hyperglycemia were seen in 11% of the women and 12% of the men. Use of loop diuretics was significantly associated with high levels of HbA1c in both women and men, even after adjusting for hypertension and congestive heart failure. Eighteen percent of users of loop diuretics had high levels compared with 8% among non-users. CONCLUSION: Our results indicate that loop diuretics may have hyperglycemic effects in the very elderly. This finding can be of clinical importance as loop diuretics are among the most commonly taken drugs in this population.

Aged↗
PubMed2004

Detection of the founder effect in Finnish CADASIL families.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease characterized by brain infarcts, cognitive decline and dementia. The disease is caused by at least 91 missense mutations, four deletions and one splice site mutation in the NOTCH3 gene, which maps to 19p13.1. In 18 out of the 21 Finnish CADASIL families so far identified, the causative mutation is an arginine to cysteine substitution in position 133 (R133C). Most of the families carrying this mutation originate from the western coast of Finland, thus suggesting a founder effect. No previous reports of a founder effect in CADASIL have been published. We haplotyped 60 patients from these 18 families for 10 microsatellite markers in order to determine whether the families descend from a common ancestor. We found a similar haplotype linked to the mutation in all 18 pedigrees, which indicates a single common ancestor for all the Finnish R133C families. The age analysis of the founder mutation places the introduction of the mutation in the late 1600s or early 1700s.

Amino Acid Substitution↗
PubMed2004

Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability.

OBJECTIVE: To analyse whether cognitive function and functional ability are related to oral health among community-dwelling older people over the age of 80 years. BACKGROUND: This cross-sectional study is based on the Kungsholmen Elders Oral Health Survey (KEOHS). The study included oral examinations carried out in two local clinics by standardised examiners and interviews using structured questionnaires. MATERIALS AND METHODS: Altogether 159 individuals were included in this study. Coronal caries and root caries were assessed using the National Institute of Dental and Craniofacial Research (NIDCR) diagnostic criteria. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) index and functional ability was assessed by a global measure of self-reported changes. RESULTS: Older adults with a low MMSE score (< or = 23) tended to have a higher risk of coronal caries than those with higher scores. Participants with mild cognitive decline (MMSE = 24-26) and with a decrease in functional ability had a significantly higher risk of root caries. These associations changed little when adjusted by the covariates. In addition, people with a low MMSE (0-23) had a four times higher risk of not using dental services regularly. This result was unchanged after adjusting for the variables studied. CONCLUSIONS: This study revealed associations between the cognitive and functional status of the individual and aspects of oral health, that may contribute to a deeper understanding of the background of oral health status in older adults.

Activities of Daily Living↗
PubMed2004

Fibrosis and stenosis of the long penetrating cerebral arteries: the cause of the white matter pathology in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

In cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) the vascular smooth muscle cells are destroyed and granular osmiophilic material is deposited followed by fibrosis of the arterial wall. To verify whether true stenosis of the fibrotic white matter arteries is a key pathogenic event in CADASIL, we analyzed the thickness of walls (expressed as sclerotic index) and luminal diameters of penetrating arterioles in both grey matter and white matter of four CADASIL patients due to the C475T (R133C) mutation in the Notch3 gene and in 9 age-matched controls. We also reconstructed 9 arterioles from 1000 serial sections in two CADASIL patients. The thickness of the arteriolar walls in both grey matter and white matter was significantly increased in the CADASIL patients compared with controls. Furthermore, in CADASIL patients the arteriolar walls were significantly thicker in the white matter than in the grey matter. The distribution curve of arteriolar internal diameters in CADASIL patients shifted towards smaller sizes. In serial sections, the marked increase in the thickness of the white matter penetrating arterioles or their branches did not occur until the internal diameters had decreased to about 20 to 30 pm and external diameters to about 100 to 130 microm. In conclusion, long penetrating arterioles and their branches supplying subcortical structures in CADASIL are stenosed and their walls are thickened. This conforms to the abundance of infarcts and primary ischemic damage in CADASIL patients' white matter.

Actins↗
PubMed2003

Predictors of death among long-term stroke survivors.

