Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The brain mediates and integrates all cognitive activities, emotional experiences and finally behaviours. Stroke is undoubtedly a privileged disease for human behavioural studies, because of its high incidence. Recent advances in high-resolution magnetic resonance imaging techniques and functional neuroimaging allow both the precise localization of lesions and on-line visualization of the activity of cerebral areas and networks. Nevertheless, the neuropsychiatry of stroke remains uncertain in its relationship with brain dysfunction. Clinical studies on registry populations, single case studies, and functional neuroimaging data provide interesting findings, but differences in methods and great individual intervariability still prevent a complete understanding of emotional perception and behavioural responses in stroke. We adopted an anatomical-functional model as an operational framework in order to systematize the recent literature on emotional, behavioural and mood changes after stroke. The dysfunction of the areas subserving fundamental and executive functions induces behavioural and affective changes (such as depression, anxiety, apathy) that reflect the dysfunction of the whole system. Conversely, lesions in the system of instrumental functions induce signature syndromes (aphasia, anosognosia). At any delay from stroke, the diagnosis and treatment of mood and behavioural changes are a priority for clinicians and healthcare professionals to improve the quality of life of patients.
 ...
PMID:Emotions, behaviours and mood changes in stroke. 1179 52

This study investigated the prevalence and clinical correlates of hopelessness among 91 patients diagnosed with probable Alzheimer's disease (AD) according to National Institute of Neurological Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Hopeless ideation was measured with Item 3 on the Hamilton Depression Rating Scale (Suicide), which inquires specifically whether the patient thinks "life is not worth living." The results showed that hopelessness was present in 10% (n = 9) of the sample. Patients with these cognitions evidenced greater psychological symptoms of mood disturbance and more insight into their cognitive and functional impairments. Unrelated factors included age, education, Mini-Mental State Examination score, neurovegetative signs of depression, affective expressions of depression, agitation/disinhibition, and psychosis. Although indifference is frequent in AD, these results indicate that thoughts of hopelessness are also a common phenomenon, occurring in approximately 10% of our probable AD cohort. These thoughts appear to be related to the subjective expressions of depression and anxiety rather than the neurovegetative or affective signs and are more prominent among patients with greater deficit awareness.
 ...
PMID:"Life is not worth living": hopelessness in Alzheimer's disease. 1193 42

Cerebrovascular disease is the second most common cause of acquired cognitive impairment and dementia and contributes to cognitive decline in the neurodegenerative dementias. The current narrow definitions of vascular dementia should be broadened to recognise the important part cerebrovascular disease plays in several cognitive disorders, including the hereditary vascular dementias, multi-infarct dementia, post-stroke dementia, subcortical ischaemic vascular disease and dementia, mild cognitive impairment, and degenerative dementias (including Alzheimer's disease, frontotemporal dementia, and dementia with Lewy bodies). Here we review the current state of scientific knowledge on the subject of vascular brain burden. Important non-cognitive features include depression, apathy, and psychosis. We propose use of the term vascular cognitive impairment, which is characterised by a specific cognitive profile involving preserved memory with impairments in attentional and executive functioning. Diagnostic criteria have been proposed for some subtypes of vascular cognitive impairment, and there is a pressing need to validate and further refine these. Clinical trials in vascular cognitive impairment are in their infancy but support the value of therapeutic interventions for symptomatic treatment.
 ...
PMID:Vascular cognitive impairment. 1284 65

We investigated the frequency and neurocognitive correlates of attention deficit hyperactivity disorder and traits of this disorder (ADHD/Traits) after childhood stroke and orthopedic diagnosis in medical controls. Twenty-nine children with focal stroke lesions and individually matched children with clubfoot or scoliosis were studied with standardized psychiatric, intellectual, academic, adaptive, executive, and motivation function assessments. Lifetime ADHD/Traits were significantly more common in stroke participants with no prestroke ADHD than in orthopedic controls (16/28 vs. 7/29; Fisher's Exact p < .02). Lifetime ADHD/Traits in the orthopedic controls occurred exclusively in males with clubfoot (7/13; 54%). Participants with current ADHD/Traits functioned significantly worse (p < .005) than participants without current ADHD/Traits on all outcome measures. Within the stroke group, current ADHD/Traits was associated with significantly lower verbal IQ and arithmetic achievement (p < .04), more nonperseverative errors (p < .005), and lower motivation (p < .004). A principal components analysis of selected outcome variables significantly associated with current ADHD/Traits revealed "impaired neurocognition" and "inattention-apathy" factors. The latter factor was a more consistent predictor of current ADHD/Traits in regression analyses. These findings suggest that inattention and apathy are core features of ADHD/Traits after childhood stroke. This association may provide clues towards the understanding of mechanisms underlying the syndrome.
 ...
PMID:Attention deficit hyperactivity disorder and neurocognitive correlates after childhood stroke. 1463 40

