Tag:

stroke; cerebrovascular accident; CVA; cerebrovascular accident (CVA)

Breast Cancer Chemotherapy May Cause Brain Changes and Cognitive Decline

by Dr. Michael Lee – Health Editor August 3, 2025

written by Dr. Michael Lee – Health Editor

Summary of research on “Chemobrain” & Brain Atrophy

This article details research investigating “chemobrain,” the cognitive difficulties some cancer patients experience after chemotherapy. Here’s a breakdown of the key findings and considerations:

Key Findings:

Brain Atrophy: Voxel-based morphometry (VBM) analysis revealed significant brain atrophy (shrinkage) in the frontal, parietal, and cingulate regions of patients with chemobrain compared to control groups.This pattern overlaps with changes seen in Alzheimer’s disease and vascular cognitive impairment. Atrophy was also noted in the orbitofrontal and temporal regions.
Cognitive Impairment: Neurocognitive testing showed reduced semantic and verbal fluency and lower Mini-Mental State Examination scores in the chemobrain group,supporting the MRI findings.
Not Necessarily Progressive: the study only represents a single time point and doesn’t demonstrate ongoing brain shrinkage. it shows a difference in brain volume at that moment, not necessarily a decline over time.
Potential Link to Alzheimer’s: Some affected brain regions are associated with memory impairment, a hallmark of Alzheimer’s, but researchers caution this is a preliminary finding due to the small sample size.

Crucial Considerations & limitations:

Small Sample Size: The researchers acknowledge the need for larger studies. Control Group Age: The control group was older, making the observed atrophy in the chemobrain group even more significant (as brain atrophy naturally increases with age).
Study Design Concerns: An external expert (Dr.Eric Brown) pointed out that the study didn’t image all chemotherapy patients, but selected those with the most cognitive impairment. This could mean the results don’t represent the average chemotherapy patient.
Comorbidities: The study didn’t rule out the possibility that some patients may have had pre-existing conditions like Alzheimer’s contributing to their cognitive issues.
Causation vs. Correlation: It’s unclear if chemotherapy causes the brain changes,or if some patients are predisposed to cognitive decline.
Specific Chemotherapy Drugs: The research doesn’t identify if specific drugs are more strongly linked to these effects.

Future Research:

Longitudinal Studies: The team plans to follow patients over time to track brain changes and memory recovery.
Expanded Cancer Types: The study will be expanded to include other cancers in both men and women.
* Investigating Women’s Higher Dementia Risk: researchers hope this work may shed light on why women are more likely to develop dementia.

In essence, the study provides evidence of structural brain changes in patients experiencing “chemobrain,” but emphasizes the need for further research to understand the underlying mechanisms, long-term effects, and potential preventative measures.

August 3, 2025 0 comments

Health

PCPs Guide to Prescribing Blood Thinners for AF

by Dr. Michael Lee – Health Editor August 1, 2025

written by Dr. Michael Lee – Health Editor

AFib Patients Need Vigilant Blood Thinner Monitoring

Early Bleeding Risk Highlighted in New Study

Primary care physicians are on the front lines of identifying heart conditions like atrial fibrillation (AF). Managing AF often involves prescribing blood thinners to mitigate a significantly increased stroke risk.

Understanding Anticoagulant Therapy

Individuals diagnosed with AF face a fivefold higher likelihood of experiencing a stroke. To combat this, blood-thinning medications, or anticoagulants, are frequently prescribed to reduce blood clot formation, as noted by the American Society of Hematology.

Up to six million Americans contend with AF, a condition whose prevalence escalates with age. The ASH reports that AF leads to an estimated 450,000 hospitalizations annually.

Crucial Early Monitoring for Safety

Close observation of how patients respond to blood thinners during the initial months of treatment is paramount. A recent study published in *Blood Advances* revealed that AF patients administered lower doses of oral anticoagulants encountered a greater frequency of bleeding events within the first three months of therapy.

When Should Doctors Prescribe Blood Thinners?

Primary care physicians (PCPs) should consider prescribing oral anticoagulants when they manage patients with atrial fibrillation, acute deep venous thrombosis, or acute pulmonary embolism. This recommendation comes from Dr. **R. Michael Benitez**, a cardiologist and professor at the University of Maryland Medical Center.

