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

Our objectives were to investigate the utility of the Hachinski Ischemic Score (HIS) in differentiating patients with pathologically verified Alzheimer's disease (AD), multi-infarct dementia (MID), and "mixed" (AD plus cerebrovascular disease) dementia, and to identify the specific items of the HIS that best discriminate those dementia subtypes. Investigators from six sites participated in a meta-analysis by contributing original clinical data, HIS, and pathologic diagnoses on 312 patients with dementia (AD, 191; MID, 80; and mixed, 41). Sensitivity and specificity of the HIS were calculated based on varied cutoffs using receiver-operator characteristic curves. Logistic regression analyses were performed to compare each pair of diagnostic groups to obtain the odds ratio (OR) for each HIS item. The mean HIS (+/- SD) was 5.4 +/- 4.5 and differed significantly among the groups (AD, 3.1 +/- 2.5; MID, 10.5 +/- 4.1; mixed, 7.7 +/- 4.3). Receiver-operator characteristic curves showed that the best cutoff was < or = 4 for AD and > or = 7 for MID, as originally proposed, with a sensitivity of 89.0% and a specificity of 89.3%. For the comparison of MID versus mixed the sensitivity was 93.1% and the specificity was 17.2%, whereas for AD versus mixed the sensitivity was 83.8% and the specificity was 29.4%. HIS items distinguishing MID from AD were stepwise deterioration (OR, 6.06), fluctuating course (OR, 7.60), hypertension (OR, 4.30), history of stroke (OR, 4.30), and focal neurologic symptoms (OR, 4.40). Only stepwise deterioration (OR, 3.97) and emotional incontinence (OR, 3.39) distinguished MID from mixed, and only fluctuating course (OR, 0.20) and history of stroke (OR, 0.08) distinguished AD from mixed. Our findings suggest that the HIS performed well in the differentiation between AD and MID, the purpose for which it was originally designed, but that the clinical diagnosis of mixed dementia remains difficult. Further prospective studies of the HIS should include additional clinical and neuroimaging variables to permit objective refinement of the scale and improve its ability to identify patients with mixed dementia.
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PMID:Meta-analysis of the Hachinski Ischemic Score in pathologically verified dementias. 933 96

One hundred and ninety-nine elderly stroke patients, who received rehabilitation treatment, were examined, to clarify the relationship between cognitive function and discharge place. The patients who moved to long-term care facilities showed more severe disabilities of basic activities of daily living (ADL), more frequent incontinence, and lower functional impairments (Brunnstrom stage), compared with those discharged to their home. Multivariate regression analysis was done with discharge place as the dependent variable. Independent variables were age, sex, kind of stroke, rehabilitation period, level of ADL and IQ on Kohs test, or performance IQ on the Wechsler Adult Intelligence Scale. Older age, higher levels of ADLs, and higher scores on Kohs test IQ or Wechsler Adult Intelligence Scale Performance IQ were all significantly linked with home discharge. These results suggest that non-verbal cognitive dysfunction may affect discharge place in elderly stroke patients after rehabilitation therapy.
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PMID:[Relationship between cognitive function and discharge place among stroke patients after rehabilitation]. 964 16

We performed a community-based study on a cohort of 221 stroke patients followed for 3 years. In this paper, we tried to answer the following questions: Is the risk of dying increased throughout the first 3 years after stroke? What are the causes of death after the 1st month? What factors at stroke onset are independent predictors of early and late mortality? The relative risk of death was estimated using age- and sex-specific mortality rates for the Netherlands. Causes of death were registered by the attending physicians, mostly general practitioners. During the 1st month 26% of the patients died. At 1, 2 and 3 years, the cumulative mortality rates were 37, 46 and 54%, respectively. Stroke patients had an increased risk of dying, approximately twice that of the general population, during the 3 years of follow-up. In women, this increased risk was more pronounced than in men. After 1 month, cardiovascular pathology, stroke and diseases resulting from stroke were the causes of death in 70% of the patients, i.e. substantially higher than in the general population, matched for age and sex. Factors predicting mortality after stroke varied over time. Severity of the stroke, preexisting atrial fibrillation and congestive heart failure were associated with early mortality (within 30 days). For 1-month survivors, incontinence and preexisting atrial fibrillation were associated with mortality in the 1st year after stroke. After 1 year, only age was associated with mortality.
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PMID:Risks and causes of death in a community-based stroke population: 1 month and 3 years after stroke. 1002 30

