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The prevalence of gait disorders among neurological inpatients is unknown, although disturbed gait is a common symptom. Gait disorders often lead to loss of independence with restraints for the patients and caregivers and costs for the health system. We designed a prospective study and investigated all patients admitted to a neurological hospital during a 100-day period for the presence of a gait disorder. Clinical investigation and several disease-specific rating scales were carried out for 493 patients. In 60% of the patients, a disturbance of gait was diagnosed. Most frequent diagnoses were stroke (21%), Parkinson's disease (17%), and polyneuropathy (7%). Within these diagnoses, the rate of patients with disturbed gait was high in Parkinson's disease (93%), subcortical arteriosclerotic encephalopathy (85%), and motor neuron disease (83%). Advanced age, dementia, alcohol abuse, and treatment with antiepileptics, neuroleptics, benzodiazepines, and chemotherapeutics were identified as risk factors for a gait disorder. A decline of cognitive function was accompanied by a reduction of walking speed. According to these results, gait disorders are among the most frequent symptoms in neurology.
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PMID:Prevalence of gait disorders in hospitalized neurological patients. 1539 43

The relative risks of coronary heart disease (CHD) and overall mortality are reduced by moderate consumption of alcoholic beverages, particularly wine, which has major implications for public health. It appears likely that this beneficial effect of alcohol will soon be extended to some mental disorders. Although data on psychosis and mood and anxiety disorders are currently lacking, it appears that the relative risks of developing ischaemic stroke and Alzheimer's or vascular dementia are also lowered by moderate alcohol consumption. Such findings are still tentative because of the inherent methodological problems involved in population-based epidemiological studies, and it is unclear whether the benefit can be ascribed to alcohol itself or to other constituents specific to wine such as polyphenols. Plausible biological mechanisms have been advanced for the protective effect of alcohol and wine against CHD, many of which will also play roles in their protective actions against cerebrovascular disease and dementia. The specific antioxidant properties of wine polyphenols may be particularly important in preventing Alzheimer's disease. Because of the substantially unpredictable risk of progression to problem drinking and alcohol abuse, the most sensible advice to the general public is that heavy drinkers should drink less or not at all, that abstainers should not be indiscriminately encouraged to begin drinking for health reasons, and that light to moderate drinkers need not change their drinking habits for health reasons, except in exceptional circumstances.
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PMID:Alcohol, wine and mental health: focus on dementia and stroke. 1558 12

Several international studies from Spain, the Netherlands, Poland, Croatia, and Finland indicate contradicting findings regarding cardiovascular dysfunction among seamen, deep sea fishermen, and harbor workers. The purpose of the present survey was to evaluate the prevalence of hypertension in a selected group of Lithuanian seamen. The survey was conducted during a one year period and involved sailors from commercial, passenger, and fishing boats. The survey took into account the sailors' marital status, education, professional rank and duty, and length of stay at sea. It also included demographical data, complete family health history, the sailor's awareness about their health in general, and awareness about their blood pressure in particular. Their dietary habits, changes in body weight, the history of alcohol intake and tobacco usage were also recorded. Analysis of our data indicates that 44.9% of Lithuanian mariners suffer from a clinically significant elevation of blood pressure, as compared to 53% of the general population of Lithuania. Some of the leading risk factors are: a high cholesterol diet and increased body mass index (BMI), smoking, alcohol abuse, family situation and level of education. The high prevalence of the cardiovascular risk factors was to be found related to ischemic heart disease and cerebrovascular illness. This may be influenced by poor eating habits, poor health awareness and other social and environmental factors which are common to seamen. Increased blood pressure is a widespread condition that affects a large portion of the population in developed countries. It is an important risk factor for cardiovascular and cerebrovascular disease, as well as a significant preventable cause of mortality. According to the World Health Organization (WHO), hypertension is a risk factor for cardiovascular disease, which accounts for an estimated 17 million deaths each year. With hypertension, the risk of stroke increases 2.6-3.8 times, the risk of ischemic heart disease (IHD)--2.0-2.2 times, and that of congestive heart failure (CHF)--3.0-4.0 times. Hypertension is often accompanied by other cardiovascular risk factors such as dyslipidemia, smoking, diabetes and increased body mass index (BMI). When hypertension is present in conjunction with other risk factors, the risk of mortality associated with IHD can increase tenfold. On the other hand, risk factors such as an increased BMI, smoking, alcohol abuse, lack of exercise and a diet high in salt and fatty foods can themselves play an instrumental role in the etiology of hypertension. Several studies have been performed on the prevalence of hypertension among the general population in Lithuania, which is higher than that of most other European countries. Reviews performed by the programs CINDI (Countrywide Integrated Noncommunicable Disease Intervention) and MONICA (MONItoring CArdiovascular Disease) determined that about half of all studied persons of middle age in Lithuania were hypertensive. Our work is the first study seeking to examine the prevalence of hypertension among Lithuanian seamen, as well as its association with various risk factors and dependence on demographic indices.
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PMID:Prevalence of hypertension in Lithuanian mariners. 1563 17

