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

Nimodipine is a calcium antagonist which improves learning and memory in brain-lesioned or aged animals (LeVere & Sandin, 1989; Schuurman & Traber, 1989). It also accelerates the recovery of experimentally damaged sciatic nerves (van der Zee et al., 1987) and reduces age-associated gait abnormalities in aging rats (Schuurman et al., 1987). Selective action on cerebral vessels has also been proven. Vasoconstriction was prevented or reduced with nimodipine under experimental conditions (Toward, 1981) and cerebral blood flow could be increased (Kazda et al., 1982). The drug has been tested in subarachnoid hemorrhage, stroke, severe head injury, cerebral resuscitation after cardiac arrest, impaired brain function in old age, and dementia. Methodological aspects of clinical studies with this agent are examined in this paper.
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PMID:Global rating, symptoms, behavior, and cognitive performance as indicators of efficacy in clinical studies with nimodipine in elderly patients with cognitive impairment syndromes. 150 90

The advent of neuroimaging has brought medical attention to the frequency of unsuspected white matter lesions in the brains of elderly people. In 1987 Hachinski suggested the term "leuko-araiosis" to identify such white matter abnormalities detected by computed tomography and magnetic resonance imaging to emphasize that their etiology and clinical relevance require clarification. Since then, leuko-araiosis has been recognized among approximately ten percent of apparently normal, elderly people over age sixty-five. The severity and frequency of leuko-araiosis increases with advancing age, risk factors for stroke, history of strokes particularly of the lacunar type and dementia of both the vascular and Alzheimer type. Current concepts concerning the pathogenesis and neurological concomitants of leuko-araiosis are reviewed. The etiology of leuko-araiosis may be heterogeneous but is most likely ischemic in nature. However, as white matter lesions progress among the elderly they are likely to become associated with cognitive impairments and motor dyspraxias presumably resulting from cortico-subcortical disconnections, particularly involving the frontal cortex and basal ganglia and may themselves be considered a radiological "risk factor" or precursor for dementia.
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PMID:White matter lesions in the elderly. 150 48

To determine whether hypertension, the predominant risk factor for stroke and vascular dementia, is associated with brain atrophy, magnetic resonance imaging (MRI) scans were performed to quantify brain volumes and cerebrospinal fluid spaces. Eighteen otherwise healthy, cognitively normal older hypertensive men (mean +/- SD age, 69 +/- 8 years, duration of hypertension 10-35 years) and 17 age-matched healthy, normotensive male control subjects were studied in a cross-sectional design. Axial proton-density image slices were analyzed using region-of-interest and segmentation analyses. The hypertensive subjects had significantly larger mean volumes of the right and left lateral ventricles (p less than 0.05, both absolute volume and volume normalized to intracranial volume) and a significantly smaller normalized mean left hemisphere brain volume (p less than 0.05) with a trend toward significance for a smaller normalized mean right hemisphere volume (p less than 0.09). Four hypertensive subjects and one healthy control subject were found to have severe periventricular hyperintensities on T2-weighted MRI images. When data for these subjects were removed from the analyses, the normalized lateral ventricle volumes remained significantly larger in the hypertensive group. Lateral ventricle enlargement was not related to age or use of diuretics in the hypertensive group nor to duration of hypertension between 10 and 24 years. Our findings suggest that long-standing hypertension results in structural changes in the brain. Longitudinal studies will determine whether MRI-associated changes are progressive and if such changes identify hypertensive subjects at increased risk for clinically apparent brain dysfunction.
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PMID:Brain atrophy in hypertension. A volumetric magnetic resonance imaging study. 151 53

White matter of the brain in 25 autopsy cases with the stroke and chronic cerebro-vascular pathology produced by arterial hypertension (AH) was studied morphologically. Focal and diffuse changes of the white matter were found against the background of the hypertonic angiopathy. These changes were represented by lacunar infarcts, foci of incomplete necrosis, perivascular encephalolysis, more seldom by small haemorrhages in combination with edema, cribriform lesions and widespread spongiosis of the white matter. Alterations of the cortex-medullary arteries, microcirculatory bed, disturbances of the dynamics of liquor and permeability of blood-brain barrier play the most important role in the white matter damage. The authors distinguish 3 forms of this damage. The complex of these alterations is regarded as a morphological substrate of a vascular dementia associated with AH.
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PMID:[Arterial hypertension and pathology of cerebral white matter]. 152 4

