The strong association of SSBI, FWT2HL, and PVH with hypertension suggests a common underlying mechanism (presumably small-vessel vasculopathy). The SSBI showed the most significant association for clinical subcortical stroke. The FWT2HL was also a risk factor for the stroke but was less significant than SSBI. The subjects with SSBI should be considered at high risk for clinical subcortical brain infarction or brain hemorrhage.

We investigated the effects of pacemaker implantation on cerebral blood flow and cognitive function in 14 severely bra-dycardic patients (mean age 75.2 years). Cerebral blood flow and verbal intelligence improved after the pacemaker implantation. Systolic and mean arterial blood pressure was significantly reduced after the implantation. Changes in cerebral blood flow significantly correlated with changes in heart rate in polynomial regression analysis, but not with changes in cardiac output. Before the implantation, verbal cognitive function was lower in bradycardic patients than in age-matched control subjects, and brain CT showed significant advanced atrophy in these patients. However, verbal cognitive function was also improved after the implantation. Pacemaker implantation in the severe bradycardic elderly should be beneficial not only for cardiac function but also for brain function. We concluded that these results suggest that heart rate is one of the important factors in the regulation of cerebral circulation in patients with severe bradycardia. Pacemaker implantation in the elderly improved quality of life and may prevent mental deterioration.

No abstract

These results suggest that dysfunction of specific cortical and subcortical regions in both hemispheres asymmetrically contributes to depressive state after stroke.

Weinvestigated the relationship between cigarette smoking and silent brain infarction in 365 neurologically normal male Japanese subjects (smokers: 119, nonsmokers: 246). Silent brain infarction was identified in 32 (26.9%) of 119 smokers and in 54 (22.8%) of246 nonsmokers. Mild or moderate periventricular hyperintensity was presented in 27 smokers (22.7 %) and 54 nonsmokers (22.8%). There was no significant difference in the regional cerebral blood flow or the average systolic, diastolic, and mean arterial blood pressures between groups. The HDL-cholesterol level was significantly lower in smokers than in nonsmokers (p<0.01). Cigarette smoking was not related to the incidence of silent brain infarction or leuko-araiosis in healthy adults in Japan. (Internal Medicine 35: 704-706, 1996)