A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.
We investigated potential risk factors for Alzheimer's disease (AD) in a clinicopathologic study of 407 patients with definite AD, 100 non-Alzheimer dementia patients, and 50 normal subjects. The AD patients had more first-degree relatives with dementia than the non-AD dementia group (odds ratio of 1.85, 95% confidence interval of 1.07-3.20) or the normal elderly (odds ratio of 3.60, 95% confidence interval of 1.50-8.64) but did not have significantly more head injuries, medical and psychiatric illnesses, or relatives with Down's syndrome. The AD patients with a family history of dementia had their dementia at a later age than those without an affected relative. These findings indicate a familial risk for AD that is greater than for other dementing illnesses and has age-related penetrance. This study does not support other putative risk factors for AD such as head trauma and familial Down's syndrome.
BackgroundDepression affects approximately 40% of people with dementia, and is critical to quality of life. Here we examined the relationship between chronic depression and cognition in people with ischemic stroke and used plasma proteomics to get at potential mechanisms and identify novel therapeutic targets.MethodWe recruited subjects 5 months to 9 years after ischemia, age >40, who completed a 60 minute battery of cognitive tests. Composite scores of memory, processing speed, working memory, spatial functioning, and a global cognition score (the average of all cognitive tests) were created based on age‐normed performance. Mood was assessed with the Stroke Impact Scale (SIS3), transformed to a 100‐point scale. Linear regression models analyzed the relationship between depression and cognitive scores in 99 subjects. Plasma was analyzed by O‐link proteomics for 1011 proteins in 85 subjects. Additional regression models were constructed to estimate SIS3 using proteomics. Models were subject to bootstrapping for robustness, and cross‐validation to ensure results were reported on subjects blinded during model training. Pearson correlation identified linear associations between individual proteins and mood. We also investigated differences in proteins with subjects dichotomized into non‐depressed (SIS3>63) or depressed (SIS3≤63) groups.ResultMood was significantly associated with global cognitive score (R=0.368; p<0.001), visuospatial score (R=0.255; p=0.014), and processing speed (R=0.430; p<0.001), but not memory (p=0.441) or working memory (p=0.166). Proteomics alone predicted SIS3 in multivariable models. A total of 180 proteins correlated significantly with SIS3. Plasma levels of IL‐6 (p=0.0325), and TRIM5 (p=0.0011) were significantly elevated in subjects with depression, while HPGDS was significantly reduced (p<0.001). There was no difference in plasma levels of candidate proteins IL‐1ß (p= 0.0830) or TNF (p=0.5287) between depressed and non‐depressed subjects.ConclusionWe report that depression is associated with cognitive outcomes in a population with ischemia, and that machine learning models can predict mood from comprehensive plasma proteomics. We also identified proteins of interest including HPGDS (produces Prostaglandin D) and TRIM5 (upstream of NFkB) that point to an immune association with ischemia‐triggered depression. Future studies are needed to replicate these findings, and preclinical models may help uncover mechanistic relationships that could lead to new therapies.
Introduction: Infection after stroke is more common with large strokes and thus peripheral markers of inflammation are not well defined in stroke survivors with smaller strokes. We sought here to define the prevalence of infection, low grade fever (T≥38°C), and white blood cell count over 11x10 3 /mL (WBC>11) in the first week after stroke in subjects with smaller stroke sizes, and to ask how inflammation in the acute period affects cognitive outcomes in this population. Methods: We performed systematic chart review of hospitalization after ischemic stroke (up to 7 days) in 65 subjects enrolled in the StrokeCog study who returned for testing 5-13 months later (median stroke volume 6 mL, [IQR 0.5, 16.6]). We assessed infection (CDC consensus criteria), highest WBC, and presence of T≥38°C. Mann-Whitney U test and general linear models were used to assess whether WBC in the first week predicted outcomes at follow-up: MoCA, Stroke Impact Scale Depression (SIS3), a global cognitive score, and composite scores of memory, motor functioning, processing speed, language, and spatial ability. Models were adjusted when appropriate for age, sex, and stroke size or NIHSS at admission. Results: Infection and T≥38°C were each present in 8%, and WBC>11 in 18% of participants within 7 days of stroke. Since only high WBC was present in a substantial proportion of subjects, we compared outcomes in high (>11) vs. normal (≤11) WBC. Subjects with high WBC had larger strokes (13cc [6.6, 38.6] vs. 3.2[0.4, 10.6], p= 0.027) and worse admission NIHSS (10[4,13)] vs 2[1,5], p =0.003). In addition, WBC>11 in the first week was associated with worse mood and lower scores in memory, language, and global cognition months later. After adjustment, WBC remained significantly predictive of mood ( p =.039) and global cognition ( p =0.003); language remained significant if adjusted for stroke size ( p =0.010) but not NIHSS ( p =0.19). Conclusions: Infection and T≥38°C are uncommon during acute hospitalization of ischemic stroke survivors who can return to complete comprehensive testing batteries 5-13 months later. WBC>11 within the first week after stroke may be a marker of later inflammation and predicts more chronic depression and worse cognitive outcomes in this population.
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