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

Depression and apathy are the two most frequent behavioral complications of stroke. This article reviews the prevalence of these conditions in poststroke patients, as well as their clinical correlates, longitudinal course, and possible mediators. A number of controlled clinical trials of the efficacy of various drugs in the treatment of poststroke depression are also reviewed.
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PMID:Apathy and depression following stroke. 1827 28

Stroke is a leading cause of adult disability because of its physical and cognitive consequences. Cognitive changes are important contributors to family caregivers' experiences of emotional distress. To date, measures to assess cognition treat it as a global construct, but it is more likely that unique domains differentially affect family caregivers. The research objectives in this study were to: (1) identify the different domains of cognitive changes in the form of behavioral and psychological symptoms after stroke, and (2) establish the reliability of the Brain Impairment Behavior Scale (BIBS) in measuring cognitive domains. Family caregivers of stroke survivors (N = 300) completed the BIBS as part of cross-sectional and longitudinal studies. A subsample of caregivers completed the BIBS twice, 2 weeks apart, to examine the scale's test-retest reliability. We used exploratory factor analysis to identify four domains of behavioral and psychological symptoms in the BIBS: apathy, depression/emotional distress, comprehension/memory problems, and irritability. Internal consistency for the subscales representing each identified domain ranged from .78 to .91, and the 2-week intra-class correlation coefficients ranged from .75 to .88. Future research and clinical use of this measure will increase our understanding of how specific domains of stroke survivors' behavioral and psychological symptoms affect the well-being of family caregivers.
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PMID:Factor structure and reliability of the brain impairment behavior scale. 1833 Apr 9

Apathy is defined as lack of feeling, emotion, or concern. The objective of this study was to examine the frequency of apathy after a first-ever stroke and to prospectively study the impact of apathy on functional recovery. The patients enrolled in this study had the following characteristics: (i) they had experienced a first ischemic or hemorrhagic stroke; (ii) they ranged from 45 to 90 years of age; (iii) the interval from onset to admission ranged from 21 to 90 days; and (iv) they did not demonstrate either marked dementia or aphasia. The functional status was assessed by the Barthel index and the functional independence measures on admission and after a 3-month rehabilitation period. On the basis of the apathy scale, the patients were grouped into those experiencing apathy and those who did not. Next, the scores of the functional measures in the two groups were compared. A total of 67 patients--38 males and 29 females--were analyzed. Fourteen patients (21%) were diagnosed as being apathetic. The apathetic patients tended to be older and more cognitively impaired than the nonapathetic patients. The severity of neurological deficits, the frequency of depression, and the functional status on admission did not differ substantially in the patients with or without apathy. Although the difference was marginal, apathetic patients showed less improvement in the Barthel index or the subscore of functional independence measures than nonapathetic patients after rehabilitation. Thus, we concluded that apathy is not a rare condition after first-ever stroke and it may impair stroke recovery.
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PMID:Apathy and functional recovery following first-ever stroke. 1900 81

Malignant middle cerebral artery (MMCA) infarction is associated with a mortality rate of 80% under conservative treatment. Decompressive hemicraniectomy (DH) reduces mortality and improves the functional outcome of surviving patients. The purpose of this study was to examine quality of life (QoL) and neurobehavioral deficits in patients with space-occupying infarctions of the right- or left-sided hemisphere at 6 months after stroke. The Sickness Impact Profile (SIP) was used to assess QoL in 19 out of 29 consecutive patients that underwent DH after a malignant MCA infarction (14 on the right and 5 on the left hemisphere). Behavioral changes were evaluated with the Frontal Behavioral Inventory and the Beck Depression Inventory. Patients and relatives were also asked if, knowing the present outcome, they would agree again, in retrospect, to a DH. Barthel Index >60 was seen in 37% of our patients. Functional outcome was related to age. We found a higher reduction in the SIP's physical domain than in the psychosocial domain. Depressive symptoms were present in 50% of the patients. We didn't find significant differences in QoL or functional outcome between patients with right or left-sided infarctions. The most frequent neurobehavioral symptoms were decreased speech output, apathy, reduced spontaneity and irritability. Most patients and their relatives would again give consent to hemicraniectomy. The results show that younger patients had a significantly better outcome. QoL seems to be acceptable in both left- and right-sided infarctions, and retrospective agreement to hemicraniectomy is high in both patients and their relatives.
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PMID:Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. 1928 45

Emotional and behavioral disturbances are a frequent complication in stroke survivors. They are underdiagnosed, have a high impact on quality of life and are often a precipitant of institutionalization. For the caregivers of stroke survivors, these disturbances are a main cause of exhaustion. Health professionals have an insufficient training in their diagnosis and management which demands qualified skills and dedication of a multiprofessional team. In this article, we update some of the most common or relevant poststroke emotional and behavioral disturbances, including poststroke mania and poststroke depression, poststroke anxiety disorders, posttraumatic stress disorder, personality changes with focus on apathy and disturbances of emotional expression control. Significant advances in the management of poststroke emotional and behavioral disturbances will need the use of comparable instruments and methods and multicenter collaboration.
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PMID:Poststroke emotional and behavior impairment: a narrative review. 1934 52