BACKGROUND AND PURPOSE: We evaluated the risk factors for death among long-term stroke survivors compared with stroke-free subjects. METHODS: In 1997 we investigated 221 stroke survivors (mean, 9.4 years after index stroke) and 243 stroke-free subjects; both groups were recruited from a population-based health study. During the subsequent 5 years, all deaths (51 and 21 in the stroke and stroke-free groups, respectively) were registered. RESULTS: The age- and sex-adjusted total mortality rate for the 5-year follow-up was 21.0% in the stroke group and 7.9% in the stroke-free group (P<0.0001), depending on different rates of cardiovascular deaths (P<0.0001). Better physical and social functioning (P<0.0001) and moderate use of alcohol (P<or=0.004), the latter compared with no use, decreased risk of death, irrespective of stroke status. A myocardial infarction risk score had no impact on death in the stroke group, in contrast to the increased risk seen among the stroke-free group (P=0.0001). CONCLUSIONS: The long-term stroke survivors had significant excess risk of death compared with stroke-free subjects. Better physical and social functioning and moderate use of alcohol were associated with decreased risk, whereas a myocardial infarction risk score increased risk for death only in the stroke-free group.

Adult↗
PubMed2003

Pulse pressure and risk of Alzheimer disease in persons aged 75 years and older: a community-based, longitudinal study.

BACKGROUND AND PURPOSE: Elevated blood pressure has been found to increase the risk of dementia, including Alzheimer disease. We sought to investigate whether pulse pressure was predictive of Alzheimer disease and dementia. METHODS: A community-based, dementia-free cohort (n=1270) aged > or =75 years was clinically examined twice over 6 years to detect incident dementia with the use of the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Cox proportional hazards models were used to analyze pulse pressure in association with incident Alzheimer disease and dementia after adjustment for several potential confounders, including systolic pressure and diastolic pressure. RESULTS: During the 5464.6 person-years (median, 4.7 years) of follow-up, 339 subjects developed dementia, including 256 Alzheimer disease cases. Pulse pressure as a continuous variable was not statistically related to the risk of Alzheimer disease and dementia. In the categorical analysis, however, in comparison with median tertile of pulse pressure (70 to 84 mm Hg), subjects with higher pulse pressure had adjusted relative risks (95% CI) of 1.4 (1.0 to 2.0; P=0.04) for Alzheimer disease and 1.3 (0.9 to 1.7) for dementia. The corresponding figures related to lower pulse pressure were 1.7 (1.2 to 2.3) for Alzheimer disease and 1.4 (1.0 to 1.9; P=0.03) for dementia. This association was particularly pronounced among women. CONCLUSIONS: Higher pulse pressure is associated with increased risk for Alzheimer disease and dementia in old adults, which is probably due to artery stiffness and severe atherosclerosis. Poor cerebral perfusion related to decreased pulse pressure may explain the association between lower pulse pressure and increased dementia risk.

Aged↗
PubMed2003

Clinical findings in nondemented mutation carriers predisposed to Alzheimer's disease: a model of mild cognitive impairment.

Individuals carrying a mutation associated with Alzheimer's disease (AD) may serve as a model of mild cognitive impairment (MCI). Nondemented individuals from these families can be subdivided into asymptomatic and symptomatic groups. Four families were studied. Two families are associated with APP mutations (KN670/671ML, E693G) and two with PS1 mutation (M146V, H163Y). Clinical symptoms, level of global cognitive functioning as evaluated by Mini-Mental State Examination, neuropsychological test results, neuroradiological examinations (magnetic resonance imaging (MRI) and single-photon emission tomography (SPECT)), as well as cerebrospinal fluid (CSF) measurements of tau and beta-amyloid are reported. Nondemented mutation carriers did not report any symptoms indicating cognitive decline. In addition, no clinical signs of dementia or marked cognitive impairment in neuropsychological tests were found. A reduction of temporal blood flow with SPECT was indicated in 5/13 nondemented mutation carriers. Two of these 13 individuals had moderate hyperintensities in deep white matter as observed on MRI. CSF measurements of A beta 42/43 were inconclusive because of large biological variation. A nonsignificant elevation of tau was detected in mutation carriers. In conclusion, clinical examinations of relatively young individuals carrying an AD mutation did not reveal any marked abnormalities before the clinical onset of dementia.

Adolescent↗
PubMed2003

Social relations as determinants of oral health among persons over the age of 80 years.

