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

The occurrence of the cardiac arrhythmias was estimated by using 24-hour ECG Holter monitoring in 30 patients with multi-infarct dementia and in 30 with ischaemic stroke. Holter monitoring revealed pathological cardiac arrhythmias in 36.7% patients with multi-infarct dementia and in 40% with single ischaemic focus in the brain. It also allowed to reveal more frequent occurrence of cardiac arrhythmias in patients with ischaemic stroke (40%), than standard ECG (17%).
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PMID:[Demonstration of cardiac arrhythmias in multi-infarct dementia and ischemic stroke using Holter monitoring]. 129 97

A retrospective analysis of the medical charts of 117 patients (50 men and 67 women) with multi-infarct dementia took place. All patients admitted to the psychogeriatric nursing home 'Joachim en Anna' in Nijmegen between 1980 and 1989 were studied. The aim of the study was to obtain epidemiological information and to investigate the prevalence of comorbid conditions, prognosis and mortality. The results were compared with patients with Alzheimer's disease. The patients remained in the institute for 1.4 years and the mean total duration of the disease was 5.3 years. About twenty-five percent died in the first three months of admission. Life expectation, counted from time of admission, was 6 years shorter in comparison with Dutch mortality tables. Morbidity frequently seen at admission included circulatory system diseases and cerebrovascular accidents. The risk factor hypertension was seen in a smaller percentage of patients than expected. During the stay the diseases most frequently diagnosed were respiratory and urinary tract infections, adverse effects of drugs, constipation and chronic ulcers of the skin. About twenty percent of the patients were struck by a (recurrent) cerebrovascular accident or a transient ischaemic attack. Most patients died of dehydration or bronchopneumonia. There was, apart from the diagnosis of multi-infarct dementia, no single patient aspect that could predict a poor prognosis. Nursing home patients with multi-infarct dementia are clearly different from patients with Alzheimer's disease. Time spent in the nursing home and duration of disease are shorter. They have more comorbid conditions, especially of a cardiovascular nature, and they have a poor life expectation.
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PMID:[Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer's disease]. 143 2

Forty patients who fulfilled the DSM-III-R criteria for multi-infarct dementia and had a score of 7 points or more on Hachinski ischemia score (HIS) were analyzed with the purpose to correlate the rating scales and CT scans. Among the examined patients there were 32 women with the average age of 68.5 +/- 9.8 years and 8 men with the average age of 68.8 +/- 10.4 years. No significant difference between sex in relation to Folstein Mini-mental state examination (MMSE), Gottfries-Brane-Steen scale (GBS) and Sandoz clinical assessment-geriatric scale (SCAG) was found. There is no correlation of GBS and SCAG on MMSE. With regression analysis a good correlation was found between GBS and SCAG, and we suggest that in such studies only one of these two scales is sufficient. CT abnormalities were found in about 77% of examined patients without difference according to sex. But, GBS score demonstrated greater disability among MID patients with abnormal CT scans than in MID patients with normal CT scans. In medical history of male MID patients completed stroke was significantly more common than among women, while the female MID patients had in their history significantly more frequent transient ischemic attack (TIA). This finding should be checked in a greater patient population. It is stressed that in everyday clinical practice it is necessary to use the diagnosis of multi-infarct dementia, e.g. to differentiate cerebral diseases according to etiology and pathogenesis.
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PMID:Rating scales and computed tomography in multi-infarct dementia. 146 3

We compared the extent of documentation of the diagnoses, vascular dementia and stroke, on inpatient (hospital) medical records and death certificates among 23 multi-infarct dementia index cases and 14 multi-infarct controls without cognitive dysfunction who were enrolled in a hospital-based case-control study and were followed longitudinally. Both the inpatient medical records and the death certificates markedly under-diagnosed vascular dementia when compared to the case-control study diagnosis. Furthermore, the diagnosis of stroke was grossly underdiagnosed on the death certificates. In lieu of the lack of medical record and death certificate documentation of vascular dementia, studies that utilize such information may be in considerable error. Clarification of the criteria for the diagnosis of vascular dementia and greater physician and public awareness of vascular dementia are needed.
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PMID:Vascular dementia: a clinical and death certificate study. 149 74

