| 1. |
- Aked, Joseph, et al.
(författare)
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Completeness of case ascertainment in Swedish hospital-based stroke registers
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:2, s. 148-155
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a worldwide development toward using data from hospital-based stroke registers to estimate epidemiological trends. However, incomplete case ascertainment may cause selection bias. We examined the completeness of case ascertainment and selection bias in two hospital-based Swedish stroke registers. Methods: First-ever stroke cases between March 2015 and February 2016 in the catchment area of Skåne University Hospital, Lund, Sweden, were included from multiple overlapping sources: two hospital-based stroke registers, Riksstroke-Lund and Lund Stroke Register (LSR); local outpatient and inpatient registers; primary care registers; and autopsy registers. The resulting population-based cohort was used as reference to assess completeness of case ascertainment and patient characteristics in Riksstroke-Lund and LSR. Results: In total, 400 stroke patients were identified. Riksstroke-Lund detected 328 (82%) patients, whereas LSR detected 363 (91%). Patients undetected by hospital-based registers had higher 28-day case fatality than those detected (44% vs 9%; P =.001). Patients only detected in primary care (n = 11) more often lived in healthcare facilities compared with those detected by hospital-based registers (57% vs 7%; P =.001). Patients not detected by Riksstroke-Lund, but detected by population-based sources, had less severe strokes (median NIHSS 3 vs 5; P =.013). Conclusions: Some first-ever stroke patients, such as those with high early case fatality and those with mild stroke, may go undetected with hospital-based screening used in clinical stroke registers. This can result in selection bias due to not identifying specific groups of patients including some with high early case fatality and those living in healthcare facilities.
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| 2. |
- Andersson, Klara, et al.
(författare)
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Valproic acid and socioeconomic associations in Swedish women with epilepsy 2010-2015
- 2021
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 143:4, s. 383-388
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Tidskriftsartikel (refereegranskat)abstract
- Objective We investigated the correlation between socioeconomic status and the prescription of Valproic acid (VPA) in women of fertile age in Sweden. Methods This is a registered-based cohort study including all women living in Sweden aged 18-45 years in the years 2010-2015, with a diagnosis of epilepsy and no intellectual disability (n = 9143). Data were collected from the National Patient Register, the Drug Prescription Register, and the Longitudinal integration database for health insurance and labor market studies (LISA). Results Women with only 9 years of school were more often prescribed VPA than women with a University degree (12.9% compared to 10.7% in 2015 [p = 0.015]). Similar differences were seen between the lowest and highest income group (16.6% compared to 12.7% in 2015 [p < 0.001]). The odds of having a VPA prescription in 2015 was 1.59 (p < 0.001) in women with 9 years of school compared to women with a University degree, and 1.60 (p < 0.001) in the lowest income group relative to the highest income group after adjusting for age. From 2010 to 2015, the proportion with VPA prescription in the whole cohort diminished with an absolute reduction of -2.2% (p < 0.001). The decrease was similar among the different education and income groups (p = 0.919 and p = 0.280). Significance The results indicate that the increased knowledge on VPA teratogenicity was implemented across socioeconomic strata in the Swedish healthcare system. Women with lower income or education level remained more frequent VPA users. Whether this difference reflects epilepsy type or severity, or socioeconomic disparities, merit further study.
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| 3. |
- Apostolaki-Hansson, Trine, et al.
(författare)
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Patient factors associated with receiving reversal therapy in oral anticoagulant-related intracerebral hemorrhage
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:5, s. 590-597
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Tidskriftsartikel (refereegranskat)abstract
- Background: We aimed to describe baseline characteristics of patients with oral anticoagulant-related intracerebral hemorrhage (OAC-ICH) in Sweden and to identify predictive variables associated with receiving hemostatic treatment in the event of OAC-ICH. Methods: We performed an observational study based on data from Riksstroke and the Swedish Causes of Death Register to define baseline characteristics of patients with OAC-ICH who received reversal treatment compared with patients who did not receive reversal treatment during 2017–2019. Predictive analysis was performed using multivariable logistic regression to identify odds ratios for factors associated with receiving OAC reversal treatment. Results: We included 1902 patients ((n = 1146; OAC reversal treatment) (n = 756; no OAC reversal treatment)). The proportion of non-Vitamin K oral anticoagulant associated ICH (NOAC-ICH) patients who received reversal treatment was 48.4% and the proportion of Vitamin K antagonist-associated ICH (VKA-ICH) patients was 72.9%. Factors associated with a lower odds of receiving reversal treatment were increased age (OR = 0.98; 95% CI: 0.96–0.99), previous stroke (OR = 0.78; 95% CI: 0.62–0.98), comatose LOC (OR = 0.36;95%CI: 0.27–0.48; ref. = alert), pre-stroke dependency (OR = 0.72; 95% CI: 0.58–0.91), and NOAC treatment (OR = 0.34; 95% CI: 0.28–0.42). Care at a university hospital was not associated with higher odds of receiving reversal treatment compared to treatment at a county hospital. Conclusion: Treatment with a reversal agent following OAC-ICH was related to several patient factors including type of OAC drug. We identified that only 48% of patients with NOAC-ICH received hemostatic treatment despite an increase in these cases. Further studies are required to guide the use of reversal therapies more precisely, particularly in NOAC-ICH.
