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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report a 63-year-old man with a history of brief isolated manic episodes who became persistently hypomanic after a small right thalamic infarct. Detailed behavioral and neuropsychologic assessment were performed 18 months after the stroke and revealed a prosopoaffective agnosia as the foremost cognitive disorder, i.e., an impairment in the identification of emotional facial expressions with preserved discrimination of facial identity. Difficulties in reasoning on humorous material and other signs of mild right hemisphere dysfunction were present, but other perceptual, frontal and abstract-reasoning cognitive functions were unimpaired. Prosopoaffective agnosia has not been reported previously in thalamic lesions or in primary or secondary mania. The authors discuss the hypothetical relationships between a right hemisphere deficit in processing emotions and relapsing of the patient's hypomanic behavior.
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PMID:Persistent recurrence of hypomania and prosopoaffective agnosia in a patient with right thalamic infarct. 956 Aug 27

We performed a review of the published literature on dementia, stroke, and vascular dementia (VaD) emanating from Australia and sought the opinions of senior clinicians and investigators in the field of dementia. We conclude from these sources that the public health importance of cognitive impairment and dementia secondary to cerebrovascular disease is recognized in Australia as is the potential to alter the public health burden significantly by preventative strategies. VaD is considered to be a heterogenous group of syndromes, and there is a lack of consensus on the appropriate diagnostic criteria. The concept is considered to be in evolution and empirical support is needed for its definition, subtyping, and the understanding of the pathophysiological mechanisms. An alternative term--vascular cognitive disorder--is suggested to overcome some of the difficulties inherent in the concept of "dementia" as used currently. The importance of noncognitive disorders of vascular origin is highlighted. No treatment is recognized to be specifically effective in VaD. Australian clinicians and researchers are beginning to grapple with the many difficulties entailed in our understanding of the cognitive and noncognitive consequences of cerebrovascular disease. There is a need for an international consensus on diagnostic criteria, particularly for drug development and research.
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PMID:Vascular dementia: an Australian perspective. 1060 2

A large proportion of right-hemisphere stroke patients show hemispatial neglect, a neurological deficit of perception, attention, representation, and/or performing actions within their left-sided space, inducing many functional debilitating effects on everyday life, and responsible for poor functional recovery and ability to benefit from treatment. This spatial cognition disorder affects the orientation of behavior with a shift of proprioceptive representations toward the lesion side. This shift is similar to that produced by psychophysical manipulations as a wedge-prism exposure in normal healthy subjects. In both subjects, one major compensative effect of short-term prism adaptation is a shift of proprioceptive representations, demonstrated by a shift in manual straight-ahead pointing in the dark, in a direction opposite to the visual shift. In neglect patients, prism adaptation involves the shift of proprioceptive representations to the left with a reduction of rightward bias observed in neglect patients in visuo-manual tasks as line-bisection, line-cancellation or copy drawing. Improvement of neglect is also observed in no visuo-manual tasks as mental imagery, auditory extinction or posture. This generalization of prism adaptation effects at different neglect level symptoms suggests that the process of prism adaptation may activate brain functions related to multisensory integration and higher spatial representations. Moreover the positive effects found for both sensorimotor and more cognitive spatial functions lasted for at least two or more hours after prism removal. Unlike reduction of neglect through sensory stimulations, the long-lasting improvement of neglect after prism adaptation suggests the activation of short-term plasticity of brain functions related to coordinate transformations and space representations. Lastly, the duration of these effects could be useful in rehabilitation programs, as suggested by the effects of prism adaptation on disabling neglect symptoms as wheelchair driving, posture or writing.
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PMID:Bottom-up transfer of sensory-motor plasticity to recovery of spatial cognition: visuomotor adaptation and spatial neglect. 1269 67

Cognitive disorders after stroke are one of the main causes of disability in daily activities. The main aim of this study was to investigate the frequency of post-stroke dementia, post-stroke mild cognitive impairment (MCI) and post-stroke amnestic MCI at different times after first-ever stroke; 196 patients were included in the study. In addition, cognitive disorders and their clinical course were studied. Frequency of post-stroke dementia was about 10% at all evaluation times; most patients had post-stroke MCI. Of the cognitive functions investigated, mental speed and calculation were most frequently affected. Performance on almost all cognitive tests was improved 6 and 12 months after stroke. Thus, while the frequency of post-stroke dementia is low, the frequency of post-stroke MCI is high, but improvement of cognitive function is possible.
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PMID:Cognitive functioning after stroke: a one-year follow-up study. 1521 Oct 68

Vascular cognitive impairment (VCI) was proposed as an umbrella term to include subjects affected with any degree of cognitive impairment resulting from cerebrovascular disease (CVD), ranging from mild cognitive impairment (MCI) to vascular dementia. VCI may or may not exclude the host of "focal" circumscribed impairments of specialized functions such as language (aphasia), intentional gesture (apraxia), or categorical recognition (agnosia), among others, that may result from a stroke. Therefore, there are no universally accepted diagnostic criteria for VCI. We conclude that this concept could be more useful if it were to be limited to cases of vascular MCI without dementia, by analogy with the concept of amnestic MCI, currently considered the earliest clinically diagnosable stage of Alzheimer disease (AD). In agreement with our view,the Canadian Study on Health and Aging successfully implemented a restricted definition of VCI, excluding cases of dementia (i.e., vascular cognitive impairment no dementia, VCI-ND). The Canadian definition and diagnostic criteria could be utilized for future studies of VCI. This definition excludes isolated impairments of specialized cognitive functions. Vascular dementia (VaD): The main problem of this diagnostic category stems from the currently accepted definition of dementia that requires memory loss as the sine qua non for the diagnosis. This may result in over-sampling of patients with AD worsened by stroke (AD+CVD). This problem was minimized in controlled clinical trials of VaD by excluding patients with a prior diagnosis of AD, those with pre-existing memory loss before the index stroke, and those with amnestic MCI. We propose a definition of dementia in VaD based on presence of abnormal executive control function, severe enough to interfere with social or occupational functioning. Vascular cognitive disorder (VCD): This term, proposed by Sachdev [P. Sachdev, Vascular cognitive disorder. Int J Geriat Psychiatry 14 (1999)402-403.] would become the global diagnostic category for cognitive impairment of vascular origin, ranging from VCI to VaD. It would include specific disease entities such as post-stroke VCI, post-stroke VaD, CADASIL, Binswanger disease, and AD plus CVD. This category explicitly excludes isolated cognitive dysfunctions such as those mentioned above.
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PMID:Vascular cognitive disorder: a new diagnostic category updating vascular cognitive impairment and vascular dementia. 1553 26