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.
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PMID:Akinetic mutism and mixed transcortical aphasia following left thalamo-mesencephalic infarction. 1022 14

During the period from July 1995 to June 1996 we performed transurethral resection of the prostate (TURP) on 824 patients with benign prostatic hyperplasia (BPH). Among them, 13 were dementia patients between 74 and 96 years old; they presented with urinary hesitancy in 6, retention in 4, frequency in 2 and incontinence in 1 patient. Past history included stroke in 7, hypertension in 6, pulmonary tuberculosis in 4, diabetes in 3, asthma in 2, angina pectoris in 1, Parkinson's disease in 1, pneumonia in 1, and hepatitis in 1. Careful preoperative examination revealed that they were proper candidates for TURP. They underwent TURP under spinal anesthesia. The mean operative time was 34 min, ranging from 20 to 60 min. The adenoma resected weighed 24 g on the average, ranging from 7.5 to 48 g. During surgery, although hypotension was noted in 2 patients, there was no serious morbidity. Their mental condition was well controlled with ketamine and diazepam during and after surgery. Postoperative complications included acute myocardial infarction in 1, multiple gastric ulcer in 1, and decubitus in 1. None died within 3 months after TURP, 3 died there after, and 10 patients were alive at the mean follow-up period of 26 months. Six patients reported good urination, 3 reported some improvement in urination after surgery, although requiring intermittent catheterization and 1 developed mild incontinence. In conclusion, TURP appears to provide some benefit in selected patients with dementia and should not be considered to be a contraindication for such patients.
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PMID:[Transurethral resection of the prostate for patients with dementia]. 1036 42

The aim of this prospective study was to investigate the value of CT scan in prognosis of acute ischaemic stroke patients as a variable additional to clinical stroke syndromes to develop a simple classification of CT scan features to provide a practical approach to prognosticate and manage such patients. One hundred and eight nine patients admitted with ischaemic stroke were investigated with a CT scan. CT scan features were classified into two groups: large infarct, LI (across more than one lobe) and non-large infarcts (N-LI) for all other features. Patients were also studied for clinical syndromes, analysing results for total anterior circulation syndrome (TACS). Outcome was measured as early post stroke Barthel index, acute phase and 3-month mortality. Patients with LI had features of severe strokes and had a lower Barthel index (p < 0.001), lower Glasgow coma score (p < 0.001), more association with incontinence (p < 0.001), pyrexia (p = 0.007) and dysphagia (p < 0.001). LI patients required higher level of care in acute wards and had a higher length of stay (p = 0.01). Both the LI and TACS individually had a significantly higher mortality (p < 0.001) and similar positive predictive value, sensitivity and specificity for 3-month mortality. While the combined factor of 'large infarct and TACS' provided the highest likelihood ratio (3.1) for mortality, the factor of 'large infarct or TACS' was the most sensitive (85%) to identify majority of patients at a risk of mortality. N-LI patients had a better prognosis. Classification of cerebral infarcts into large and non-large categories identifies patients who require higher level of care in acute wards and have a higher mortality. Combined factor of 'large infarct and/or TACS' identifies the majority of patients at risk of 3-month mortality as compared to either variable taken individually. CT scan features are complimentary to clinical syndromes for managing acute stroke patients.
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PMID:Prognostic value of CT scan features in acute ischaemic stroke and relationship with clinical stroke syndromes. 1119 29

In measuring the progression of, or recovery from, a disease an individual's outcome may be assessed on a number of occasions. A model of the relationship between outcome and time since disease occurred which accounts for patient characteristics could be used to describe patterns of recovery, to predict outcome for a patient, or to evaluate health interventions. We use multilevel models to analyse such data, focusing on the choice of powers of time both for mean outcome and covariate effects. We give equations for predicted outcome and corresponding standard errors (i) based only on baseline characteristics, and (ii) by conditioning on previous outcomes for an individual. In a study of 331 stroke patients, outcome was measured approximately 0, 2,4,6 and 12 months after stroke. Patient characteristics included age, sex, and pre-stroke handicap, together with stroke-severity indicators (presence of limb deficit, dysphasia, dysarthria or incontinence). Of these, only the effects of age, dysphasia and presence of deficit varied with time. Conditioning on previous observations improved the accuracy of predictions. The outcome variable clearly had a skewed distribution, and the model residuals showed evidence of non-Normality. We discuss alternative models for non-Normal data, and show that, here, the standard (Normal errors) multilevel model gives equivalent parameter estimates and predictions to those obtained from alternative models.
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PMID:Multilevel growth curve models with covariate effects: application to recovery after stroke. 1124 71