Stroke is major public health problem leading to increased morbidity and mortality. Modifiable risk factors for stroke include hypertension, diabetes, atrial fibrillation, dyslipidemia, smoking, and alcohol abuse. Among these risk factors, diabetes and hypertension are rapidly growing epidemics leading to a substantial increase in cardiovascular disease and stroke. In this review, the authors discuss the risk factors for stroke with emphasis on the diabetic and hypertensive population, highlighting the interventions that have been shown to decrease stroke risk in this patient population.
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PMID:Stroke in patients with diabetes and hypertension. 1588 31

Excessive alcohol consumption has long been associated with cardiovascular disorders, including cardiomyopathy, hypertension, coronary artery disease, and stroke. However, recent evidence suggests that moderate alcohol intake can actually provide a measure of cardioprotection, particularly against coronary heart disease and ischemia-reperfusion injury. To explore the various dimensions of these opposing actions of alcohol, the National Institute on Alcohol Abuse and Alcoholism and the National Heart, Lung, and Blood Institute sponsored a state-of-the-art workshop on "Alcohol and the Cardiovascular System: Research Challenges and Opportunities" in Bethesda, Maryland, in May 2003. Speakers discussed the following topics: the epidemiology of alcohol and cardiovascular disease, clinical manifestations of alcohol, genetics of alcohol and cardiovascular disease, mechanisms underlying the molecular and cellular effects of alcohol, the application of new and emerging technology, and translation from discovery to therapeutic modalities of treatment. The panel concluded that future studies are needed to: 1) determine the role of genes and the environment in assessing mechanisms underlying the benefits of alcohol use and cardiovascular disease risk; 2) define the biological mechanisms underlying alcohol-induced peripheral vascular damage; 3) clarify the role of genetic variation in alcohol-metabolizing enzymes, genetic susceptibility, and pharmacogenomics in determining cardiovascular disease risk and effective treatment; 4) determine common mechanisms underlying alcohol-induced cardiovascular disease, such as oxidative stress and inflammation; 5) assess the role of insulin resistance, blood clotting, protein kinase C isoforms, and signal transduction mechanisms mediating alcohol's beneficial effects; and 6) explore the potential of stem cells in myocardial regeneration and repair in hearts damaged by alcohol.
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PMID:Alcohol and the cardiovascular system: research challenges and opportunities. 1596 87

There are varying reports on the prevalence of risk factors in porphyria cutanea tarda (PCT). We reviewed 84 patients with PCT in a restricted uptake area in Gothenburg, Sweden and evaluated different potential risk factors for the disease and complications. Besides a thorough medical history, the patients were investigated with urinary porphyrin analyses, transferrin saturation, ferritin and liver tests. Subsamples of patients were tested for antibodies to hepatitis C virus (n = 68), haemochromatosis gene mutations (n = 58) and with the oral glucose tolerance test (n = 31). We found a prevalence of about 1 patient with PCT in 10 000 inhabitants. Nineteen (23%) patients reported heredity for PCT. Identified risk factors were alcohol abuse (38% of male patients), oestrogen treatment (55% of female patients), anti-hepatitis C virus positivity (29% of male patients), diabetes (17%) or impaired glucose tolerance (45% of tested patients) and haemochromatosis gene mutations (57% of tested patients). All patients positive for anti-hepatitis C virus belonged to the non-hereditary group. During follow-up we observed a high incidence of stroke, no case of hepatocellular carcinoma and a normal life expectancy.
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PMID:Porphyria cutanea tarda in a Swedish population: risk factors and complications. 1619 56