Apathy commonly occurs after acquired brain impairment. It is characterised by impaired initiative, diminished activity, and lack of concern; formally delineated as a decrease in cognitive, behavioural and emotional components of goal-directed activity. The impact is widespread, hampering rehabilitation and outcome. This systematic review identifies and assesses the efficacy of non-pharmacological treatments for apathy following four types of acquired brain impairment (traumatic brain injury, dementia, cerebrovascular accident, encephalitis). Nine databases were searched. Studies were reviewed according to the following criteria: age over 16 years, acquired brain impairment, non-pharmacological intervention for apathy, and data reported on treatment efficacy. The methodological quality of the studies was assessed. Searches yielded 1754 articles, with 28 meeting criteria. Methodological quality ranged greatly. The majority of trials involved the dementia population. Cognitive interventions were the most frequent mode of treatment. For those with severe impairments, the strongest evidence suggested music therapy and for milder impairment, the strongest evidence was for cognitive rehabilitation. This review reveals a need for more high quality, methodologically rigorous treatment studies for apathy, particularly within the milder ranges of impairment. Initially, however, a uniform operational definition needs to be utilised in all research studies to minimise variability. Additionally, employing a standardised outcome measure specific to apathy would greatly enhance comparison among treatments.
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PMID:Apathy after acquired brain impairment: a systematic review of non-pharmacological interventions. 1953 96

Nefiracetam is a novel pyrrolidone-type nootropic compound shown in preliminary trials to increase blood flow and improve patient outlook and energy following stroke. Of 137 stroke patients with major depression, 70 also met published diagnostic criteria for apathy (51.1%) and were randomly assigned either to placebo or 600 mg or 900 mg of nefiracetam per day, and received at least 4 weeks of treatment. Using the group with at least 4 weeks of treatment as the intention-to-treat sample with last observation carried forward, repeated measures analysis of variance of Apathy Scale scores demonstrated a significant time-by-treatment interaction. Patients taking 900 mg nefiracetam had a significantly greater change in Apathy Scale scores compared to 600 mg of nefiracetam or placebo. Future studies should assess whether apathy without depression may respond to this novel treatment.
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PMID:Double-blind treatment of apathy in patients with poststroke depression using nefiracetam. 1962 85

Research addressing positive outcomes one year after stroke has been limited. The sample comprised 125 participants with complete Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Mini-Mental State Examination (MMSE) scale scores at baseline ( approximately 4 months after ischaemic stroke) and at follow-up (1 year later), 31 persons were defined as having a favourable outcome (an MMSE score of >or=28/30 and combined ADL/IADL score equal to 14/14 at follow-up) and 94 as having a poorer outcome. Predictors of a favourable outcome following stroke included being younger, having higher premorbid IQ, no atrial fibrillation, no dementia, less apathy and fewer intercurrent cerebrovascular events. We conclude that people can have good outcomes in the year after stroke except if they experience further cerebrovascular events and/or have risk factors for cerebrovascular disease. Brain reserve appears to be protective.
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PMID:Who does well after a stroke? The Sydney stroke study. 1988 7

We report the case of a patient suffering from sudden apathy and pathological gambling-like behaviour after bilateral ischemic lesions involving the dorsal portion of the head of the caudate nuclei and adjacent anterior limb of the internal capsules. This is the first report of the association of an apathy and abnormal gambling behaviour following a stroke affecting sub-cortical structures. Although the location of the lesions, affecting the dorsal striatum, may explain the emergence of an apathetic state, it is, however, at first sight, not easy to explain the gambling behaviour because the patient was normal in tests evaluating sensitivity to reward, and no radiological abnormality was found in the cortical-sub-cortical system of reward. It is proposed that, for this patient, the mechanism of maladaptive gambling behaviour was the development of a routine behaviour related to the patient's cognitive inertia, a mechanism different from the changes in reward sensitivity observed after damage to the orbital ventral prefrontal-ventral striatum system or in dopamine dysregulation syndrome in Parkinson's disease.
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PMID:"Habit" gambling behaviour caused by ischemic lesions affecting the cognitive territories of the basal ganglia. 2044 19

Depression is the most common psychiatric disorder in neurological disorders such as epilepsy, multiple sclerosis, stroke, and Parkinsons disease. It is associated with reduction of quality of life, functional impairment, and higher mortality. The diagnosis of depression in neurological disorders is difficult because of the overlapping symptoms. Neurological disorders are usually associated with sleep and appetite disturbances, fatigue, apathy, and lack of concentration, which is similar to those of depression. The etiology of depression with neurological disorders is unknown, but the interaction between biological, psychosocial, and neuropathological factors could be responsible for it. Few controlled trials have been carried out to investigate the efficacy of psychotherapeutic and pharmacological interventions in this population, and it seems that they are effective in improving depression, quality of life, and survival. Studies pertaining to prevention of depression in neurological disorders are promising.
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PMID:Depression and neurological disorders. 2104 20


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