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

In a community-based study of stroke survivors, we identified 73 consecutive patients with a stroke, the first ever in a lifetime, who had a CT scan which showed a neurologically appropriate single stroke lesion, and who did not have a psychiatric disorder in the year preceding the stroke. A detailed follow-up study of these patients using standardized psychiatric assessments failed to confirm a number of recent claims about poststroke depressive disorders. We found no evidence that left-sided lesions were associated with more severe or persistent depressive symptoms, or that right-sided lesions were associated with hypomania. The DSM III syndrome of major depression was much less common than has previously been reported, and was not specifically associated with lesions placed anteriorly in the left hemisphere. There was a weak correlation between mood symptom scores and the proximity of the stroke lesion to the frontal pole of the hemisphere, but no evidence of a difference between right and left hemisphere strokes in the nature of the relationship between lesion distribution and mood symptoms. We suggest that previous studies have different findings because of differences in the conventions applied to the definition and measurement of psychiatric disorders after stroke, and because other studies have concentrated on selected inpatient populations.
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PMID:Mood disorders after stroke and their relation to lesion location. A CT scan study. 239 85

The relation between carotid blood flow measured by Doppler spectrum analysis and brain atrophy on computed tomography (CT) was studied in 22 subjects with multiple lacunar cerebral infarctions. The subjects were divided into two groups, 7 patients with multi-infarct dementia (MID) (mean age 73 years) and 15 nondemented lacunar stroke subjects (NDLS) (mean age 66 years), according to DSM III criteria. All subjects had a score of 7 points or more on Hachinski's ischemic score and showed no carotid artery stenosis. Systolic peak frequency of the common carotid artery (CCA) was measured by Doppler spectrum analysis (Angioscan II). Brain atrophy was measured quantitatively on CT images by two-dimensional measurement using a digitizer. Peak frequencies were lower in MID than in NDLS. Brain atrophy was more severe in MID than in NDLS. There was a significant correlation between peak frequencies and brain atrophy in all subjects. These results indicate that CCA blood flow may reflect brain function in patients with multiple lacunar infarctions.
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PMID:Correlation between carotid blood flow and brain atrophy in patients with multi-infarct dementia. 253 Nov 10

Seventy elderly patients meeting the DSM-III criteria for delirium were examined during the acute stage and followed up to one year. The mean age of the patients was 75 years (range 60-88), their delirium lasted on average 20 days (range 3-81) and the psychiatric hospitalization on average 30 days (range 8-365). The most common etiologies for delirium were stroke, infections and metabolic disorders. For 57 cases (81%) a predisposing structural brain disease was found. During the index admission, the cognitive dysfunction associated with delirium ameliorated significantly (the mean +/- SD Mini-Mental State Examination score 9.7 +/- 6.6 at admission and 13.9 +/- 7.2 at discharge; P less than 0.001), but during the one-year follow-up progression of the basic central nervous system disease was seen together with declining cognition and deterioration of functions of daily living.
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PMID:Delirium among elderly persons admitted to a psychiatric hospital: clinical course during the acute stage and one-year follow-up. 276 53

Using magnetic resonance imaging and digitized brain computed tomography, we evaluated 33 elderly patients with documented lacunar stroke and divided them into three groups (nondemented, n = 15; borderline, n = 9; and demented, n = 9) by neuropsychological assessments and DSM III criteria. We evaluated the extent of white matter lesions and the degree of atrophy of specific anatomic structures, such as the corpus callosum, using magnetic resonance imaging and quantified the volumes of the ventricles, the subarachnoid spaces, and the brain parenchyma using digitized brain computed tomography. Our results show that both borderline and demented patients had significantly more extensive white matter lesions than nondemented patients, indicating a significant relation between the extent of white matter lesions and intellectual decline. In addition, borderline and demented patients had significantly larger ventricles and more brain atrophy than nondemented patients; demented patients also had significantly larger subarachnoid spaces than nondemented patients and more brain atrophy than borderline patients. Our findings suggest that in most patients with lacunar stroke, periventricular and subcortical white matter lesions with subsequent white matter atrophy first induce ventricular enlargement, followed by generalized brain atrophy, resulting in dementia.
Stroke 1989 Nov
PMID:A radiologic study of dynamic processes in lacunar dementia. 281 83

The number (Bmax) and affinity (Kd) of platelet-tritiated imipramine binding sites was determined in young and middle-aged controls 50 years of age and younger (n = 25), elderly normal controls over 60 years of age (n = 18), patients who fulfilled DSM-III criteria for major depression who were under 50 years of age (n = 29), patients who fulfilled DSM-III criteria for major depression who were 60 years of age and older (n = 19), and patients who fulfilled both DSM-III criteria for primary degenerative dementia and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease (n = 13). Both groups of depressed patients (under 50 and over 60 years of age) exhibited significant reductions (decreases 42%) in the number of platelet-tritiated imipramine binding sites with no change in affinity, when compared with their age-matched controls. There was little overlap in Bmax values between the elderly depressed patients and their controls. The patients with probable Alzheimer's disease showed no alteration in platelet-tritiated imipramine binding. There was no statistically significant relationship between postdexamethasone plasma cortisol concentrations and tritiated imipramine binding. These results indicate that platelet-tritiated imipramine binding may have potential utility as a diagnostic adjunct in geriatric depression, and moreover that the reduction in the number of platelet-tritiated imipramine binding sites is not due to hypercortisolemia.
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PMID:Marked reduction in the number of platelet-tritiated imipramine binding sites in geriatric depression. 284 32

