OBJECTIVE: Type 2 diabetes is known to be associated with decrements in memory and executive functions and information-processing speed. It is less clear, however, at which stage of diabetes these cognitive decrements develop and how they progress over time. In this study, we investigated cognitive functioning of patients with recent screen-detected type 2 diabetes, thus providing insight into the nature and severity of cognitive decrements in the early stage of the disease. Possible risk factors were also addressed. RESEARCH DESIGN AND METHODS: Included in this study were 183 diabetic patients from a previously established study cohort and 69 control subjects. A full neuropsychological assessment, addressing six cognitive domains, was made for each participant. Raw test scores were standardized into z scores per domain and compared between the groups. Possible risk factors for cognitive decrements were examined with multivariate linear regression. RESULTS: Relative to scores for the control group, mean z scores were between 0.01 and 0.2 lower in the diabetic group across all domains, but after adjustment for differences in IQ between patients and control subjects, only memory performance was significantly reduced (mean difference −0.15 [95% CI −0.28 to −0.03]). A history of macrovascular disease and current smoking were significant determinants of slower information-processing speed in patients with diabetes. CONCLUSIONS: This study shows that modest cognitive decrements are already present at the early stage of type 2 diabetes. A history of macrovascular disease and smoking are significant risk factors for some early decrements.

Limb-shaking is a specific clinical feature of transient ischaemic attacks that has been associated with a high-grade stenosis or occlusion of the internal carotid artery. The aim of this study was to describe the clinical characteristics of limb-shaking in patients with internal carotid artery occlusion and to investigate whether patients with limb-shaking have a worse haemodynamic state of the brain than patients with internal carotid artery occlusion without limb-shaking. We included 34 patients (mean age 62 ± 7 years, 82% male) with limb-shaking associated with internal carotid artery occlusion and 68 sex- and age-matched controls with cerebral transient ischaemic attack or minor disabling ischaemic stroke associated with internal carotid artery occlusion, but without limb-shaking. We investigated clinical characteristics, collateral pathways on contrast angiograms and carbon dioxide-reactivity measured by transcranial Doppler. The results showed that limb-shaking usually lasted less than 5 min and was often accompanied by paresis of the involved limb. Compared with controls, patients with limb-shaking more frequently had symptoms precipitated by rising or exercise (odds ratio 14.2, 95% confidence interval 4.2–47.9), more frequently had recurrent ischaemic deficits after documented internal carotid artery occlusion (but before inclusion in the study) (odds ratio 8.2, 95% confidence interval 2.3–29.3), more often had leptomeningeal collaterals (odds ratio 6.8, 95% confidence interval 2.0–22.7), and tended to have a lower carbon dioxide-reactivity (mean 5% ± 16 versus 12% ± 17; odds ratio 0.97 per 1% increase in carbon dioxide-reactivity, 95% confidence interval 0.94–1.00). In conclusion, limb-shaking transient ischaemic attacks in patients with internal carotid artery occlusion can be recognized by their short duration, are often accompanied by paresis and precipitated by rising or exercise and are indicative of an impaired haemodynamic state of the brain.

Patients with a hemispheric infarct and massive space-occupying brain oedema have a poor prognosis. Despite maximal conservative treatment, the case fatality rate may be as high as 80%, and most survivors are left severely disabled. Non-randomised studies suggest that decompressive surgery reduces mortality substantially and improves functional outcome of survivors. This study is designed to compare the efficacy of decompressive surgery to improve functional outcome with that of conservative treatment in patients with space-occupying supratentorial infarction The study design is that of a multi-centre, randomised clinical trial, which will include 112 patients aged between 18 and 60 years with a large hemispheric infarct with space-occupying oedema that leads to a decrease in consciousness. Patients will be randomised to receive either decompressive surgery in combination with medical treatment or best medical treatment alone. Randomisation will be stratified for the intended mode of conservative treatment (intensive care or stroke unit care). The primary outcome measure will be functional outcome, as determined by the score on the modified Rankin Scale, at one year.

Background: Prion-like transmission of amyloid-ß through cadaveric dura, decades after neurosurgical procedures, has been hypothesized as an iatrogenic cause of cerebral amyloid angiopathy (CAA). We investigated new and previously described patients to assess the clinical profile, radiological features, and outcome of this presumed iatrogenic CAA-subtype (iCAA). Methods: Patients were collected from our prospective lobar hemorrhage and CAA database (n=251) with patients presenting to our hospital between 2008 and 2022. In addition, we identified patients with iCAA from 2 other Dutch CAA-expertise hospitals and performed a systematic literature-search for previously described patients. We classified patients according to the previously proposed diagnostic criteria for iCAA, assessed clinical and radiological disease features, and calculated intracerebral hemorrhage (ICH)-recurrence rates. We evaluated the spatial colocalization of cadaveric dura placement and CAA-associated magnetic resonance imaging markers. Results: We included 49 patients (74% men, mean age 43 years [range, 27–84]); 15 from our database (6% [95% CI, 3%–10%]; 45% of patients <55 years), 3 from the 2 other CAA-expertise hospitals, and 31 from the literature. We classified 43% (n=21; 1 newly identified patient) as probable and 57% (n=28) as possible iCAA. Patients presented with lobar ICH (57%), transient focal neurological episodes (12%), or seizures (8%). ICH-recurrence rate in the new patients (16/100 person-years [95% CI, 7–32], median follow-up 18 months) was lower than in the previously described patients (77/100 person-years [95% CI, 59–99], median follow-up 18 months). One patient had a 10 year interlude without ICH-recurrence. We identified no clear spatial relationship between dura placement and CAA-associated magnetic resonance imaging markers. During follow-up (median, 18 months), 20% of the patients developed transient focal neurological episodes and 20% cognitively declined. Conclusions: iCAA seems common in patients presenting with nonhereditary CAA under the age of 55. Clinical and radiological features are comparable with sCAA. After diagnosis, multiple ICH-recurrences but also long symptom-free intervals can occur. Harmonized registries are necessary to identify and understand this potentially underrecognized CAA-subtype.

Prediction of clinical outcome in the acute stage of ischaemic stroke can be difficult when based on patient characteristics, clinical findings and on non-contrast CT. CT perfusion and CT angiography may provide additional prognostic information and guide treatment in the early stage. We present the study protocol of the Dutch acute Stroke Trial (DUST). The DUST aims to assess the prognostic value of CT perfusion and CT angiography in predicting stroke outcome, in addition to patient characteristics and non-contrast CT. For this purpose, individualised prediction models for clinical outcome after stroke based on the best predictors from patient characteristics and CT imaging will be developed and validated.