Standard gamble (SG) is commonly used to elicit preferences in order to assess health related quality of life. There has been little qualitative research exploring how respondents answer such questions. An SG study was designed to elicit values for the health states associated with anti-hypertensive medication, stroke and cardiovascular disease. This paper describes a qualitative study that was carried out alongside the SG exercise in order to document the thought processes respondents bring to bear in formulating their responses. Data were generated using 'think aloud' techniques and semi-structured interviews. Values were generally well-constructed: responses were thoroughly considered, and respondents made complex trade-offs and arrived at a point of indifference. However, some respondents incorporated inappropriate information into their choices, redefining the hypothetical 'Option B' resulting in problems interpreting the probabilistic information. Consideration of non-health factors was commonplace, in particular the impact of choices on others. We discuss these findings in terms of the use of qualitative methods in health economics and the wider discourse surrounding the theoretical underpinnings of health state valuation.
 ...
PMID:Responses to standard gambles: are preferences 'well constructed'? 1472 92

In the present study we assessed the presence and severity of unconventional affective symptoms (apathy, anhedonia and emotional lability) and depression in 33 elderly patients with first ever stroke and evidence of a single supratentorial lesion at neuroimaging. Patients were submitted to neurological, functional, and affective assessment at a mean interval of 2 weeks after stroke onset. Given the putative role of the frontal lobes in the pathogenesis of these symptoms, we also performed a cognitive assessment focused on executive functions. The prevalence of the various affective symptoms was as follows:apathy 15.2 %, anhedonia 6.1 %, emotional lability 48.5 %, depression 57.6 % of cases. Patients had a normal global cognitive level (mean short portable mental status questionnaire: 8.4 +/- 1.0, range 7-10). Apathy and anhedonia showed significant reciprocal correlations and they were also correlated with the executive score and the Barthel index;apathy was also correlated with depression; emotional lability, instead, was correlated only with depression. The study of possible anatomo-functional correlates between unconventional affective symptoms and lesion site did not show significant differences (stroke in the right versus left hemisphere, anterior versus posterior and cortical versus subcortical locations).
 ...
PMID:Unconventional affective symptoms and executive functions after stroke in the elderly. 1520 29

Patients who have had stroke are at significant risk for various neuropsychiatric illnesses. The most common and important of these are poststroke depression and poststroke dementia (attributable to vascular dementia, Alzheimer's dementia, or a combination of mechanisms). Poststroke neuropathology may lead some patients to experience concurrent and "overlapping" mood and cognitive symptoms. Less frequently, poststroke anxiety disorders, psychosis, isolated pathologic expressions of emotions, and apathy or fatigue may be encountered. The authors review the current literature on poststroke neuropsychiatry and offer an integrated approach to pathophysiologic concepts and clinical surveillance, screening, diagnosis, and evidence-based pharmacologic and nonpharmacologic intervention for these clinical problems on the clinical boundary between neurology and psychiatry.
 ...
PMID:Poststroke Neuropsychiatric Illness: An Integrated Approach to Diagnosis and Management. 1527 61

When psychological and behavioral disorders of Alzheimer's disease appear suddenly, somatic, iatrogenic and reactive or relational psychological causes must be ruled out or treated before concluding that the cause is lesional. Non-pharmacological interventions should be privileged for the prevention and management of behavioral manifestations of mild to moderate intensity: psychological support of the patient (short therapies), training the caregiver, work on daily habits, reorganization of the home, behavioral measures against apathy and especially agitation, rehabilitation strategies, and therapy involving music, light, aromas, etc. Pharmacological therapies are only moderately effective in these disorders. They must be targeted and follow a sequence of prescription that maximizes tolerance and distinguishes treatment of acute and chronic states. Anticholinesterase agents may be useful in this domain to prevent or ease some symptoms (especially apathy). The efficacy of memantine must be confirmed by additional data. Some selective serotonin reuptake inhibitors agents may be useful not only in depression but also anxiety, emotional disturbances, irritability and compulsiveness. Atypical neuroleptics are better tolerated than the classic ones. They are most effective in this context but must be reserved for specific indications and limited in time because of the increased risk of stroke. Other psychotropics (benzodiazepines, carbamates, antiepileptics) should be used cautiously in this context.
 ...
PMID:[Treatment of the psychological and behavioural disorders of Alzheimer's disease]. 1598 46

The psychopathology of stroke encompasses several psychiatric and behavioral disorders that have high prevalence in the geriatric population, reduce the patient autonomy and increase the caregiver's burden. These disorders are usually associated with other cognitive and neurological deficits, and are labelled as neuropsychiatric when the whole clinical picture is consistent with the specific dysfunction of a neural system or brain region. Thus the neuropsychiatry of stroke comprises disorders of the perception/identification of the self and the environment (anosognosia of hemiplegia, misidentification syndromes, confabulations, visual hallucinations, delirium and acute confusional state), amotivational syndromes (apathy and athymhormia), disorders of emotional reactivity (blunted affect, emotional incontinence, irritability, catastrophic reactions), poor impulse or ideation control (mania) and personality changes. The clinical profile of the subcortical vascular dementia also points to specific brain dysfunction (frontal-subcortical pathways) that manifests with behavioral (depression, emotionalism, irritability) and cognitive symptoms (psychomotor retardation, attention, executive and memory deficits). However, post-stroke depression and anxiety, which have a more variable clinical presentation and might be assimilated, for several aspects, to post-traumatic or adaptive disorders, are disorders less characterized in their neural correlates.
 ...
PMID:[Psychopathology of stroke]. 1631 15

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.
 ...
PMID:Prevalence and clinical correlates of neuropsychiatric symptoms in dementia. 1639 42


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>