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

Patients with Huntington's Disease (HD) who were without dementia were compared to unilateral stroke patients and controls as previously reported in 1983, to discover if they had a prosodic defect. Subjects were presented tape-recorded speech filtered sentences and asked to indicate the tone of voice as happy, sad or angry (affective prosody), or as a question, command or statement (propositional prosody). HD patients were impaired in comprehension of both types of prosody compared to controls but were not different from stroke patients. A second study compared early HD patients with at-risk siblings and spouse controls on comprehension of affective and propositional prosody, discrimination of both types of prosody, rhythm discrimination and tonal memory (Seashore tests). HD patients were impaired in both comprehension and discrimination of all types of prosody. HD patients were less accurate than at-risk patients on the tonal memory task but not on the rhythm discrimination task. These findings suggest compromise in ability to understand the more subtle prosodic aspects of communication which may contribute to social impairment of HD patients very early in the course of the disease.
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PMID:Comprehension of prosody in Huntington's disease. 214 17

Leuko-araiosis is a purely descriptive term indicating images of bilateral, patchy or diffuse areas of decreased density frequently observable in the deep white matter on brain CT scans of adults and elderly subjects. While in earlier studies these images were considered as the "in vivo" expression of leukoencephalopathy associated with Binswanger disease, subsequently they have been reported in a rather broad spectrum of clinical conditions, including healthy aging and dementia of different types. Evidence of arterial hypertension and lacunar stroke is found in only two-thirds of subjects with leuko-araiosis. The results of pathological studies are conflicting about the nature of leukoencephalopathy, and the type and severity of medullary artery involvements. Probably several mechanisms underlie leuko-araiosis. They might act separately or be combined in different cases. Classification by physiopathological mechanism may be a suitable aim of future research in this field.
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PMID:Leuko-araiosis: a reappraisal. I. CT studies. 220 63

Single-photon emission computed tomography (SPECT) of the brain using hexamethyl propylene amine oxime (HMPAO) was performed in a 37-year-old patient suffering from mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). Reduced blood flow was observed bilaterally in the parieto-occipital regions (resembling Alzheimer type dementia) and in the right parietal lobe.
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PMID:HMPAO-SPECT imaging resembling Alzheimer-type dementia in mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). 221 1

From the view point of prevention and treatment of dementia, dementia can be classified into three main groups. The first is treatable or preventable dementia. Unfortunately, this group occupies only 10 or 20% of all demented patients. However, early diagnosis and treatment of diseases belonging to this group are particularly important. The other two groups are Alzheimer-type dementia (ATD) and vascular dementia. Early diagnosis of ATD is still rather difficult. We recently have found that alpha 1-antichymotrypsin (alpha 1-ACT) increases significantly in the serum and cerebrospinal fluid in ATD. Thus, alpha 1-ACT can be used as an antemortem biological marker of ATD. Positron emission CT (PET) is also useful for the early diagnosis of ATD, because decrease in CMRO2 in the unilateral temporo-parietal region occurs in a relatively early stage of this disease. On the other hand, vascular dementia can be said to be becoming one of the treatable or preventable dementias. Vascular dementia is mainly based on cerebral infarction. Therefore, prevention of initial stroke is most essential. For this purpose, correction of risk factors and use of antiplatelet agents in those cases suffering a transient ischemic attack or subjective symptoms are necessary.
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PMID:[Early diagnosis and prevention of dementia in the aged]. 221 6

Cerebral amyloid angiopathy can present as lobar intracerebral hemorrhage in an elderly person, presumably due to increased fragility of the vessels affected by amyloid deposition. For this reason, patients presenting with intracerebral hemorrhage and suspected of having cerebral amyloid angiopathy have often been treated nonsurgically. Since 1983 we have evaluated 11 patients with cerebral amyloid angiopathy (nine women and two men, mean age 73 years) who have undergone either intracerebral hematoma evacuation or brain biopsy. Nine of the 11 patients presented with intracerebral hemorrhage, which was unilobar in three patients and multilobar in six and involved the parietal lobes seven times, the frontal lobes four times, the temporal lobes four times, and the occipital lobes twice. These nine patients underwent hematoma removal, with no cases of abnormal intraoperative bleeding or recurrent hemorrhage. Six patients improved neurologically, and two were unchanged after hematoma evacuation; the remaining patient had a fatal cardiopulmonary arrest during the immediate postoperative period. During follow-up in seven patients (median 11 months, range 1 week to 74 months) none experienced a recurrent intracerebral hemorrhage and four continued to improve. Two of the 11 patients had cerebral amyloid angiopathy diagnosed by brain biopsy as part of an evaluation for dementia, also without surgical complications. This series suggests that patients with cerebral amyloid angiopathy may safely undergo operative procedures, and patients presenting with intracerebral hemorrhage may show neurologic improvement following evacuation of the hematoma.
Stroke 1990 Nov
PMID:Surgical experience with cerebral amyloid angiopathy. 223 47

