Prevalence of Sjögren's syndrome with dementia in a memory clinic.

INTRODUCTION: Sjögren's syndrome (SS) is an autoimmune disorder involving the exocrine glands, which affects 1.9-3.0% of the elderly population. Approximately 20% of all patients with SS have CNS involvement, including dementia, as a result of angiitis. AIMS: The aim of the study was to clarify the prevalence and impact of SS among patients in a memory clinic. METHODS: This study prospectively recruited patients with cognitive dysfunction in a memory clinic from 2007 to 2010. In addition to the examinations for dementia, the patients' levels of anti-SSA and SSB antibodies were measured. Schirmer's test and/or a lip biopsy were added if required. SS was diagnosed based on the American European consensus criteria. RESULTS: Out of 276 cases who completed the examinations, 265 (97/168 males/females, mean age: 77.9, median MMSE score: 23) did not demonstrated cognitive decline. Sixteen (6.3%) and seven (2.7%) patients were positive for anti-SS-A and SS-B antibodies, respectively. Twenty patients (7.5%) were diagnosed with primary SS (mean age: 77.2 years old, median MMSE: 21). Seven of these patients had previously been diagnosed with MCI (VCIND: 5, aMCI: 2), and 13 had been diagnosed with dementia. All had asymmetrical focal hypoperfusion on SPECT, and eighteen had subcortical lesions on MRI. Twelve were treated for dementia (median time: 2.1 years), and their MMSE significantly improved (median MMSE: 26, p=0.0019), while the non-SS subjects' MMSE declined (n=126, median: 22). CONCLUSION: The patients with SS accounted for 7.5% of those with a cognitive decline as determined at a memory clinic, and are characterized by subcortical white matter lesions and asymmetric hypoperfusion.

Lacunar syndrome associated with paradoxical brain embolism.

We report a patient who developed lacunar syndrome due to left upper pons infarction after performing leg exercises associated with paradoxical brain embolism. A 32-year-old man developed right arm weakness and moderate dysarthria following leg exercise. Brain MRI showed a paramedian pontine infarction of the left upper pons, and contrast transesophageal echocardiographic examination indicated that the patent foramen ovale was the embolic source. Simultaneous RI venography examination of the lower limbs identified deep venous thrombosis in the right leg as a paradoxical emboligenic source. We concluded that the presence of lacunar syndrome suggests that this mechanism was responsible for the paradoxical brain embolism.

Carotid intima-media thickness and risk of cardiovascular events in high-risk patients. Results of the Osaka Follow-Up Study for Carotid Atherosclerosis 2 (OSACA2 Study).

BACKGROUND AND PURPOSE: There is epidemiological evidence that increased carotid intima-media thickness (IMT) is a predictor of cardiovascular disease (CVD) events. However, the significance of carotid IMT in high-risk patients in whom risk factors are managed clinically has not been adequately investigated. The purpose of this study was to determine the usefulness of carotid IMT measurement in such patients. METHODS: The study comprised 900 outpatients with cardiovascular risk factors or established atherosclerosis. Carotid IMT was calculated as the mean bilateral IMT of the common carotid artery, bifurcation, and internal carotid artery. Baseline vascular risk factors, medications, and history of CVD were recorded at the time of enrollment. The incidence of CVD events was determined prospectively. RESULTS: During a mean follow-up period of 2.6 years, there were 64 CVD events. The relative risk (RR) of a CVD event increased with increased IMT. Association between CVD events and carotid IMT was significant after adjustment for risk factors and history of CVD, showing an increased risk per IMT tertile from the middle tertile (RR, 2.5; 95% confidence interval [CI]: 1.0-6.3) to the highest (RR, 3.6; 95% CI: 1.4-9.0). When patients with a history of CVD were excluded (n = 574), the predictive value of IMT was significant even after adjustment for risk factors (hazard ratio per 1 SD IMT increase was 1.57 [95% CI: 1.11-2.20]). CONCLUSIONS: Carotid IMT is an independent predictor of vascular events in high-risk patients in whom risk factors are managed clinically.

Carotid atherosclerosis as a risk factor for complex aortic lesions in patients with ischemic cerebrovascular disease.

Aortic arch atherosclerotic lesions can cause ischemic cerebrovascular disease (ICVD). The association between carotid and aortic atherosclerosis was examined, and it was investigated whether noninvasive carotid evaluation aids in the identification of aortic lesions as potential ICVD risk. The subjects comprised 147 patients with ICVD who had undergone carotid ultrasonography and transesophageal echocardiography. Carotid and aortic arch atherosclerosis was evaluated by measuring the maximum intima - media thickness (IMT), with aortic IMT of at least 4 mm, mobile plaques and/or ulcers defined as complex aortic lesions with potential ICVD risk. Carotid IMT was linearly associated with aortic IMT (r=0.53, p<0.001), and the association was independent of traditional cardiovascular risk factors (beta =0.36, p<0.001). Also, each 1 SD greater carotid IMT was associated with 4.2-fold (95% confidence interval: 2.5-7.0) higher likelihood of complex aortic lesions, with the likelihood little modified when controlling for cardiovascular risk factors. In particular, complex aortic lesions were found in 78% of patients with the highest carotid IMT tertile, compared with 14% of those with the lowest tertile (p<0.05). Based on these findings, carotid atherosclerosis is associated with aortic atherosclerosis, representing a risk factor for aortic lesions that are a potential ICVD risk.