The classic literature on pathological laughter and crying emphasizes the difference between incontinence and lability of affect. Pathological laughter and crying as key symptoms of affect incontinence are viewed as the effects of disinhibition of motor synergisms without congruent affect, which is the crucial difference to affect lability. The interpretation as a disinhibitory phenomenon is supported by clinical and electromyographic observations, which found a lack of modulation of intensity in pathological laughter and crying. In 1924, Wilson postulated a supranuclear pontobulbar center for affective synergisms that is controlled by cortex and thalamus. Accordingly, Kleist viewed a combined lesion of thalamic or brainstem structures and corticofugal motor projection systems as the pathoanatomic basis of affect incontinence. Recent work reported the frequent occurrence of affect incontinence with stroke and dementia of the Alzheimer type and thus disagrees with the classical theory. However, the methods used cannot rule out a confounding between affect lability and incontinence.
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PMID:[Pathological laughing and crying]. 1158 84

The three well-known criteria for legal competence and testamentary capacity, that is: consideration, awareness and the ability to express oneself in writing and speaking, ought to be extended by three further dimensions, namely: motivation, long-term intentions, gestures. This demands increased specialised competence and increased time, but seems indispensable in order to meet the postulate of human ethics: to give the patient the optimum support for a sensible realisation of will. This equally applies to medical experts and jurists (especially notaries and lawyers). The related demand to give increased time and attention to a patient, often in the form of repeated observation over several days, with detailed written documentation, shows that it is not at all a weakening, which is supported, but rather a more precise formation of concept. In this sense, we expect to meet better the demand of the best possible "objectivity" in evaluation, rather than within a merely schematic, single, short-time assessment. We substantiate this with several examples, taken from various areas, namely: in isolated aphasic/agraphic disorders, testamentary capacity and even legal competence can be retained according to the above criteria (despite the inability to write and speak). In analogy, also "last minute" decisions of the incurably sick person must be taken into account. We also show, however, that an assertion of legal competence (unrestricted ability to reach a decision) based on merely formalistic guide-lines, without taking into account long-term intentions and motivation, might seriously harm a patient. There is the case of a post-apoplexy patient who demanded immediate discharge to return home. This patient proved fully aware in classical questions of reference, but, due to homesickness, post-apoplectic syndrome and senile stubbornness, failed to take into account her inability to walk and incontinence. A consolidated discharge, however, was very well possible several weeks later. At an earlier stage this would have led to disaster. There will always remain a zone in which it is not possible to reach clear expert decisions either pro or contra but by incorporating the criteria above quoted, it will be possible to considerably narrow this zone. This corresponds to an evaluation process, which cultivates both optimum objectivity and optimum fairness.
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PMID:[Expanded criteria for assessment of legal competence and testifying capacity in borderline cases of organic brain syndromes--an important field for cooperation between medicine and law]. 1160 10

Evidence of the benefit of exercise for patients with musculoskeletal problems was examined by analysing meta-analyses and systematic reviews. The literature search was confined to studies where pain and/or function was used as the outcome measure. Twenty-three meta-analyses/systematic reviews were covered, and the methodical quality was assessed. Nine out of twelve meta-analyses showed that exercise had a positive effect on groups groups diagnosed with intermittent claudication, fibromyalgia, incontinence, low back pain, and stroke, whereas one meta-analysis (exercise to prevent falls in the elderly) showed no effect. Of the systematic reviews, six out of 12 showed a positive effect and five were inconclusive, owing to the lack of clinical trials. We conclude that much more research in the field of exercise and physiotherapy is needed.
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PMID:[Evidence-based grounds of physical therapy. Focus on training/exercise therapy of musculoskeletal problems]. 1181 Jul 92


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