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Background: ischaemic cerebrovascular small vessel disease (SVD) is a prevalent and under-diagnosed condition that triggers vascular cognitive impairment (VCI).Objective: to describe the neuropsychological and clinical profiles in SVD (Binswanger's disease, BD; lacunar state, LS) from the clinician's perspective at the VCI stage.Methods: a total of 1257 patients admitted to a tertiary center with a diagnosis of stroke, neuroradiological vascular disease, cognitive impairment/dementia, during a 13-year period were investigated. We prospectively assessed cognition in a subset of 141 patients with VCI (LS n = 28, BD n = 69, large vessel disease—LVD—n = 44) with MMSE, CAMDEX-H, WAIS-R, EXIT-25 and Trail making test.Results: executive dysfunction (ECD) (n = 89, 91.7% versus n = 10, 22.7%; P < 0.001) and gait disturbances (n = 74, 76.3% versus n = 15, 34.1%; P < 0.001) characterized SVD. Prior strokes (n = 9, 9.3% versus n = 23, 52.3%; P < 0.001) and embologenous cardiopathy (n = 39, 40.2% versus n = 28, 63.6%; P < 0.04) featured LVD cases. BD was defined by hypertension (n = 52, 75.4% versus n = 30, 44.1%; P < 0.001), ECD (n = 65, 94.2% versus n = 34, 47.2%; P < 0.001) and VCI onset with cognitive impairment but not strokes (n = 44, 63.8% versus n = 34, 50%; P < 0.01).Conclusions: ECD and a frontal gait are SVD's clinical landmarks in our sample. LS and BD cases share a similar cognitive profile. [ABSTRACT FROM AUTHOR]

Objectives: non-valvular atrial fibrillation (NVAF) is an established risk factor for thromboembolism and stroke. Small cross-sectional studies suggest associations between NVAF, silent cerebral infarction and decreased cognitive function. We compared change in cognitive function between patients with recent onset NVAF and controls 12 and 36 months after baseline assessment, and examined the impact of anti-thrombotic therapy. Design: prospective longitudinal cohort study with follow-up at 12 and 36 months. Setting: Sunderland and South Tyneside, North East of England. Participants: community-dwelling men and women aged over 60 with recently identified NVAF or in sinus rhythm, matched for age, sex and general practice (N = 362, 174 NVAF, 188 sinus rhythm). Participants were stratified for use of anti-thrombotic therapy. Measurements: assessment included stroke risk factors and a comprehensive battery of neuropsychological tests. Results: at 3 years, 74 cases and 86 controls remained, giving an attrition rate for cases (59%) versus controls (52%);p = 0.15. Analysis of change in cognitive function between baseline and follow-up at 12 and 36 months revealed no clinically important differences between cases and controls, nor between subgroups on aspirin, warfarin or neither. Age and other confounders did not influence the results. Conclusions: there was no association between overall cognitive decline and NVAF after 3 years' follow-up, nor any apparent effect of anti-thrombotic therapy. This is consistent with our baseline results, but conflicts with previous studies. Cognitive decline is probably multifactorial and any influence of NVAF was not identified in this study. [ABSTRACT FROM AUTHOR]

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/1 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/1 or a plasma glucose level of ≥ 11.1 mmol/1 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. [ABSTRACT FROM AUTHOR]

Presents several abstracts of studies on the aged and aging. 'Stroke Risk Factors in Older People,' by T.L. Davies, D.B. Chappel, C.M. Sudlow, G. Murolo, R. Dobson, R.A. Kenny, R.G. Thomson and H. Rodgers; 'Assessment of Nutritional Status in Community Dwelling Subjects Attending a Memory Clinic,' by C. Fallon, I. Bruce, F. Buggy, A. Eustace, S. Ni Bhriain, R. Coen, J.B. Walsh, B.A. Lawlor, D. Coakley and C. Cunningham.

An introduction is presented in which the editors discuss various reports within the issue on topics including a report on physicians' attitudes concerning anticoagulant treatment for atrial fibrillation (AF) patients, the reluctance of physicians to anticoagulate older patients, and the overestimation of bleeding risk by physicians which is a key barrier to oral anticoagulants (OAC) prescription.

The article discusses the stratification schemes of the risk factors of stroke in atrial fibrillation (AF) patients. It mentions that the need to categorize risks has fueled the development of the risk stratification systems based on stroke risk factors from non-warfarin arms of clinical trial cohorts. It also discusses the congestive heart failure, hypertension, diabetes mellitus and stroke or transient ischaemic attack (CHADS[2]) stratification scheme.

The article offers news briefs related to various studies on geriatric medicine. A study identified that cigarette smokers can have chronic pancreatitis which can be contributed by aging. According to a study, elective surgery in older patients aged 80 and above having abdominal aneurism can create considerable risk. Another study revealed that depression in old age can develop dementia.

This section discusses various research related to aging and elderly people's health. A study discovered that the risk of stroke is increased in patients who have undergone endarterectomy for carotid artery stenosis. Another study found that rheumatoid arthritis reduces life expectancy. A literature review revealed various issues concerning the primary care of depression in older people, including its prognosis.

Presents an abstract of the study "A Search for Novel Risk Factors of Stroke in South Asians," by K. M. Sharobeem, J. V. Patel, A. E. S. Ritch, F. Siddiqui and E. A. Hughes.

Presents an abstract of the report `Primary and secondary risk factor management in stroke patients,' by S.E. Gariballa et al, presented during the Autumn Meeting of the British Geriatrics Society on October 13 and 14, 1995 in London, England.

Presents an abstract of the study `Coagulation factors in acute stroke and transient ischaemic attacks,' by P.B. Khanna, B.K. Bhowmick and J. Kassab, presented during the spring meeting of the British Geriatrics Society on April 6 to 8, 1995.

Examines the role of Von Willebrand factor a (VWFa) in ischemic stroke in an elderly subject by using transient ischemic attacks and minor ischemic strokes. Mean concentrations of VWFa; Odds ratio from highest to lowest quartile of VWFa; Effect of adjustment for other potential risk factors.