Multi-infarct dementia (MID) and dementia of the Alzheimer type (DAT) are the main syndromes in the elderly. This study aims at evaluating the possible differentiation of these syndromes on a clinical basis. The patient population consisted of demented patients hospitalized during the period April 1, 1988-September 30, 1990 at the Department of Cerebrovascular Diseases. The study included 40 patients with MID and 25 with DAT. The clinical diagnosis of dementia included medical history, neurological examination, psychiatric interview and laboratory diagnostic investigations. The severity of the dementia symptoms was rated by many rating scales and a battery of neuropsychological tests. This model of clinical procedure permitted for differential diagnosis between vascular and degenerative dementia, according to DSM-III-R criteria. Patients with multi-infarct dementia of the Alzheimer type did not differ significantly with regard to age, mean duration of cognitive impairment and level of education. In the DAT group women outnumbered men, and this was statistically significant. It should be emphasized, that a great majority of patients with cerebrovascular lesions developed early cognitive impairment, that means within the first year after stroke. In the MID group hypertension, heart disease and smoking were statistically more frequent than in the DAT group. For the preliminary evaluation the severity of cognitive impairment was quantified by Mini-Mental State and Dementia Scale. These scales showed that the degree of dementia was significantly greater in DAT patients as compared to MID patients, whereas the severity of depression assessed by Hamilton's Scale was mild and similar in both group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical and differential diagnosis of multi-infarct dementia and Alzheimer's disease]. 152 70

Some papers report that the effect of heparin-mediated extracorporeal LDL less than cholesterol, LP(a), triglycerides, fibrinogen greater than precipitation (H.E.L.P.) in cardiovascular disease may results from an influence on the above-mentioned parameters. Hence, this method has been applied in multi-infarct dementia (MID), where fibrinogen, whole blood and plasma viscosity and red cell transit time (RCTT) are increased. The selection of patients was based on DMS-3, on NINCDS/ADRDA criteria and on the Hachinski Ischemic Stroke Scale. All the patients (n = 14) were examined magnet resonance imaging. Fibrinogen, cholesterol, LDL-cholesterol, HDL-cholesterol, LP(a), RCTT and plasma and whole blood viscosity were determined prior to, and after each two H.E.L.P. procedures. Fibrinogen was lowered (in a comparison of the data prior to the first and following the second plasmapheresis) from 526.4 +/- 114 to 314.1 +/- 80.1 mg/dl (p less than 0.01), cholesterol from 210.8 +/- 76.8 to 131.3 +/- 38.2 mg/dl (p less than 0.01), LDL from 125 +/- 53 mg/dl to 63.6 +/- 25.7 mg/dl (p less than 0.01), LP(a) from 26.2 +/- 13.2 to 12.0 +/- 9.5 mg/dl (p less than 0.01), HDL from 31.7 +/- 6.3 to 29.7 +/- 5.6 mg/dl (no significance), RCTT from 14.4 +/- 2.8 to 10.9 +/- 0.9 (p less than 0.01), whole blood viscosity (low shear rate) from 11.64 +/- 1.7 to 8.74 +/- 1.4 mPa/sec (p less than 0.01) and (high shear rate) from 5.38 +/- 0.58 to 4.28 +/- 0.83 mPa/sec (p less than 0.01). Plasma viscosity decreased from 1.51 +/- 0.12 mPa/sec to 1.25 +/- 0.1 mPa/sec (p less than 0.05). In cases of MID the implementation of H.E.L.P. therefore enabled an alteration of the hemorheological profile which has so far not been achieved by any hemorheologically active substance to a comparable degree and in comparable time.
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PMID:[Hemorheology and H.E.L.P. in multi-infarct dementia]. 153 54