The decision hinges on a careful balance, weighing the patient’s stroke risk without medication against their potential for significant bleeding complications.

Clear Communication is Key

Physicians can demystify AF for patients by explaining that the heart’s upper chambers are not contracting effectively, leading to stagnant blood and clot formation. Dr. **Benitez** suggests explaining that even a small clot, about 2 mm, can cause a major stroke if it travels to the brain.

“The oral anticoagulant greatly reduces the risk of the formation of these blood clots and subsequent stroke. Stroke is a terrible event that, if survived, often changes a patient’s life permanently and significantly. In the setting of atrial fibrillation, anticoagulation greatly reduces the patient’s risk of stroke.”

—R. Michael Benitez, MD, Cardiologist

For deep vein thrombosis, doctors can illustrate how a leg clot might dislodge, travel to the lungs via the heart, and cause serious or fatal pulmonary embolism. Oral anticoagulants significantly lower this danger.

Strict Adherence to Medication Regimen

Daily adherence is critical for the effectiveness of these medications in preventing strokes. Newer direct oral anticoagulants, such as apixaban and rivaroxaban, act rapidly but also dissipate quickly. Missing even two or three doses can allow blood to clot normally again, underscoring the necessity of daily intake.

While warfarin’s effects are more prolonged, missing a dose can still impact anticoagulation levels. Patients should be reminded to take it daily as prescribed.

Discussing Potential Side Effects

It is vital to screen for drug interactions, especially when introducing new medications like antibiotics, as they can affect anticoagulation levels, particularly with warfarin. This vigilance is also important, though to a lesser degree, with direct oral anticoagulants.

Patients should be informed about minor bleeding like gum or nosebleeds that typically stop easily. However, they must monitor bleeding episodes and know how to respond if injured.

“If bleeding will not readily stop then medical attention is needed, and patients who incur major injury or trauma are likely to be taken to an emergency facility where it is important for the staff caring for them to know what anticoagulant they are taking, the dose, and when they last took it. Reversal agents are now available to normalize blood clotting.”

—R. Michael Benitez, MD, Cardiologist

Regarding diet, Dr. **Benitez** notes that most foods do not significantly interact with these medications. However, patients on warfarin require specific dietary guidance.

Warfarin, a vitamin K antagonist, necessitates limiting vitamin K-rich foods, as vitamin K acts as an antidote. Common sources include leafy greens like spinach and kale, but less obvious sources like cauliflower and soy products also contain vitamin K.

“It is important for the patient to familiarize themselves with vitamin K-containing foods and to keep the intake of them low and steady from day to day if they are taking warfarin,” stated Dr. **Benitez**.

August 1, 2025 0 comments

Health

Pregnancy and Cervical Artery Dissection: Risk Assessment

by Dr. Michael Lee – Health Editor July 31, 2025

written by Dr. Michael Lee – Health Editor

Pregnancy Safe for Women with Prior cervical Artery Dissection, Study Finds

New research offers reassuring news for women with a history of cervical artery dissection (CeAD), indicating that pregnancy does not elevate the risk of recurrent cead, stroke, or death.

Basel, Switzerland – For women who have experienced cervical artery dissection (CeAD), the prospect of future pregnancy may no longer be a cause for significant concern. A groundbreaking cohort study, published in JAMA Network Open, reveals that pregnancy is not associated with an increased risk of recurrent CeAD, stroke, or death up to five years later.

The study, led by Sandro K. Fischer of the University Hospital Basel, analyzed data from 1013 women with a history of CeAD across 33 stroke centers in nine countries, with follow-up data extending from 1990 to 2023. Of these women, 114 became pregnant during the study period, while 899 did not.

Researchers tracked a composite outcome of recurrent CeAD, any type of stroke, and all-cause mortality. The findings demonstrated that the composite outcome occurred in 9% of the pregnancy group, compared to 7% in the non-pregnancy group. Crucially, the adjusted hazard ratio (aHR) for this composite outcome was 0.77 (95% CI, 0.38-1.56), indicating no statistically significant increase in risk for pregnant women.

Further analysis of secondary outcomes also showed no significant differences between the groups for recurrent CeAD (aHR,1.0), ischemic stroke (aHR, 0.5), and intracerebral hemorrhage (ICH) (aHR, 1.0). The incidence rate of recurrent CeAD was 0.7% per patient-year in the pregnancy group versus 0.5% per patient-year in the non-pregnancy group.