The present study examines the sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale (CES-D) as a screening instrument for post-stroke depression. Eighty stroke patients were evaluated by a research nurse over a two-year period using the CES-D and also by a trained psychiatrist using a standardized interview for affective, cognitive, physical and social functioning. CES-D scores correlated significantly with DSM-III diagnoses of depression in-hospital and at three months, six months, and one year follow-up but not at two years follow-up, reflecting the natural course of these depressions, as well as the predictive validity of the CES-D. Furthermore, at a cut-off point of 16, the CES-D was found to have a specificity of 90 percent, a sensitivity of 86 percent and a positive predictive value of 80 percent and thus may be a potentially useful screening instrument for post-stroke depression.
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PMID:The sensitivity and specificity of the Center for Epidemiologic Studies Depression Scale in screening for post-stroke depression. 317 80

As part of a prospective study of mood disorders in stroke patients, interviews were obtained from 37 patients at 1 year and 48 patients at 2 years follow-up. In-hospital evaluations for these 65 follow-up patients found that 9 patients (14%) had symptom clusters of major depression, 12 patients (18%) had symptom clusters of dysthymic or minor depression, and 44 patients (68%) did not meet the DSM III diagnostic criteria for depression. Although overall prevalence of depression did not change significantly over time, the prognosis for individual patients, depending on diagnostic group, was different. All of the follow-up patients with major depression in-hospital were improved by 2 years, with a significant reduction in their mean depression scores and improvement in their activities of daily living, whereas only 30% of follow-up patients with dysthymic depression improved by this time. There was no significant improvement in their mean depression scores or mean activities of daily living score. Of the patients followed up who were not depressed in-hospital, 34% had developed major or minor depression by 2 years, and their mean depression scores were significantly increased. These data suggest that the prevalence of depression among the follow-up patients remains high (between 30 and 40%) for the first 2 years after stroke, but that untreated poststroke major depression has a natural course of about 1-2 years, with associated improvement in activity of daily living scores, whereas the prognosis for poststroke dysthymic depression is frequently unfavorable and often persists for greater than 2 years.
Stroke
PMID:Two-year longitudinal study of poststroke mood disorders: diagnosis and outcome at one and two years. 362 40

The records of 60 patients evaluated psychiatrically for major depression after stroke were reviewed retrospectively. Forty-two patients were treated with one of several "cyclic" antidepressant drugs, and 18 received no drug treatment. Objective ratings, based on current standard criteria for "major depression" (DSM-III), were used to establish degree of depression at initial evaluation and within six weeks after the start of treatment. Overall, improvement in depression was no greater in treated than in untreated patients. However, a subgroup (40%) of drug-treated patients was identified with a substantial (greater than or equal to 40%) improvement in depression ratings. Only three (17%) untreated patients showed a comparable improvement within a similar time period. Eighteen (43%) of the drug-treated patients experienced minor side effects (especially mild sedation), but only three (7%) experienced major side effects that required cessation of treatment. The degree of initial depression was not correlated with the degree of motor or functional disability among patients. These results suggest that antidepressants may constitute safe and effective treatment for some patients with poststroke depression, and further studies of the pathophysiology and treatment of this disorder are indicated.
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PMID:Antidepressant drug treatment for poststroke depression: retrospective study. 367 74

Dexamethasone suppression tests (DSTs) were given to 65 acute and chronic stroke patients. For patients who had had a stroke less than 1 year earlier, nonsuppression on the DST was significantly associated with the presence of poststroke depression. The authors, who used the DSM-III symptom criteria for major depression, found that DST sensitivity was 67% but specificity was only 70%. False positive tests in the stroke patients seemed related to large lesion volume. The DST, although of limited clinical utility in this population because of false positive tests, may help define more homogeneous subtypes of poststroke depression for research.
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PMID:The dexamethasone suppression test and mood following stroke. 397 Feb 68

Twenty six patients with vascular dementia were studied. Five of them only, were referred for a cognitive decline and all the others because of focal neurological symptoms or a stroke. Twelve patients had a previous history of stroke and 21 an history of high blood pressure. Twenty three patients had gait disturbances. CT scanner and MRI showed a large proportion (23 patients) of lacunar or small sub-cortical strokes. Leuko-araiosis was present in 21 patients and cortical stroke only in 6. Finally, the lack of information concerning the onset and the course of the cognitive decline in 12 patients explain the difficulties to fulfill the criteria in some diagnostic evaluation scores particularly those of the DSM III R.
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PMID:[Vascular dementia: clinical and radiological characteristics in 26 cases]. 748 89


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