SCIENCE TIMES Department of Neurosurgery economic and social tailspin. Despite this different study cohorts. The Framingham University of Miami gloomy outlook, several studies have shown heart study found a decrease in dementia Miller School of Medicine a ray of hope with decreases in the overall over 30 years in the United States. The Miami, Florida prevalence of age-related dementia. Active Cognitive Function and Aging Study Department of Neurological Surgery research is attempting to elucidate this in England had similar findings of a Columbia University welcomed decline, though no answers have reduction in dementia over 20 years. This College of Physicians and Surgeons been discovered quite yet. A population study by Langa et al tied together an New York, New York study performed by Langa et al examined unusual finding of an increase in preva- the prevalence of dementia in the United lence of obesity, diabetes, hypertension, States between the years 2000 and 2012. and heart disease with a reduction in REFERENCES This study, the largest of this kind to the prevalence of dementia. While the 1. Derex L, Nighoghossian N, Hermier M, Adeleine P, date, had findings that confirmed previous answers lack concreteness, this change Froment JC, Trouillas P. Early detection of cerebral research, but answers still remain elusive. in dementia prevalence could be a result arterial occlusion on magnetic resonance angiography: predictive value of the baseline NIHSS score and In the year 2000 and again in the year of improved management of disease, impact on neurological outcome. Cerebrovasc Dis. 2012, the study coordinators performed or an effect of better disease screening. 2002;13(4):225-229. a cognitive assessment on over 17 000 Wealth and education as protective factors 2. Smith WS, Lev MH, English JD, et al. Significance elderly participants in the Health and against dementia might not be mutually of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke. 2009;40(12):3834- Retirement Study database. Phone inter- exclusive. It can be assumed that higher viewers collected data on a wide range of education translates to higher complexity 3. Chen CJ, Ding D, Starke RM, et al. Endovas- information which included their status in of occupation, higher wealth, and a cular vs medical management of acute ischemic stroke. Neurology. 2015;85(22):1980-1990. health, cognition, family, employment, and greater facility of making good health 4. Saver JL, Goyal M, van der Lugt A, et al. Time wealth. An objective Telephone Interview care decisions and accessing health care to treatment with endovascular thrombectomy and for Cognitive Status assessment was also – all of which could protect against the outcomes from ischemic stroke: a meta-analysis. Jama. performed at both interviews. development of dementia later in life. 2016;316(12):1279-1288. 5. Berkhemer OA, van den Berg LA, Fransen PS, A descriptive overview of the data had Known risk factors that were previ- et al. The effect of anesthetic management during shown that the 2012 cohort was older ously associated with dementia do not intra-arterial therapy for acute stroke in MR CLEAN. (which was expected, given that a large appear to be as strong of contributors, Neurology. 2016;87(7):656-664. 6. Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, portion of the cohort were participants likely as a result of the advances in Lanzino G, Kallmes DF. Conscious sedation versus who had continued from the 2000 cohort), modern medicine. With a potential public general anesthesia during endovascular acute ischemic had an average extra year of education, health crisis looming, results from this and stroke treatment: a systematic review and meta- and had a greater disparity of wealth previous studies hold promise that there analysis. AJNR Am J Neuroradiol. 2015;36(3):525- (there was a larger proportion of partic- may exist unknown, modifiable risk factors 7. Schonenberger S, Uhlmann L, Hacke W, et al. ipants in either the higher or lower in the fight against age-related dementia. Effect of conscious sedation vs general anesthesia quartiles of wealth in 2012 compared The central nervous system is both the on early neurological improvement among patients to the year 2000). With respect to the container and creator of the mind. Under- with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. Jama. health questionnaire, the 2012 cohort had standing the brain’s potential for biological 2016;316(19):1986-1996. a significantly higher prevalence of obesity, and functional self-preservation is increas- 8. Sivasankar C, Stiefel M, Miano TA, et al. Anesthetic diabetes, hypertension, and heart disease. ingly captivating. variation and potential impact of anesthetics used during endovascular management of acute Despite the increase in age and health ischemic stroke. J Neurointerv Surg. 2016;8(11): problems, the 2012 cohort had a 2.4% 1101-1106. decrease in the prevalence of “cognitive Reid Hoshide, MD, MPH impairment, not-dementia”, and a 2.8% Rahul Jandial, MD, PhD decrease in the prevalence of outright University of California A Decline in Cognitive dementia. When adjusted for age, the San Diego, California Decline: The Brain’s decrease in the prevalence of dementia City of Hope widened further to 3.0%. Significant risk Los Angeles, California Modifiable Fate factors for dementia included older age, being an ethnic minority, and a medical ognitive disease is a burdensome history of stroke or diabetes. Wealth REFERENCE affliction with a significant impact and education were significant protective on health economics and society. 1. Langa KM, Larson EB, Crimmins EM, et al. factors against dementia. As the population of the United States A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Internal The results in this study echo similar ages, it is anticipated that cognitive disease Medicine. 2017;177(1):51-58. findings in previous examinations of will place our health care system in an N28 | VOLUME 80 | NUMBER 5 | MAY 2017 www.neurosurgery-online.com
Neurosurgery – Oxford University Press
Published: May 1, 2017
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