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

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.
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PMID:The sources of convergence between measures of apathy and depression. 832 82

Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.
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PMID:The sources of convergence between measures of apathy and depression. 835 67

The frequency and correlates of sexual behavioral changes in Alzheimer disease (AD) were assessed in two studies. In the first study, we reviewed the medical records of 135 consecutive community-living patients who fit the criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer Disease and Related Disorders Association for probable or possible AD, and we asked spouses to complete a questionnaire that included two questions about sexual activity. Indifference to sexual activity was reported by 70% of the spouses, and sexual behavioral modifications were reported by 50%. No correlation was found between sexual changes and the general characteristics of the patients, the severity of the disease, or depressive symptomatology. Sexual changes were correlated to the severity of behavioral and mood disorders, mainly to a reduction of activity and emotional deficit. Seventy-seven of the patients had a second examination after an interval of 18.9 +/- 9.9 months. The links between sexual changes and the other variables were similar to those found by the first examination. In the second study, a questionnaire was sent by mail to the spouses of 100 patients. No relationship was found between sexual changes and the severity of cognitive deficits, previous sexual agreement, age, or gender. Sexual changes were considered a factor of maladjustment for the couple by 46% of the spouses.
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PMID:Sexual behavioral changes in Alzheimer disease. 872 70

Numerous emotional and behavioral disorders occur following cerebrovascular lesions. Depression is the most common of these, affecting up to 40% of patients. Clinical correlates of post-stroke depression include severity of physical and cognitive impairment as well as location of brain injury. Perhaps the most compelling reason to identify post-stroke depression, however, is its substantial impact on recovery in activities of daily living, cognitive function, and survival. Antidepressant medication has been shown to effectively treat depression, although its administration may require careful clinical monitoring. Other post-stroke emotional/behavioral disorders include mania, bipolar disorder, anxiety disorder, apathy, and pathological crying. Controlled studies have not documented the effect of these disorders on long-term recovery, but the potential impact of syndromes such as mania and apathy on rehabilitation efforts or pathological crying on social functioning are evident. With the exception of pathological crying, which has been shown to respond to antidepressant drug therapy, the other post-stroke emotional/behavioral disorders need to be evaluated in controlled treatment trials for response to therapy.
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PMID:Neuropsychiatric consequences of stroke. 904 57

Owing to the lack of instruments specifically constructed to study emotional and affective disorders of stroke patients, the nature of post-stroke depression (PSD) remains controversial. With this in mind, the authors constructed a new scale, the Post-Stroke Depression Scale (PSDS) which takes into account a series of symptoms and problems commonly observed in depressed stroke patients. The PSDS and the Hamilton Depression Rating Scale (HDS) were administered to a group of 124 patients, who had been classified, on the basis of DSM III-R diagnostic criteria, in the following categories: No depression (n = 32); Minor PSD (n = 47); Major PSD (n = 45). Scores obtained by these stroke patients on the PSDS and on the HDS were compared to those obtained on the same scales by 17 psychiatric patients also classified as major depression on the basis of DSM III-R diagnostic criteria. An analysis of the symptomatological profiles clearly showed that: (1) a continuum exists between the so-called "major" and "minor" forms of PSD; (2) in both groups of depressed stroke patients the depressive symptomatology seems due to the psychological reaction to the devastating consequences of stroke, since the motivated aspects of depression prevailed in depressed stroke patients, whereas the (biologically determined) unmotivated aspects prevailed in patients with a functional form of major depression; and (3) in stroke patients a DSM III-based diagnosis of major PSD could be in part inflated by symptoms (such as apathy and vegetative disorders) that are typical of major depression in a patient free from brain damage, but that could be due to the brain lesion per se in a stroke patient.
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PMID:The Post-Stroke Depression Rating Scale: a test specifically devised to investigate affective disorders of stroke patients. 926 9

Numerous studies in stroke patients suggest that the left frontal anterior region may be strategic for depression. However, these findings could not always be replicated. Some authors even deny any etiological contribution of lesion location to depression. The predominant role of the right hemisphere in secondary mania is well recognized. In disorders such as apathy, anxiety, catastrophe reactions and pathological laughing and crying, further studies are needed to determine the potential clinico-topographic correlations. Affective disorders are important to consider in stroke patients, since they may influence neurological recovery and may be responsive to treatment. Remarkable features of emotional behavior, such as disinhibition, denial, indifference, overt sadness and aggressiveness, are not rare during the acute phase of stroke and might be overlooked if not searched for systematically with appropriately designed scales. Some of these early behaviors, such as denial, may relate to the late development of depression, anxiety and other disorders. Systematic studies on large samples of patients may allow to establish which of these acute emotional behavioral changes are markers for the delayed development of mood disorders.
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PMID:Affective disorders following stroke. 928 28

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

Traumatic brain damage may cause acute emotional symptoms such as uncontrolled crying, apathy, and sleep problems. Rehabilitation may be less effective in patients afflicted by these symptoms. Citalopram, a selective serotonin reuptake inhibitor (SSRI), has a documented immediate and dramatic effect on pathological crying in stroke patients. The present case history of a 6-year-old boy with a traumatic right-sided hemorrhage in the basal ganglia indicates that early SSRI treatment has a dramatic effect on pathological crying and in addition may have a concomitant beneficial effect on motor paresis, sleep disturbance, and neurobehavioral problems.
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PMID:Citalopram treatment of traumatic brain damage in a 6-year-old boy. 1022 20

Following right hemisphere stroke, many patients display an indifference to objects and events in the left side of the world ('neglect'). Here, we describe a new technique that might help accelerate recovery from neglect. The patient sits at a table and a mirror is propped vertically on the patient's right side in the parasagittal plane, so that when the patient rotates his head rightward and looks into the mirror, he sees the neglected side of the world reflected in the mirror. Our question was: since the sensory information was now coming from the non-neglected left side, would this somehow make him overcome the neglect? In pilot experiments, two types of responses were seen: (a) In one subset of patients the presence of the mirror seemed to enhance the patients' awareness of the neglected field, so that they reached correctly for an object that was shown in the neglected field. Will repeated practice with this task accelerate recovery from neglect? (b) The second group of patients kept reaching into the mirror to grasp the reflection or kept groping behind the mirror ('mirror agnosia'). If the mirror was placed in the coronal position and the object placed behind their head, then some of these patients (from group B) reached correctly for the object. Quite apart from its obvious theoretical implications, we believe this technique might provide a new approach for the treatment of visual hemineglect.
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PMID:Can mirrors alleviate visual hemineglect? 1046 67

The purpose of this study was to evaluate the discriminability of apathy and depression by determining whether the relationship of these two dimensions of behavior varies in different diagnostic groups. Using the authors' Apathy Evaluation Scale and the Hamilton Rating Scale for Depression, we rated 123 subjects, mean age 72 years, who met research criteria for healthy elderly controls, left or right hemisphere stroke, probable Alzheimer's disease, and major depression. Elevated apathy scores unassociated with elevated depression were most frequent in Alzheimer's disease and right hemisphere stroke, and also occurred in a small number of left hemisphere stroke and normal subjects. In major depression, apathy was associated with high depression scores, although a substantial number of major depressives showed elevated depression without elevated apathy. In left hemisphere stroke, probable Alzheimer's disease, and major depression, there were significant positive correlations between apathy and depression. The slope of the regression of apathy on depression was greatest in probable Alzheimer's disease and major depression. These results indicate that the relationship between apathy and depression differs across diagnostic groups and, thus, support the discriminability of apathy and depression.
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PMID:Group differences in the relationship between apathy and depression. 1067 22


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