Interestingly, five of the ten primary outcome events in the pregnancy group occurred during the postpartum period, suggesting a potential heightened vulnerability during this specific phase.

“These findings suggest that pregnancy is not associated with an increased risk of subsequent events; therefore, prior CeAD does not justify advising against future pregnancy,” the investigators stated. They added that these results “may be helpful for individual counseling and family planning for women with prior CeAD.”

While the study offers significant reassurance,its exploratory nature,potential referral bias,and the underrepresentation of women at higher presumed recurrence risk in the pregnancy group are noted limitations. The small number of events also contributed to statistical imprecision.

Despite these limitations, the study’s findings provide valuable insights for clinicians and patients, potentially alleviating anxieties surrounding pregnancy for women with a history of CeAD and supporting informed family planning decisions.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

July 31, 2025 0 comments

Health

Subclinical Aldosteronism Linked to Increased Cardiovascular Risk

by Dr. Michael Lee – Health Editor July 25, 2025

written by Dr. Michael Lee – Health Editor

Hear’s a rewritten version of the article, aiming for 100% unique phrasing while retaining the core data:

New study Suggests Subclinical Aldosterone Imbalance May Predict cardiovascular Risk

A recent investigation into the “E” cohort has shed light on a potential link between subtle imbalances in the renin-angiotensin-aldosterone system (RAAS) and the likelihood of experiencing critically important cardiovascular events. The research aimed to determine if subclinical primary aldosteronism (PA), a condition where the adrenal glands produce too much aldosterone without obvious symptoms, is associated with major adverse cardiovascular events (MACEs). MACEs in this study were defined as a combination of heart attack, stroke (both ischemic and hemorrhagic), hospital admission for heart failure, and death from cardiovascular causes.

The participants in this study had a median age of 56 years, with the vast majority (92%) identifying as White. Approximately half of the individuals (55%) presented with blood pressure readings exceeding 130/80 mm Hg. Notably, a small proportion of the cohort had diabetes (7%) or a prior history of cardiovascular disease (3%).

Median levels of aldosterone were recorded at 219 pmol/L (with an interquartile range of 163-299 pmol/L), and renin concentrations averaged 7.5 ng/L (IQR, 4.5-11.7 ng/L). The median aldosterone-to-renin ratio (ARR), a key indicator of PA, was 30 pmol/L per ng/L (IQR, 19-50 pmol/L per ng/L).

Over a median follow-up period of 10.8 years (IQR, 10.6-11.0 years), 2.8% of the participants experienced an incident MACE. The most frequent MACE was myocardial infarction, followed by stroke and hospitalization for heart failure. During the study, seven individuals died from cardiovascular causes, contrasting with 47 non-cardiovascular deaths.

The findings revealed that lower renin levels (adjusted hazard ratio [aHR], 2.22; 95% confidence interval [CI],1.02-4.76) and a higher ARR (aHR, 2.43; 95% CI, 1.15-5.12) were both linked to an increased risk of MACE.However,the researchers did not find a significant association between higher aldosterone concentrations alone and MACE.

Further multivariable analysis indicated that a renin concentration of 4 ng/L or less was associated with a 2.1-fold greater risk of MACE (95% CI, 1.21-3.72). Similarly,an ARR of 70 pmol/L per ng/L or higher was linked to a twofold increase in MACE risk (aHR,2.03; 95% CI,1.09-3.80).

Individuals who met both of these criteria – representing about 21% of the study population – faced approximately 2.4 times the likelihood of experiencing a MACE (aHR, 2.42; 95% CI, 1.25-6.48). The researchers also noted that over 80% of participants with an ARR of 70 pmol/L per ng/L or more also had renin levels of 4 ng/L or lower. Importantly, these associations remained consistent nonetheless of blood pressure levels.

Dr. Hundemer, a lead researcher, suggested that individuals with normal blood pressure who later develop hypertension may be more likely to have underlying subclinical PA.He posited that many cases currently categorized as “primary” or “essential” hypertension might actually be driven by aldosterone-mediated mechanisms due to subclinical PA. He emphasized the need to move beyond a generalized approach to early hypertension management and adopt a more individualized strategy that addresses the specific biological drivers of hypertension and cardiovascular disease in each person.