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

Prevention of the chronic health conditions of older people can potentially affect both life expectancy and health. In the past, fatal conditions, namely coronary heart disease, cancer, and stroke, dominated work on preventive strategies with the only outcome of concern being mortality. The present increasing life expectancy of the population has put persons at risk for the nonfatal and often disabling conditions of old age, such as dementia, osteoporosis and hip fracture, sensory impairments, and arthritis, to name a few. These conditions have major effects on, not the quantity, but the quality of life. In the future, quality of life measured in a variety of ways will be necessary to evaluate the effects of preventive strategies for nonfatal conditions.
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PMID:Measurement issues in preventive strategies: past, present, and future. 153 97

The causes of early rehospitalization (within 3 weeks) of very elderly patients, its possible avoidance and appropriate preventive measures were analysed retrospectively in patients of a geriatric hospital. Included were all those patients who had been admitted to the hospital from their home several (mean: five) times between 1987 and 1990 (48 women, 19 men; mean age 81.3 +/- 7.2 years--a total of 331 re-admissions). The most frequent diagnoses were heart failure (38.8%), acute cerebrovascular accident or its sequelae (31.3%), dementia (23.9%), fall or its sequelae (22.3%) and diabetes (20.9%). Of the 331 re-admissions 87 (26.3%) occurred during the first 3 weeks after discharge. The most important reasons of this early re-admissions were inadequate home care (41.4%), undesirable drug effects and non-compliance (25.3%), as well as rapid progression of the basic disease (14.9%). In the judgement of the hospital team more than 40% of the early re-admissions were avoidable, among those re-admitted because of inadequate home care and those in connection with drug intake even more than half. Early hospitalization is frequently avoidable, if individual geriatric assessment is undertaken and discharge carefully planned.
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PMID:[The early rehospitalization of elderly patients. Causes and prevention]. 154 42

Accurate diagnosis of vascular dementia is important for the recognition of underlying pathophysiology and the institution of appropriate therapy. It is also important for the determination of the incidence and prevalence of not only vascular dementia but also Alzheimer's disease (AD), since differentiating between these two entities is often problematic. The State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) herein propose criteria for the diagnosis of ischemic vascular dementia (IVD). These criteria broaden the conceptualization of vascular dementia, include the results of neuroimaging studies, emphasize the importance of neuropathologic confirmation, refine nosology, and identify areas that require further research. Parallel use of the proposed definitions of "possible" and "mixed" categories in the diagnosis of both AD and IVD would ensure compatibility between the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for AD and the ADDTC criteria for IVD. Uniform classification of subtypes of IVD will improve the generalizability of individual studies and aid in multicenter collaborations.
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PMID:Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. 761 13

This is a prospective study concerning 101 percutaneous endoscopic gastrostomies (PEG) performed in patients aged from 70 to 98 (83.6). We obtained a success in 99%. Indications were stroke and its consequences in 36%, dementia in 22%, depressive syndrome in 38% (7% in the postoperative period) laryngeal or oesophageal tumors in 4%. This technique was carried out in outpatients without anesthesia but PEG must be considered to be a surgical method. Only 5% patients presented major immediate complications with three deaths (3%) due to the technique. Follow-up (30 days) demonstrated 11 other deaths. Would earlier PEG have given better results? Oral feedings (alone or both oral and PEG) were possible in 51% patients. PEG is a valuable technique of feeding assistance in the aged, offering an alternative to nasogastric tube and could be used more extensively in old patients.
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PMID:[Percutaneous endoscopic gastrostomy: its value in assisted alimentation in malnutrition in elderly patients. Apropos of 101 consecutive cases in patients over 70 years of age]. 155 Mar 20

Antiphospholipid antibodies may be found in about 10% of all subjects with acute stroke but probably are present in as many as 50% of young persons with stroke and perhaps even in high prevalence in persons who have coexisting rheumatologic diseases such as SLE. In these latter groups, the association may be as high as 50%. Probably the best related syndrome is Sneddon's syndrome, which has a high prediction to dementia. Furthermore, vascular dementia may be a prominent feature of the aPL syndrome in subjects under age 55. The cause and mechanism by which aPL are related to stroke remain unknown. Likewise, there is a dearth of information about prognosis, morbidity, and stroke recurrence in subjects who have these immunoglobulin markers. Thus therapy remains very problematic, but current strategies include the use of antiaggregate therapy, warfarin, and limited implementation with prednisone and plasmaphoresis. Data that demonstrate clear cut benefit of any of these therapies are lacking. Ultimately, unraveling these crucial problems concerning the aPL syndrome may provide great insight into certain stroke mechanisms.
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PMID:The role of antiphospholipid antibodies in stroke. 155 99


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