We performed clinical and neuroradiologic studies, including positron emission tomography, in five patients with vascular dementia of the Binswanger type. The clinical features of these cases consisted of slowly progressive dementia, together with vascular risk factors such as hypertension and often a history of minor stroke, and characteristic white matter lesions on brain computed tomograms or magnetic resonance images. Digital subtraction angiography of the cervical and intracranial arteries demonstrated no occlusive lesion in any patient. Both cerebral blood flow and the cerebral metabolic rate for oxygen were markedly reduced in the white matter (54-77% of control values), and both were decreased in the parietal (73% of control), frontal (74-80%), and temporal (74-83%) cortices, where no abnormalities were detected by brain computed tomography or magnetic resonance imaging. We conclude that vascular dementia of the Binswanger type may be caused by disconnection between the cerebral cortex and subcortical structures due to ischemic damage in the white matter.
Stroke 1990 Dec
PMID:Cerebral blood flow and oxygen metabolism in patients with vascular dementia of the Binswanger type. 226 76

In a community-based study of patients with a first-ever stroke, intellectual impairment (as defined by scores on a common screening test for dementia, the Mini-Mental State Examination) was found in 26% at 1 month post-stroke, and in 21% at 6 and 12 month follow-up. Low scores on the screening test were associated with greater age, physical disability before the stroke, larger stroke lesion volumes as measured on CT scan, and non-stroke changes such as atrophy and white matter low attenuation on the CT scan. There was a negative correlation between scores on the Mini-Mental State Examination and symptom levels on two measures of mood disorder. However, there was no evidence of a specific relationship between major depression and low scores on the Mini-Mental State. We examined various aspects of the relationship between mood symptoms and low scores on the Mini-Mental State, but found no evidence to support the suggestion that this relationship represented an example of depressive pseudodementia. We discuss the significance of our findings for clinical psychiatry and neuropsychology.
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PMID:The relationship between intellectual impairment and mood disorder in the first year after stroke. 228 89

To determine interrater reliability of dementia diagnosis, 4 physicians experienced in the evaluation of dementia patients applied 3 sets of diagnostic criteria to each of 62 patients, based on a standardized set of medical record information. All patients had undergone similar examinations and follow-up to establish the initial clinical diagnosis (76% had autopsy). Raters were blind to the diagnosis and to follow-up information after the initial evaluation period. This paper presents interrater agreement (kappa values) for a diagnosis of Alzheimer's disease using the American Psychiatric Association diagnostic criteria from the Diagnostic and Statistical Manual (DSM-III), the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for the clinical diagnosis of Alzheimer's disease, and the Eisdorfer and Cohen Research Diagnostic Criteria (ECRDC) for primary neuronal degeneration. The NINCDS showed somewhat higher average interrater reliability (kappa = 0.64) than the DSM-III (kappa = 0.55) and considerably higher interrater reliability than the ECRDC (kappa = 0.37). One rater displayed conspicuously lower levels of interrater reliability than the other 3, especially in DSM-III and ECRDC. This study indicates that interrater reliability of DSM-III and NINCDS criteria are comparable. Documentation of interrater reliability and, if necessary, training to improve reliability is an important consideration in research where different observers are diagnosing dementing illnesses.
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PMID:Interrater reliability of Alzheimer's disease diagnosis. 230 Feb 44

To assess prospectively the accuracy of standard antemortem clinical diagnostic criteria for Alzheimer's disease, post-mortem examinations were performed on 25 patients who had met DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke criteria for probable Alzheimer's disease. Seventeen patients (68%) met neuropathological criteria for Alzheimer's disease. Two presenile-onset patients had diffuse neocortical senile plaques of insufficient number for definite Alzheimer's disease. Six patients had non-Alzheimer's disease diagnoses. Five of these six had presenile-onset dementia. These results suggest caution in the antemortem diagnosis of Alzheimer's disease in presenile-onset dementia.
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PMID:Neuropathological findings in patients with clinical diagnoses of probable Alzheimer's disease. 230 54

Patients with Parkinson's disease (n = 81) are compared with normal controls and three clinical groups, each representing a different level of cerebral impairment (TIA; Stroke; Alzheimer's disease (AD) and multi-infarct dementia (MID). Psychometric measures of abstract reasoning, speed of information processing, verbal and visual memory, visuospatial perception and psychomotor functions are taken using a neuropsychological test battery with appropriate age-correction and normalized scaling. Following differentiation between the uncomplicated idiopathic Parkinson's syndrome and Parkinson plus (signs of cerebral polypathy and/or a degenerative process exceeding the nigro-striatal system) the neuropsychological profile reveals intellectual impairments approaching the dementia level (AD/MID) only in the Parkinson plus subgroup. With the exception of the severe motor deficiencies, the overall performance of patients with an uncomplicated Parkinson's syndrome is largely on the level of age-matched controls. Slight deficits exist only in the speed of information processing (action under time restriction) and in visuoconstructive performance.
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PMID:[Comparative psychological test studies of the intellectual ability of Parkinson patients]. 232 Jan 95


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