Stroke Survivor Depressive Symptoms Are Associated With Family Caregiver Depression During the First 2 Years Poststroke
Family caregivers of stroke survivors frequently experience stress and emotional distress because of their new role of caregivers. When the caregivers are not doing well, the rehabilitation of the stroke survivor suffers as a result. The goal of this study was to determine the contributions of stroke survivor physical disability and behavioral and psychological symptoms on caregiver emotional distress in the first 2 years after stroke. A total of 399 stroke survivor/caregiver dyads participated in the study. Caregivers reported more emotional distress when caring for stroke survivors who had more depressive symptoms and cognitive impairment. Caregivers who were younger, female, in poorer physical health, experienced more lifestyle interference, and reported less mastery experienced more emotional distress. In contrast, the physical disability, illness severity and comorbid conditions of the stroke survivor were not significantly associated with caregiver emotional distress. This study suggests that caregivers may be more challenged by the emotional and behavioral consequences of stroke as opposed to managing its physical consequences. It also highlights the importance that the physician caring for the stroke survivor should also be on the lookout for the emotional well-being of the caregiver of the stroke survivor. See p 302.
Decreased Kidney Function: An Unrecognized and Often Untreated Risk Factor for Secondary Cardiovascular Events After Carotid Surgery
Chronic kidney disease is an important risk factor for the development of atherosclerosis and cardiovascular disease. The objective of this study was to investigate the contribution of moderate kidney failure to cardiovascular morbidity and mortality after carotid endarterectomy. Moderate kidney disease was defined in this study as an estimated glomerular filtration rate (GFR) 30–59 and normal or mildly reduced kidney function as estimated GFR ≥60. Patients with end-stage kidney disease, estimated GFR <30, were excluded. Among the 1085 patients selected for this study, 26.5% had moderate kidney failure. Compared to the group with normal kidney function, the group with moderate kidney failure consisted of more women, older age, higher prevalence of diabetes mellitus and hypertension, and more frequently had a history of myocardial infarction and peripheral intervention. During a median follow-up of 2.95 years, fatal cardiovascular endpoints occurred more commonly in the moderate kidney failure group with an adjusted hazard ratio of 2.22. Myocardial infarction also occurred more commonly in the moderate kidney failure group with a hazard ratio of 1.90. The risk of stroke was not significantly higher in patients with moderate kidney failure. This study shows that moderate kidney failure is a common and independent risk factor for both cardiovascular death and myocardial infarction following carotid surgery. This is important because worsening kidney function can in part be prevented by angiotensin-converting enzyme inhibitors. See p 307.
De Novo Aneurysm Formation and Growth of Untreated Aneurysms: A 5-Year MRA Follow-Up in a Large Cohort of Patients With Coiled Aneurysms and Review of the Literature
Patients with symptomatic intracranial aneurysms are frequently found to have additional aneurysms and may develop new aneurysms over time. LOTUS, long-term stability of coiled intracranial aneurysms, is a study in which MRA (3-D time of flight) was performed on patients in a large cohort with previously coiled aneurysms at 5 years follow-up. In 50 of 276 patients (18%), 75 additional aneurysms were found on follow-up MRA. The majority, 89%, of these additional aneurysms were unchanged, whereas only 5 had grown (from 1–3 mm) and only 2 were de novo (both 3 mm). The cumulative 5-year incidence of de novo aneurysm formation was 0.75%. The clinical implication of these findings from the MRA done at 5 years was that only 4 additional aneurysms in 3 patients were treated. The authors conclude that MRA screening of patients with coiled aneurysms within the first 5 years after treatment has a low rate of de novo aneurysm development and growth of additional aneurysms and an even lower rate of treatment of these aneurysms. Because of this, the authors suggest that screening of all patients within 5 years after aneurysm treatment does not seem beneficial. However, because of the possibility of aneurysm regrowth and/or recurrent subarachnoid hemorrhage following initial aneurysm treatment, patients should still be screened with noninvasive angiography in the period following treatment. Subsequently, perhaps only those patients with higher risk of additional aneurysm growth or de novo aneurysm formation should be periodically imaged. See p 313.
The requirements for the listing of authors in the reference section of Stroke are changing. For references with more than 6 authors, only the first 6 authors should be listed followed by et al for the remainder. The instructions to authors have been updated to reflect this change.
- © 2011 American Heart Association, Inc.
- Stroke Survivor Depressive Symptoms Are Associated With Family Caregiver Depression During the First 2 Years Poststroke
- Decreased Kidney Function: An Unrecognized and Often Untreated Risk Factor for Secondary Cardiovascular Events After Carotid Surgery
- De Novo Aneurysm Formation and Growth of Untreated Aneurysms: A 5-Year MRA Follow-Up in a Large Cohort of Patients With Coiled Aneurysms and Review of the Literature
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