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| 4. |
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| 5. |
- Appelros, Peter, et al.
(författare)
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Stroke prevalence in a medium-sized Swedish municipality
- 2021
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Ingår i: Acta Neurologica Scandinavica. - : Munksgaard Forlag. - 0001-6314 .- 1600-0404. ; 143:2, s. 210-216
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Many patients who have had stroke survive with functional disability for years. Stroke prevalence is a fundamental measure of the impact of stroke in society. Stroke prevalence has never been evaluated in Sweden.MATERIALS & METHODS: 2019 with respect to stroke survivors (ICD-10 I60-I69) living in Kumla (population 21,738), a municipality well representative of Sweden.RESULTS: 330 individuals with stroke were found, of which 42% were women. The mean age was 74.1 years in men and 75.1 years in women. 11.5% of the patients had more than one stroke. The mean duration since the first stroke was 8.3 years. The crude prevalence per 100,000 was 1754 in men, 1281 in women and 1518 in both sexes. Adjusted to the European population, the ratio was 1570 per 100,000, and to the World population 936 per 100,000.CONCLUSIONS: In spite of a declining stroke incidence in Sweden, the stroke prevalence in Kumla, Sweden, is relatively high. Comparisons with other studies indicate that a decline in prevalence may have occurred since the early 2000s. Modern registers can support data collection, but the index stroke may have occurred almost forty years back in time.
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| 6. |
- Asp, Amanda, et al.
(författare)
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Impaired procedural memory in narcolepsy type 1
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146:2, s. 186-193
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Sleep enhances the consolidation of memories. Here, we investigated whether sleep-dependent memory consolidation differs between healthy subjects and narcolepsy type 1 (NT1) patients. Material and Methods We recruited 18 patients with NT1 and 24 healthy controls. The consolidation of spatial (declarative memory; 2-dimensional object location) and procedural (non-declarative memory; finger sequence tapping) memories was examined across one night of at-home sleep. Sleep was measured by an ambulatory sleep recording device. Results The overnight gain in the number of correctly recalled sequences in the finger-tapping test was smaller for NT1 patients than healthy subjects (+8.1% vs. +23.8% from pre-sleep learning to post-sleep recall, p = .035). No significant group differences were found for the overnight consolidation of spatial memory. Compared to healthy subjects, the sleep of NT1 patients was significantly more fragmented and shallow. However, no significant correlations were found between sleep parameters and overnight performance changes on the memory tests in the whole group. Conclusion The sleep-dependent consolidation of procedural but not spatial memories may be impaired among patients with NT1. Therefore, future studies are warranted to examine whether sleep improvement, for example, using sodium oxybate, can aid the sleep-dependent formation of procedural memories among NT1 patients.
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| 7. |
- Balogh, Nora, et al.
(författare)
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The five-items memory screen-extended variant: A tool for assessing memory
- 2020
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 141:2, s. 162-167
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose The detection of memory impairment is an important part of dementia screening. However, the scope of memory measures in current screening batteries is limited. There is a need for a short yet sensitive instrument for early detection of memory impairment that could serve as a complement to existing globally oriented screening tests, for example, Mini-Mental State Examination (MMSE). To that end, the current study investigates the sensitivity and psychometric properties of the memory screening instrument The Five-Items Memory Screen -Extended Variant (FIMS-XV). Methods Hundred and forty-five participants included in the Gothenburg Mild Cognitive Impairment Study-27 patients with subjective cognitive impairment (SCI), 73 with mild cognitive impairment (MCI), and 45 with mild dementia-underwent cognitive screening including the MMSE and FIMS-XV. Ninety participants also underwent extensive neuropsychological testing. Results The FIMS-XV showed high internal consistency and strong correlations with established neuropsychological memory tests. Both the FIMS-XVdelayed recall score and the FIMS-XV total score differentiated mild dementia patients from patients with SCI and MCI. Conclusions The FIMS-XV shows promise as a sensitive tool for screening for memory impairment in all putative phases of dementia.