OBJECTIVE: To analyze whether social relations during a 7-year follow-up influence oral health among generally healthy, community-dwelling persons over the age of 80 years. METHOD: The present investigation is based on a subsample of 129 dentate community-dwelling individuals from The Kungsholmen Elders Oral Health Study (KEOHS), which included data from interviews and oral examinations. Social relations were measured in terms of marital status, living alone, frequency of contacts, number of confidants, and satisfaction with social contacts and with the frequency of contacts. Oral health was measured in terms of coronal caries and root caries. RESULTS: The primary findings of the adjusted multivariate logistic regression analysis were that persons who lived alone or who became alone during the 7 years prior to the dental examination had greater odds of having coronal caries (odds ratio (OR): 2.4, 95% CI: 1.0-5.7) than those who continually lived with others, and that persons who were continuously dissatisfied with the frequency of their social contacts were more likely to have root caries than those who reported a sustained satisfaction with the frequency of their social contacts (OR: 2.9, 95% CI: 1.2-7.2). CONCLUSION: This study suggests that social relations are related to the oral health status of old-old individuals. From a psychosocial perspective, our findings contribute to a deeper understanding of the background of oral health status in older adults.

Activities of Daily Living↗
PubMed2003

Poor outcome after first-ever stroke: predictors for death, dependency, and recurrent stroke within the first year.

BACKGROUND AND PURPOSE: The purpose of this study was to define predictors of poor outcome after a first-ever stroke. We studied risk factors and stroke severity at baseline in relationship to death, dependency, and stroke recurrence within a year after the event. METHODS: The study included a community-based cohort of first-ever stroke patients. Subarachnoid hemorrhage was not included. All patients (n=377) were subjected to investigations regarding risk factors. Stroke severity was evaluated with the National Institutes of Health Stroke Scale, and dependency was defined according to the modified Rankin Scale. Multivariate regression models were used to analyze predictors of survival, dependency, and stroke recurrence. The following independent variables were used: age, sex, cohabitation status, cigarette smoking, dementia, hypertension, ischemic heart disease, heart failure, atrial fibrillation, diabetes mellitus, transitory ischemic attack, peripheral atherosclerosis, and stroke severity. RESULTS: The 1-year mortality was 33%. After 1 year, 37% of the survivors were dependent; 9% of survivors had a recurrent stroke within a year. Dementia, age, stroke severity, and atrial fibrillation were associated with death within a year. Dependency was associated with age, stroke severity, and heart failure. Stroke recurrence was predicted by age and dementia. CONCLUSIONS: In addition to age and stroke severity, heart diseases and dementia before the stroke seem to have an impact on mortality and recurrence after 1 year. Finding and, when possible, treating these prestroke conditions may affect stroke morbidity and mortality favorably.

Adult↗
PubMed2002

Prosthetic crowns and other clinical risk indicators of caries among old-old Swedish adults: findings from the KEOHS Project. Kungsholmen Elders Oral Health Study.

OBJECTIVES: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, Sweden. This paper explored possible clinical risk indicators of coronal and root caries among the KEOHS subjects. DESIGN: In this cross-sectional study, dentate KEOHS subjects received a caries assessment using defined visual, tactile criteria. SETTING: Examinations were carried out in two local clinics by standardized examiners. SUBJECTS: One hundred twenty-nine dentate persons were examined. MAIN OUTCOME MEASURES: The examination identified decayed and filled surfaces, prosthetic crowns, and missing teeth. RESULTS: More root than coronal surfaces had untreated decay, and secondary root caries contributed the greatest number of decayed surfaces. Ninety percent of the examined dentate subjects had at least one prosthetic crown. Root surfaces exposed to crown margins were more likely to have caries than root surfaces not so exposed, particularly among women. The presence of untreated coronal caries (yes/no) was positively associated with having untreated root caries and an intermediate number (14-20) of teeth, but inversely associated with having 4+ prosthetic crowns. Active root caries (yes/no) was positively associated with having untreated coronal caries, 14-20 teeth, and 4+ prosthetic crowns. Nearly 20% of identified root lesions were present at or below the gingival margin, and most (88%) were secondary caries associated with crown margins (65%) or other restorations (23%). CONCLUSIONS: Our findings suggest that some dental characteristics, including the presence of prosthetic crowns, are risk indicators for the presence of untreated coronal and root caries.