The objective of this study is to examine the prognosis of acute cognitive disorders post-stroke, and to evaluate which clinical factors predict domain-specific cognitive recovery. We followed the course of cognitive functioning in 111 stroke patients and 77 healthy controls by administering two neuropsychological examinations with a 6 to 10 month interval (mean interval, 7.5 +/- 1.3 months). The baseline examination was administered within three weeks post-stroke (mean interval, 7.9 +/- 4.2 days). To examine determinants of domain-specific cognitive recovery, we recorded vascular risk factors, clinical variables, and lesion characteristics. Recovery in visual perception/construction (83%) and visual memory (78%) was the most common. An acute cognitive disorder predicted a long-term disorder in the same domain (all p < .05), except for visual perception/construction. Factors associated with poor cognitive recovery were age (all p < .01), preexistent verbal ability (all p < .005), lesion locations involving the temporal (all p < .05), frontal (p < .05) and occipital lobe (allp < .05), lesion volume (p < or = .001), and diabetes mellitus (p < .01). An early neuropsychological examination provides valuable information on long-term cognitive performance. The prognosis of higher-level visual disorders is the most favorable. Cognitive recovery is associated with age, preexistent ability, lesion volume, lesion location, and diabetes mellitus.
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PMID:Domain-specific cognitive recovery after first-ever stroke: a follow-up study of 111 cases. 1651 59

Acquired prosopagnosia (PA) is a rare condition after, for example, a stroke or brain injury. The congenital form of PA is generally considered to be even less common. Beside a few single case reports and anecdotal mentioning of familial cases no data on the epidemiology exists. Following a questionnaire-based screening in local secondary schools and at our medical faculty, candidates suspicious for PA underwent a semi-structured interview followed by examinations of first degree relatives. Among 689 local pupils and medical students of our university we found 17 with congenital PA. This corresponds to a prevalence rate of 2.47% (95% CI 1.31-3.63). The frequency is among the highest known for a monogenic disorder. All those index subjects (n = 14) of the target group who agreed to further examinations of their family members had other first degree relatives with the same cognitive disorder. This study provides epidemiological evidence that congenital PA is a very common cognitive disorder which almost always runs in families. The segregation pattern of this hereditary prosopagnosia (HPA) is fully compatible with autosomal dominant inheritance.
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PMID:First report of prevalence of non-syndromic hereditary prosopagnosia (HPA). 1681 75

Cognitive disorders are a common long-term consequence of many forms of acquired neurological damage of different aetiology. The already high prevalence of diseases causing cognitive deficits (in particular stroke) is expected to increase in the near future, leading to a greater need for cognitive rehabilitation. The impact of cognitive impairment on daily functioning may be even greater than that of physical limitations in affected patients, contributing to the high cost of brain disorders. New technologies, including telerehabilitation, may provide an effective response to this challenge, allowing increased access to rehabilitation services as well as reduced care costs for individuals needing cognitive rehabilitation.
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PMID:Telecommunications technology in cognitive rehabilitation. 1933 82

Hemispatial neglect refers to a cognitive disorder in which patients with unilateral brain injury cannot recognize or respond to stimuli located in the contralesional hemispace. Hemispatial neglect in stroke patients is an important predictor for poor functional outcome. Therefore, there is a need for effective treatment for this condition. A number of interventions for hemispatial neglect have been proposed, although an approach resulting in persistent improvement is not available. Of these interventions, our review is focused on caloric stimulation and optokinetic stimulation. These lateralized or direction-specific stimulations of peripheral sensory systems can temporarily improve hemispatial neglect. According to recent functional MRI and PET studies, this improvement might result from the partial (re)activation of a distributed, multisensory vestibular network in the lesioned hemisphere, which is a part of a system that codes ego-centered space. However, much remain unknown regarding exact signal timing and directional selectivity of the network.
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PMID:Therapeutic effects of caloric stimulation and optokinetic stimulation on hemispatial neglect. 2039 81

This paper for the first time reports detailed neurolinguistic findings in a patient with Neuro-Sweet syndrome. In this patient the presenting symptoms of central nervous system (CNS) involvement primarily consisted of a selective grammar deficit restricted to spontaneous speech. On MRI a left prefrontal ischemic stroke (superior part BA 6) and two small subcortical left parietal infarctions were found. Neurolinguistic analyses, however, did not reveal a profile consistent with any observations of agrammatism caused by structural damage to the language areas critically involved in grammatical processing. It is hypothesized that selectively distorted grammar might reflect disruption of the frontosubcortical network involved in language processing. Prefrontal neurobehavioral abnormalities associated with functional disruption of the inferior medial frontal regions as demonstrated by SPECT, additionally suggest that agrammatic symptoms may be linked to a higher-level cognitive disorder following encephalopathic CNS involvement.
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PMID:Grammar disruption in a patient with Neuro-Sweet syndrome. 2187 95


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