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| 8. |
- Banote, Rakesh Kumar, et al.
(författare)
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Blood biomarkers in epilepsy
- 2022
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Ingår i: Acta Neurologica Scandinavica. - : Hindawi Limited. - 0001-6314 .- 1600-0404. ; 146, s. 362-368
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Tidskriftsartikel (refereegranskat)abstract
- Robust and accessible biomarkers are greatly needed in epilepsy. Diagnostic and prognostic precision in the clinic needs to improve, and there is a need for objective quantification of seizure burden. In recent years, there have been advances in the development of accessible and cost-effective blood-based biomarkers in neurology, and these are increasingly studied in epilepsy. However, the field is in its infancy and specificity and sensitivity for most biomarkers in most clinical situations are not known. This review describes advancements regarding human blood biomarkers in epilepsy. Examples of biochemical markers that have been shown to have higher blood concentrations in study subjects with epilepsy include brain proteins like S100B or neuronal specific enolase, and neuroinflammatory proteins like interleukins, and tumor necrosis factor-alpha. Some of the blood biomarkers also seem to reflect seizure duration or frequency, and levels decrease in response to treatment with antiseizure medication. For most biomarkers, the literature contains seemingly conflicting results. This is to be expected in an emerging field and could reflect different study populations, sampling or analysis techniques, and epilepsy classification. More studies are needed with emphasis put on the classification of epilepsy and seizure types. More standardized reporting could perhaps decrease result heterogeneity and increase the potential for data sharing and subgroup analyses.
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| 9. |
- Barro, Christian, et al.
(författare)
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Neurological symptoms and blood neurofilament light levels.
- 2021
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Ingår i: Acta neurologica Scandinavica. - : Hindawi Limited. - 1600-0404 .- 0001-6314. ; 144:1, s. 13-20
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Tidskriftsartikel (refereegranskat)abstract
- Neurofilament light chain (NfL) is an incredibly specific marker of neuronal injury that is not specific for cause or location of the neuronal damage. NfL is increasingly considered as possible biomarker of disease activity in neurological conditions. Several works reviewed the utility of NfL in the different diseases. Nonetheless, NfL is a universal marker of neuronal damage, which interpretation spaces beyond the single disease. Because of this, the interpretation of NfL may benefit by also considering how neurological symptoms relate to its blood concentration. Here, we review how different neurological symptoms can be associated with blood NfL levels with a practical interpretation of it.
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| 10. |
- Bhan, Alok, et al.
(författare)
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Neurofilament and Brain Atrophy and Their Association with Cognition in Multiple Sclerosis: A 10-Year Follow-Up Study
- 2023
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Ingår i: ACTA NEUROLOGICA SCANDINAVICA. - 0001-6314 .- 1600-0404. ; 2023
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Cognitive impairment is an important contributor to disability in multiple sclerosis (MS). Disconnection of neuronal circuits due to axonal injury is probably an important underlying mechanism for this disability. Neurofilament light chain (NfL) is a neuron-specific constituent of axons and has gained increasing attention as a biomarker of axonal injury. Objective. To assess the association between NfL in serum (sNfL) and cerebrospinal fluid (cNfL) and cognitive function over 10 years and compare these associations with volumetric brain magnetic resonance imaging (MRI) measurements. Methods. Newly diagnosed MS patients were followed prospectively with baseline NfL and MRI as well as with clinical and cognitive assessments for up to 10 years. Results. Forty-one patients were included. Baseline sNfL correlated negatively with symbol digit modalities test (SDMT) at baseline (r=-0.45, p=0.005), year 5 (r=-0.41, p=0.017), and at year 10 (r=-0.52, p=0.008). Baseline cNfL correlated with baseline SDMT (r=-0.34, p=0.030) and SDMT at year 10 (r=-0.44, p=0.037). Baseline volumes of whole brain (r=0.476, p=0.002), gray matter (r=0.467, p=0.002), T1 (r=-0.627, p<0.001), and T2 lesion volumes (r=-0.475, p=0.002) correlated significantly with baseline SDMT. Longitudinal analyses showed that both MRI volumes and EDSS were associated with the rate of SDMT decline, whereas sNfL and cNfL were not. Conclusion. NfL levels measured in serum and cerebrospinal fluid were both associated with cognitive functioning in MS patients over a 10-year period from diagnosis. However, MRI volumes correlated strongly in addition to the rate of cognitive decline.
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