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ABSTRACT: Diabetes is associated with an increased risk of developing dementia. However, data on the patients with newly diagnosed type 2 diabetes are limited.
To investigate the relationship between newly diagnosed type 2 diabetes and the risk of developing dementia, ischemic stroke and intracranial hemorrhage after disease diagnosis and the interrelationship between dementia and the stroke events.
Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 3717 patients newly diagnosed with type 2 diabetes and 37,170 age- and sex-matched comparison patients from the same period. All patients were tracked for 7years following their index visit in 2000-2001.
After adjusting for potential confounders, dementia risk was approximately 63% higher (hazard ratio [HR], 1.63; 95% CI, 1.33-1.99) among newly diagnosed type 2 diabetic patients than among comparison subjects. Newly diagnosed type 2 diabetes also increased the risk of developing ischemic stroke but not intracranial hemorrhage. About 43.6% of diabetic patients who developed dementia also had ischemic stroke during the follow-up period, higher than the rate 29.6% in the comparison group.
This study shows that newly diagnosed type 2 diabetes is associated with a 63% higher future risk of dementia during the 7-year follow-up period. The high dementia and ischemic stroke overlap rate in the diabetic study group suggests vascular events play an important role in the pathogenesis of developing dementia.
Journal of diabetes and its complications 07/2012; 26(5):382-7. · 2.11 Impact Factor
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ABSTRACT: PURPOSE: The impact of epilepsy following different subtypes of stroke is unclear. The aim of this study was to evaluate the risk of post-stroke epilepsy with different stroke subtypes. METHODS: A total of 4126 stroke patients and 24,756 age- and sex-matched controls were retrieved from the Longitudinal Health Insurance Database 2005, a major dataset of the National Health Insurance Research Database, from 2000 to 2003. All were then individually tracked to their last medical visit up to five years from 30 days after their first-ever stroke incident to identify those who developed epilepsy. RESULTS: Among the 4126 stroke patients, 72.2% had ischemic stroke, 14.7% had intracerebral hemorrhage (ICH), 2.3% had subarachnoid hemorrhage (SAH), 2.0% had other and unspecified intracranial hemorrhage (OIH), including subdural hemorrhage and epidural hemorrhage, and 8.9% had multiple stroke subtypes. The adjusted hazard ratio for the development of epilepsy was 11.5 (95% CI 8.2-16.2) for the patients with stroke compared to the controls. 2.6% of the patients with stroke developed epilepsy during the 5-year follow-up period. The rate of post-stroke epilepsy was highest in patients with multiple subtypes (7.7%), followed by ICH (4.3%), SAH (4.2%), OIH (2.5%) and ischemic stroke (1.6%). CONCLUSION: Stroke patients had a significantly higher risk of developing epilepsy than the controls. The risk of post-stroke epilepsy was higher in patients with hemorrhagic stroke than ischemic stroke.
Epilepsy research 06/2012; · 2.48 Impact Factor
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ABSTRACT: Patients with Parkinson's disease (PD) are subject to posture instability and falling. However, PD was not included as one of the risk factors in commonly used fracture risk calculation tools and the fracture rate in patients with PD was rarely reported. The aim of this study was to evaluate the risk of hip fracture in patients with PD.
Data were collected from the National Health Insurance Research Database of Taiwan. The study group included 394 patients with PD diagnosed in 1999-2000. The comparison cohort was comprised of 3940 age- and sex-matched patients from the same enrollment period. All patients were tracked from their index visits for eight years.
Hip fracture developed in 10.4% of patients with PD and 4.1% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed a significantly higher rate of hip fracture in PD. The Cox proportional regression model showed an adjusted hazard ratio of 2.71 (95% confidence interval = 1.92-3.83, P < 0.001) for patients with PD.
The hip fracture rate was as high as 10.4% in PD patients during 8 years follow-up period. While assessing the risk of hip fracture, PD should be taken into consideration. For those very high risk patients (elderly women with PD, osteoporosis, diabetes and diabetic neuropathy), many efforts should be made to prevent fracture.
Parkinsonism & Related Disorders 01/2012; 18(5):506-9. · 3.80 Impact Factor
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ABSTRACT: The purpose of this study was to investigate the risk of future intracerebral hemorrhage development in patients with liver cirrhosis.
Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 948 patients with liver cirrhosis diagnosed in 1999 and 9480 age- and sex-matched patients of the same year. All patients were tracked from their index visits for 9 years.
Intracerebral hemorrhage developed in 1.3% of patients with liver cirrhosis and 1.0% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed no significant difference between the 2 cohorts (P=0.39). A stratified Cox proportional regression model showed an adjusted hazard ratio of 1.62 (95% CI, 0.85 to 3.10) for patients with liver cirrhosis to develop intracerebral hemorrhage compared with patients without liver cirrhosis.
Patients with liver cirrhosis had a similar intracerebral hemorrhage incidence rate but a trend of increased risk for intracerebral hemorrhage compared with the comparison cohort during the 9-year follow-up period.
Stroke 07/2011; 42(9):2615-7. · 5.73 Impact Factor
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ABSTRACT: Headache could be the only manifestation of a myocardial infarction or angina pectoris. The recognition of myocardial ischemia as the cause of headache is important in clinical practice. We report two cases of cardiac cephalalgia, defined as headache attributed to myocardial ischemia. The first patient presented with a thunderclap headache probably secondary to a myocardial ischemia and the second patient presented with isolated headaches secondary to angina pectoris triggered by exertions. The clinical presentations of cardiac cephalalgia are highly variable and the most consistent feature is severe in intensity. Cardiac cephalalgia should be considered one of the differential diagnoses of exertional headache and thunderclap headache when the patient is older or has cardiovascular risk factors.
Acta neurologica Taiwanica 03/2010; 19(1):57-61.