Dr. Wenyu Huang, an associate professor at Northwestern University’s Feinberg School of Medicine, concurred that current practices might be overlooking a considerable number of at-risk individuals. She pointed out that while Endocrine Society guidelines now recommend screening all hypertensive patients for primary aldosteronism, this new study extends the concern to individuals with normal blood pressure. Although the study establishes an association rather than causation, Dr. Huang believes these findings warrant significant attention.

Both Dr. Hundemer and Dr. Huang reported no relevant financial conflicts of interest. Paul Basilio, a freelance writer and editor based in Glenside, Pennsylvania, contributed to this report.

July 25, 2025 0 comments

Health

GLP-1 Drugs Reduce Dementia & Stroke Risk in Diabetes Patients

by Dr. Michael Lee – Health Editor July 20, 2025

written by Dr. Michael Lee – Health Editor

Here’s a rewritten version of the article, aiming for 100% uniqueness while preserving all verifiable facts:

New Study Suggests GLP-1 receptor Agonists May Offer Neuroprotective and Cardiovascular Benefits in Type 2 Diabetes

A recent study published in JAMA Network Open indicates that glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a class of medications commonly used for type 2 diabetes and obesity, may provide meaningful benefits beyond blood sugar control, perhaps reducing the risk of neurodegenerative diseases, stroke, and all-cause mortality.

The research, lead by Dr. Huan-Tang Lin of Chang Gung Memorial Hospital in Taiwan, analyzed data from a large cohort of individuals with type 2 diabetes. The study compared patients prescribed GLP-1 ras with those taking other antidiabetic medications, including biguanides, sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, dipeptidyl peptidase 4 inhibitors, and SGLT2 inhibitors. The “other antidiabetic drug” group comprised 30,430 participants, with an average age of 58 years, 51% women, and 56% identified as white individuals.The primary focus of the study was to assess the incidence of new-onset neurodegenerative conditions such as dementia, Parkinson’s disease, and mild cognitive impairment, as well as cerebrovascular events including ischemic stroke and intracerebral hemorrhage. The secondary outcome measured was all-cause mortality.

Key Findings Highlighted:

Reduced Risk with GLP-1 ras: Patients treated with GLP-1 RAs demonstrated a statistically significant lower risk of dementia (hazard ratio [HR] 0.63), ischemic stroke (HR 0.81), and all-cause mortality (HR 0.70) when compared to individuals on other antidiabetic drugs.
Specific Drug Benefits: Semaglutide use was associated with a reduced risk of dementia (HR 0.63). Tirzepatide, conversely, was linked to a lower risk of stroke (HR 0.69) and all-cause mortality (HR 0.48) compared to the “other antidiabetic drug” group.
No Significant Differences for certain Conditions: The study did not find any significant differences in the risk of Parkinson’s disease or intracerebral hemorrhage between the GLP-1 RA group and the comparator group.
Enhanced Benefits in Specific Subgroups: The potential neuroprotective effects of GLP-1 RAs appeared to be more pronounced in women (HR 0.85),individuals aged 60 years and older (HR 0.85), White individuals (HR 0.86),and those with a body mass index (BMI) between 30 and 40 (HR 0.82).

Clinical Implications:

The investigators suggest that semaglutide and tirzepatide may offer benefits for brain health and cerebrovascular outcomes that extend beyond their primary role in glycemic control, potentially leading to improved long-term cognitive function and survival rates in adults with type 2 diabetes and obesity.

Dr. Sarah Marzi, PhD, from the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, who was not involved in the study, commented that if future trials confirm these neuroprotective effects, GLP-1 RAs could potentially be utilized in clinical practice for disease prevention strategies.

Study Limitations:

The researchers acknowledge several limitations inherent to the observational nature of the study. These include the possibility of residual confounding from unmeasured factors such as frailty or functional status, which could introduce healthy user or selection bias. The database utilized did not include biomarker data, genetic profiles, or neuroimaging assessments, which limits the ability to explore mechanistic explanations. Furthermore, the analysis did not account for death as a competing risk, and medication exposure was based on prescriptions rather than confirmed adherence or precise dosages.

The study received funding from the Ministry of science and Technology, Taiwan, and Chang Gung Memorial Hospital. The investigators reported no relevant conflicts of interest.