Age Distribution↗
PubMed2002

CADASIL: a common form of hereditary arteriopathy causing brain infarcts and dementia.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disease leading to cognitive decline and dementia. CADASIL usually begins with migraine in about one third of the patients. More severe manifestations, transient ischemic attacks or recurrent strokes, appear between 30 and 50 years of age. CADASIL, however, may be diagnosed well before the first stroke on the basis of characteristic white matter hyperintensities upon magnetic resonance imaging and presence of pathognomonic granular osmiophilic material in arterial walls, including dermal arteries, since the arteriopathy is generalized. Gradual destruction of vascular smooth muscle cells (VSMC) leads to progressive wall thickening and fibrosis and luminal narrowing in small and medium-sized penetrating arteries. The reduced cerebral blood flow finally causes lacunar infarcts, mainly in the basal ganglia and fronto-temporal white matter, which lead to cognitive deficits and dementia of the subcortical vascular type. CADASIL is caused by single missense mutations or small deletions in Notch3 gene encoding a transmembrane receptor Notch3, of which upon ligand binding a nuclear signaling protein is generated by regulated intramembrane proteolysis. Notch signaling is essential during development, regulating cellular differentiation. In adults Notch3 is expressed only in VSMCs and it may promote cell survival by inhibiting apoptosis, but its exact function is unknown. Mutations result in either a gain or loss of one (or rarely, 3) cysteine residue(s) in one of the 34 epidermal growth factor-like repeats in the extracellular amino-terminal region of Notch3. It is as yet unclear which disturbance in the Notch signaling pathway leads to the characteristic vascular pathology of CADASIL.

Arteries↗
PubMed2002

Dental caries in persons over the age of 80 living in Kungsholmen, Sweden: findings from the KEOHS project.

OBJECTIVES: The Kungsholmen Elders Oral Health Study (KEOHS) evaluated the oral health status of generally healthy, community-dwelling persons over the age of 80 living in Kungsholmen, an area in central Stockholm. This paper reports findings regarding the prevalence and severity of dental caries among the dentate participants. BASIC RESEARCH DESIGN: Caries examinations were conducted on eligible persons participating in the Kungsholmen Project, an ongoing, longitudinal study of older adults. SETTING: Caries examinations were carried out between 1994 and 1996 at two local clinics by three standardised examiners using defined visual, tactile criteria. PARTICIPANTS: Among 296 potentially eligible participants, 159 were examined, and a total of 129 had at least one tooth. MAIN OUTCOME MEASURES: The caries examination identified decayed and filled surfaces and missing teeth. RESULTS: Of the dentate subjects examined, 80% had teeth in both arches; 98% had at least one coronal filling; 81% had one or more restored root surfaces. Depending upon age and gender, between 36% and 56% of those examined had untreated coronal caries, and between 54% and 75% had untreated root caries. CONCLUSIONS: These findings document the substantial and ongoing impact of dental caries in a sample of generally healthy, community-dwelling older adults and underscore the importance of continued caries prevention and treatment in the aged.

Age Factors↗
PubMed2001

Blood pressure and dementia in persons 75+ years old: 3-year follow-up results from the Kungsholmen Project.

A community cohort of 1270 non-demented 75+ years old persons was followed to evaluate the influence of blood pressure on incidence of dementia. Two hundred and eighteen dementia cases were detected during an average of three years of follow-up. Subjects with baseline systolic pressure >/= 180 mm Hg had an age- and gender-adjusted relative risk (RR) of 1.6 (95% to persons with systolic pressure of 141-160 mm Hg. This association persisted, although not statistically significant, when education, vascular diseases, and antihypertensive drug use were entered in the model (RR = 1.4; 95% systolic pressure were not related to dementia incidence. However, individuals with a decrease of 5--19 mm Hg and >/= 20 mm Hg in systolic pressure from baseline to follow-up had a RR of 1.8 (95% 2.6) and 2.5 (95% also found in subjects with diastolic pressure reduction. In conclusion, our findings support an association between high systolic pressure and increased risk of dementia, whereas blood pressure reduction may be secondary to the dementia process itself.

Journal Article↗
PubMedDate not supplied

Impaired motor speed, visuospatial episodic memory and verbal fluency characterize cognition in long-term stroke survivors: the Tromsø Study.

The cognitive function after stroke is examined in acute and subacute phase, but poorly characterized in long-term stroke survivors. This paper discusses cognitive function among long-term stroke survivors, with matched stroke-free subjects, based on a population survey. General cognition, verbal, executive and visuospatial function, memory, attention, and motor speed were tested as well as motor function in upper extremities. Stroke survivors and controls were most effectively discriminated by means of motor speed, followed by visuospatial episodic memory and verbal fluency. This pattern of cognitive disturbances may be a consequence of cerebral lesions in frontal subcortical areas, and is different from Alzheimer's disease.

Aged↗