The purpose of this research was to assess the frequency and severity of neuropsychiatric and behavioral symptoms and to examine the association between preexisting medical conditions and specific neuropsychiatric symptoms in demented individuals. We studied 211 demented subjects (87.7 percent male) who were participants in epidemiological studies of dementia. Using the Neuropsychiatric Inventory (NPI), we assessed the frequency and severity of neuropsychiatric symptoms. We collected medical history information during a structured telephone interview. Our analyses focused on determining prevalence of neuropsychiatric symptoms by dementia diagnosis and severity. We also examined the association of history of head injury, alcohol abuse, and stroke with development of neuropsychiatric symptoms. We found that neuropsychiatric symptoms were common, with approximately three-fourths of the subjects exhibiting at least one symptom during the preceding month. Apathy (39.3 percent), agitation (31.8 percent), and aberrant motor behavior (31.1 percent) were the most frequent symptoms. Frequency and severity of symptoms were similar for the all-dementia and Alzheimer's disease-only groups, neuropsychiatric symptoms varied by severity of dementia, but generally not in a consistent ordinal pattern. History of alcohol abuse, head injury, or stroke was associated with presence of specific neuropsychiatric symptoms in dementia. While psychiatric symptoms are common in dementia, they also vary by type and severity of dementia. The finding that certain medical conditions may increase risk for specific types of neuropsychiatric symptoms expands our knowledge of the natural history of dementia and should improve management of dementia in medically ill patients. Our results may also shed light on mechanisms that underlie neuropsychiatric symptoms.
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PMID:Prevalence and clinical correlates of neuropsychiatric symptoms in dementia. 1639 42

Stroke is one of the major public health problems worldwide. Determining the cerebrovascular risk factors (RF) is very important in the efforts of primary and secondary stroke prevention. The aim of the study was to establish the frequency of RF in patients with ischaemic (IS) or haemorrhagic stroke (HS) hospitalized in the stroke unit in the Department of Neurology of the Silesian Medical University from August 2000 to June 2002. We analysed data of 229 patients (29 with HS and 200 with IS). Functional outcome was evaluated by use of modified Rankin scale, Barthel Index and Scandinavian Neurological Stroke Scale at discharge. Statistical analysis was performed with Student's t-test, coefficient of correlation and multivariate logistic regression. 94.8% (n = 217) of all the patients had one or more RF. The most common RF were: hypertension (78.2%), coronary heart disease (54.2%), obesity (29.2%), diabetes mellitus (24.8%) and dyslipidaemia (24%). No correlation between the number of RF and functional outcome at discharge was observed. Cigarette smoking (p < 0.01) and alcohol abuse (p < 0.005) were more frequent in young patients (< 55 years). Previous ischaemic stroke was more common in older patients (>55 years). In male patients cigarette smoking and alcohol abuse were found more frequently than in female (p < 0.001). The mortality in examined patients was 22.2% (20.4% in patients with IS and 45.8% with HS). Male gender (p < 0.05), history of previous cardiac infarction (p < 0.05) and previous ischaemic stroke (p < 0.01) were associated with increased mortality. The other variables studied did not show significant differences.
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PMID:[Analysis of cerebrovascular risk factors in patients with stroke treated in the stroke unit]. 1664 91

Strokes among young people are not only the most threatening complications of the cerebrovascular diseases, but they also lead to considerable disability and society' dependency. Among patients under 40 years old heart diseases constitute about 18% causes of ischaemic strokes. Other causes of strokes are: artery wall dissection, blood clotting disturbances, birth control pills, stimulants (alcohol abuse, cigarettes, narcotics), vascular immunological diseases. Among these causes there are modifiable factors, which can be eliminated through patients' education, change of the lifestyle and proper treatment of diseases. In paper there is presented the case of 22-year-old woman, who had in the first hours after delivery the paresis of left limbs with paresis of left facial nerve, proceded by loss of consciousness and convulsions. In computer tomography (CT) and magnetic resonance imaging (MRI) there was extensive angiogenic lesion in the area of right internal cervical artery revealed in duplex ultrasonography. In transesophageal echocardiography (TEE) there was revealed haemodynamically significant patent foramen ovale (PFO). In the patient in ten months after stroke there was performed diagnostic cathetarization and then transvascular occlusion of PFO using Starflex 28 mm implant. The patient was rehabilitated from the early time after stroke. Based on carried out examination results that the most likely hypothesis seems to be embolic-thrombotic stroke in the course of hemodynamically significant heart defect (paradoxical embolism in patent foramen ovale) revealed in drastic way during delivery. The earlier lasted process of dissection of cervical internal right artery cannot be also excluded as a cause of stroke.
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PMID:[Stroke in young woman in the first day after delivery]. 1681 81

The aim of the study was to assess risk factors for vascular dementia (VaD) in elderly psychiatric outpatients without dementia, and to determine to what extent clinical interventions targeted such risk factors. Out of 250 clinical charts, 78 were selected of patients over 60 years old, who showed no signs of dementia. Information was obtained regarding demographics, clinical conditions (diagnosis according to ICD-10), complementary investigation, cognitive functions (via CAMCOG), neuroimaging, and the presence of risk factors for VaD. Depression was the most prevalent psychiatric disorder (74%). A great majority of the patients (86%) had at least one risk factor for VaD. One-third of the sample showed three or more risk factors for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), tryglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (19.2%), alcohol abuse (16.7%), and sedentarism (14.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD.
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PMID:Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions. 1731 60


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