Neurogenic mechanisms are important in the maintenance of most forms of hypertension, yet the brain is highly vulnerable to the deleterious effects of elevated blood pressure. Hypertensive encephalopathy results from a sudden, sustained rise in blood pressure sufficient to exceed the upper limit of cerebral blood flow autoregulation. The cerebral circulation adapts to chronic less severe hypertension but at the expense of changes that predispose to stroke due to arterial occlusion or rupture. Stroke is a generic term for a clinical syndrome that includes focal infarction or hemorrhage in the brain, or subarachnoid hemorrhage. Atherothromboembolism and thrombotic occlusion of lipohyalinotic small-diameter end arteries are the principal causes of cerebral infarction. Microaneurysm rupture is the usual cause of hypertension-associated intracerebral hemorrhage. Rupture of aneurysms on the circle of Willis is the most common cause of nontraumatic subarachnoid hemorrhage. Stroke is a major cause of morbidity and mortality, particularly among persons aged 65 years or older. Treatment of diastolic hypertension reduces the incidence of stroke by about 40%. Treatment of isolated systolic hypertension in persons aged 60 years and older reduces the incidence of stroke by more than one third. Blood pressure management in the setting of acute stroke and the role of antihypertensive therapy in the prevention of multi-infarct dementia require further study.
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PMID:Hypertension and the brain. The National High Blood Pressure Education Program. 158 Jul 19

Cerebrospinal fluid (CSF) levels of corticotropin-releasing hormone (CRH) and ACTH, and plasma levels of CRH, ACTH and cortisol were determined in samples taken simultaneously from 28 patients with dementia including senile dementia of the Alzheimer type (SDAT), multi-infarct dementia (MID), dementia following a cerebrovascular accident (CVD), and the borderline-to-normal state. CRH levels in CSF were significantly reduced in patients with SDAT and CVD, but not in those with MID, as compared with the borderline cases. ACTH levels in CSF were significantly reduced in the patients with SDAT compared to those with MID. Reduced CRH levels in CSF were found in the patients who showed severe dementia and poor activities of daily living (ADL). Plasma levels of CRH, ACTH and cortisol were normal and were not significantly different among the four groups of patients. CRH levels in CSF were positively correlated with ACTH levels in CSF, but not with the levels of plasma CRH, ACTH or cortisol. Plasma CRH levels were positively correlated with plasma ACTH levels. These results suggest that: 1) abnormalities in the extrahypothalamic CRH system play a role in the pathophysiology of senile dementia, which may not be specific to SDAT; 2) CSF CRH is correlated with the severity of dementia and ADL; 3) the levels of CRH in CSF and plasma are independent, and 4) the plasma CRH reflects, at least in part, the activity of the hypothalamic CRH regulating the secretion of pituitary ACTH.
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PMID:Cerebrospinal fluid and plasma corticotropin-releasing hormone in senile dementia. 164 37

Multi-infarct dementia (MID) indicates a dementia disorder primarily caused by multiple cerebral infarcts. Since other pathogenetic mechanisms cause vascular dementia we evaluated clinical, CT scan and CSF neurochemical parameters of 134 MID and 67 PVD (probable vascular dementia) patients. We found no differences with regard to the presence of major risk factors. Only TIA/stroke episodes and focal neurological signs were significantly more frequent in MID than in PVD cases, an anticipable result on the basis of MID definition. CT scan findings showed a prevalence of subcortical with respect to cortical lesions in both groups, with a higher frequency in MID patients. Subjects with deep infarcts more frequently showed TIA/stroke episodes and diabetes mellitus. No differences were detectable in CSF monoamine metabolite levels. We conclude that in the majority of vascular dementias subcortical damage seems to have a major pathogenetic role.
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PMID:Is multi-infarct dementia representative of vascular dementias? A retrospective study. 169 87

During a three-year period, 337 CT or MR scans were ordered for psychiatric patients in a teaching hospital. Scans were normal in 185 instances, equivocal in 34, and abnormal in 118 instances. When a history of neurologic disorder and/or the presence of abnormal neurologic/organic mental signs was positive, scans were abnormal in 74% of cases; when these indicators were negative, scans were normal in 72% of cases. In all, only 4 new diagnoses were made. Two patients, both with markedly abnormal neurological findings, were shown to have brain tumors, which changed their management. Two others showed abnormalities which would have been missed, both of which were of no clinical consequence. The following are suggested as sound indications for ordering CT or MR brain imaging among psychiatric patients: 1) positive history of head injury, stroke or other neurologic disease, as well as suspected Alzheimer disease or multi-infarct dementia; 2) presence of abnormal neurologic signs or organic mental signs, such as confusion or cognitive decline; and, 3) a first psychotic break or personality change after the age of 50 years.
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PMID:Clinical use of CT and MR scans in psychiatric patients. 178 61


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