Search

Background Alzheimer's disease (AD) and cardiovascular and cerebrovascular diseases (CVD) are significant concerns among the elderly, sharing overlapping risk factors. Hawaii's unique demographic profile, characterized by its strong ethnic diversity, shows marked racial health disparities. For instance, the Native Hawaiian/Pacific Islander (NHPI) population is identified as a high-risk group for multiple health conditions, including CVD.Objective This study investigates the impact of AD on the risk of developing CVD, with a focus on racial influences, utilizing Hawaii Medicare data.Methods Employing nine years of longitudinal Hawaii Medicare data, this study identified elderly patients diagnosed with AD who subsequently developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), or stroke. To assess the risk of CVD, we utilized multistate models and employed propensity score-matched controls. Additionally, we evaluated racial and ethnic differences in the risk of these diseases, while accounting for other relevant risk factors.Results Our findings revealed an elevated risk of AMI, HF, and IHD among individuals diagnosed with AD. Additionally, socioeconomic status (SE) was identified as a crucial factor in the risk of cardio and cerebrovascular diseases. Within the low SE group, NHPIs exhibited increased risks of HF and IHD compared to their white counterparts. Interestingly, NHPIs demonstrated reduced risks of HF in the higher SE group.Conclusions The presence of AD increases the likelihood of developing AMI, HF, and IHD. Moreover, the risk of CVD appears to be influenced by race/ethnicity in Hawaii, as well as socioeconomic status.

Background: There is an expanding body of literature implicating heart disease and stroke as risk factors for Alzheimer’s disease (AD). Hawaii is one of the six majority-minority states in the United States and has significant racial health disparities. The Native-Hawaiians/Pacific-Islander (NHPI) population is well-known as a high-risk group for a variety of disease conditions.Objective: We explored the association of cardiovascular disease with AD development based on the Hawaii Medicare data, focusing on racial disparities.Methods: We utilized nine years of Hawaii Medicare data to identify subjects who developed heart failure (HF), ischemic heart disease (IHD), atrial fibrillation (AF), acute myocardial infarction (AMI), stroke, and progressed to AD, using multistate models. Propensity score-matched controls without cardiovascular disease were identified to compare the risk of AD after heart disease and stroke. Racial/Ethnic differences in progression to AD were evaluated, accounting for other risk factors.Results: We found increased risks of AD for AF, HF, IHD, and stroke. Socioeconomic (SE) status was found to be critical to AD risk. Among the low SE group, increased AD risks were found in NHPIs compared to Asians for all conditions selected and compared to whites for HF, IHD, and stroke. Interestingly, these observations were found reversed in the higher SE group, showing reduced AD risks for NHPIs compared to whites for AF, HF, and IHD, and to Asians for HF and IHD.Conclusions: NHPIs with poor SE status seems to be mostly disadvantaged by the heart/stroke and AD association compared to corresponding whites and Asians.

Better characterizing moyamoya disease (MMD) from ischemic strokes of other etiologies may facilitate earlier diagnosis by raising suspicion for a diagnostic work-up.

To examine outcomes at age 4.5 years and compare to earlier ages in children with fetal antiepileptic drug (AED) exposure.

The risk of dose-dependent seizures is a safety issue with bupropion hydrochloride. To evaluate the presence of specific electroencephalographic (EEG) waveforms, 210 adult subjects taking stable doses of bupropion hydrochloride were recruited to undergo 2 EEGs in a prospective, single-center cohort study. The occurrence of spike waves, sharp waves, and focal slowing was recorded and assessed with a continuation ratio logit model for polytomous responses. This model showed that there was a relationship between sex and the incidence of these waveforms, such that the odds of female subjects having sharp waves was increased by a factor of 2.53 (P= 0.05) when compared with male subjects and controlled for both age and dose. Similarly, female subjects were 2.45 (P= 0.09) times more likely than males to have focal slowing on EEG. Overall, 19.8% (39/197) of this representative population was found to have abnormal, asymptomatic EEG findings. The presence of these waveforms in individuals taking a medication known to lower the seizure threshold may be a risk factor for developing seizures.

Intravascular lymphomatosis (IL) is a rare variant of non‐Hodgkin's lymphoma with an unusual predilection for the central nervous system (CNS). Most cases are not diagnosed until postmortem because of variable clinical presentation and nonspecific laboratory findings. Neuroimaging findings vary widely and range from diffuse involvement of the deep white matter to infarct‐like lesions. Cerebral magnetic resonance imaging (MRI) may show parenchymal and meningeal gadolinium enhancement. The authors describe brain MRI findings of linear, punctate, and patchy enhancement suggestive of CNS IL in two patients confirmed by brain biopsy/histologic studies. High index of clinical suspicion and careful interpretation of MRI (including gadolinium contrast studies) may contribute to premortem diagnosis and early intervention of this often‐missed disease.