July 20, 2025 0 comments

Health

Content Writing Tips: Improve Your Skills & Productivity

by Dr. Michael Lee – Health Editor July 13, 2025

written by Dr. Michael Lee – Health Editor

The gap between a brain’s chronological age and its predicted age on brain imaging appears to be a strong mediator of risk factors for cognitive decline, especially in individuals with cerebrovascular disease (CeVD), new research suggested.

In a cross-sectional study of more than 2000 participants, researchers used machine learning and brain scans to create a prediction model. An individual’s “brain age gap” (BAG) was then determined by subtracting the chronological brain age from the predicted brain age.

Results showed that a higher number of cognitive impairment risk factors were associated with lower cognitive performance scores — and that a larger BAG may influence this relationship, with the strongest effects observed in participants with CeVD.

In individuals with more markers of CeVD, such as microbleeds and infarcts, the BAG significantly influenced the link between cognitive impairment risk factors and overall cognitive function — particularly affecting executive function and language abilities.

“This suggests that accelerated brain aging, as measured by BAG, plays a disproportionate role in cognitive vulnerability among individuals with vascular pathology,” study co-investigator Saima Hilal, MD, PhD, assistant professor at the National University of Singapore, Singapore, told Medscape Medical News.

“While we expected BAG to have some mediating effect, the domain-specific nature of this influence was unexpected,” Hilal added.

The findings were published online on June 18 in Neurology.

Knowledge Gap

The investigators initiated the study to explore how the BAG neuroimaging-derived biomarker might help explain a connection between known risk factors for cognitive impairment and actual cognitive decline, particularly in Southeast Asian populations, Hilal reported.

“Prior research has largely focused on Western cohorts, leaving a gap in understanding how [CeVD]which is highly prevalent in Asia, may interact with BAG to affect cognition,” she said.

Additionally, she noted that CeVD often coexists with Alzheimer’s pathology in individuals from Southeast Asia. Understanding whether BAG could serve as a mediator in that relationship “could enhance early risk stratification and open new avenues for targeted cognitive interventions in at-risk populations,” Hilal said.

The researchers reviewed medical records for more than 2000 participants (mean age, 66 years; 53% men; 60% with no cognitive impairment) from the Singapore community and memory clinics to identify cognitive impairment risk factors.

For this, they used the Cognitive Impairment Scoring System (CISS), which consisted of 11 sociodemographic and vascular factors, including age, education, smoking status, blood pressure, and history of diabetes.

The investigators also measured cognitive performance using tests that assessed overall global cognition, executive function, language, memory, attention, visuomotor speed — which is the ability to coordinate visual information with motor actions — and visuoconstruction, which involves coordinating fine motor skills with spatial abilities.

Within the study population, 1437 did not have dementia and 646 served as the matched control group. All individuals had undergone structural MRIs.

CeVD burden was determined using markers associated with small and large vessel disease and cognitive dysfunction, including lacunar and cortical infarcts, cerebral microbleeds, and white matter hyperintensities.

‘Meaningful Biomarker’

Results showed a significant association between a higher CISS score (showing more impairment risk factors) and lower performance across all cognitive domains measured, especially visuomotor speed (β = -2.7; P < .001) and visuoconstruction (β = -3.0; P < .001).

In the full patient population, BAG significantly influenced the relationship between CISS score and global cognition (proportion mediated, 9%; P < .05), especially the domains of language (18%; P = .001) and visuoconstruction (10%; P = .008).

The effect was even stronger for those with high CeVD burden. In this group, the association between CISS score and overall global cognition was significantly mediated by BAG (20%; P = .01), as were executive function (34%; P = .03) and language abilities (27%; P = .008).

There were no significant effects in the low-CeVD-burden group.

“These findings underscore the importance of stratifying by vascular burden and considering domain-specific outcomes when investigating brain aging,” Hilal said.

“For clinicians, the key message is that the brain age gap can serve as a meaningful intermediate biomarker linking modifiable risk factors to cognitive decline,” she added.

The investigators noted, however, that the study’s focus on a Southeast Asian population only could limit the generalizability of the findings.

“Future longitudinal studies should verify these relationships and explore additional factors not captured in our model,” they wrote.

The study was funded by the National University of Singapore, the National Medical Research Council Singapore, and the Singapore Ministry of Education. The investigators reported having no relevant financial relationships.

July 13, 2025 0 comments

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