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

Post-cerebrovascular accident depression (PCVAD) affects 30 to 50% of hemiplegic patients in the first two years post-CVA, and has major physical and social repercussions. Particularly closely studied since the beginning of the eighties, PCVAD is considered a therapeutic entity in its own right by many authors. The clinical picture is one of melancholia in 5 to 25% of cases, and of minor or masked depression (with psychomotor retardation and somatic disorders predominating) in 75 to 95% of cases. Etiopathogenesis varies depending on post-CVA period: during the first few months, the depletion of intra-cerebral neurotransmitters is considered to play a dominant role; subsequently, difficulty in coping with the handicap would appear to be the main factor. The diagnostic scales which may be used are CIM 10 or DSM IV. For quantification, Hamilton's, the MADRS, Zung's or the CESD scales may be used. There is as yet no scale specific to PCVAD. The therapeutic approach still remains empirical, due to the rarity of published studies. Tricyclic antidepressants and inadvisable as first-line treatment due to their anticholinergic effects. Serotoninergic agents are well tolerated, but their efficacy is currently insufficiently documented, despite a recent study. Electroconvulsive therapy (ECT) has been tried, with a certain degree of success, by some authors, but no controlled study is currently available. Personal and familial psychological management would appear necessary but this has not yet been validated. In a preliminary, open-label study in 15 patients presenting with PCVAD, the authors obtained normalization of the MADRS in 10 cases following 6 weeks of treatment with fluoxetine (Prozac). No adverse effects were observed. A multicenter, controlled study is currently ongoing in Bordeaux, France.
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PMID:[Post-cerebrovascular stroke depression]. 933 62

Thirteen patients resuscitated after circulatory arrest due to cardiopulmonary aetiologies were studied with regard to survival and outcome. Exclusion criteria were known central nervous system disorders or death secondary to cerebrovascular accident. The serum level of neuron-specific enolase (NSE), presumably a reliable marker of neuronal death, was measured by enzyme immunoassay in peripheral blood samples over the course of 4 days at 12 h intervals. On the first and third day post-resuscitation, median nerve somatosensory evoked potentials (SSEPs) were recorded and evaluated for the absence of the cortical potential--presently the standard approach for assessing prognosis in terms of post-resuscitation hypoxaemic brain damage. Absent cortical potentials were found in six patients with NSE levels above 140 micrograms l-1. Five of these patients died; one patient survived with loss of cortical functioning. Five patients had normal SSEP findings, and their NSE maximum levels were below 25 micrograms l-1. All five patients survived without neurological deficits. One patient with a peak NSE level of 36 micrograms l-1 on the second day developed a prolonged delirium (according to DSM III-R criteria) and one patient with a peak level of 76 micrograms l-1 on the fourth day developed an acute respiratory distress syndrome; both patients had preserved cortical potentials. In conclusion, pathological SSEPs and increased NSE levels are of comparable prognostic value. They may well be complementary investigations. The neuron-bound enzyme NSE is a biochemical marker which varies with the extent of neuronal damage, while absence of the cortical potentials may indicate neurophysiological loss of function.
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PMID:A comparison of the prognostic value of neuron-specific enolase serum levels and somatosensory evoked potentials in 13 reanimated patients. 942 76

In a prospective study of more than 200 cases of dementia and 119 controls, annual technetium-99m-hexamethyl-propylene amineoxime (99mTc-HMPAO) single-photon emission computed tomography (SPECT) and annual medial temporal lobe (MTL) oriented X-ray computed tomography (CT) have been used to evaluate the diagnostic potential of functional and structural neuroimaging in the differential diagnosis of dementia. Some subjects have had up to 7 annual evaluations. So far, of 151 who have died, 143 (95%) have come to necropsy. Histology is known for 118, of whom 80 had Alzheimer's disease (AD), 24 had other "non-AD" dementias, and 14 controls with no cognitive deficit in life also had no significant central nervous system pathology. To compare the findings in the dementias with the profile of structural and functional imaging in the cognitively normal elderly, scan data from 105 living, elderly controls without cognitive deficit have also been included in the analysis. All clinical diagnoses were according to National Institute of Neurological and Communicable Disease and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R) criteria, and all histopathological diagnoses according to the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) criteria. Early data from this cohort have suggested that the combination of both MTL atrophy seen on CT with parietotemporal hypoperfusion on SPECT may predict the pathology of AD. The diagnostic sensitivity, specificity, accuracy, and positive and negative predictive values of the NINCDS-ADRDA and DSM-III-R criteria could be assessed in this cohort against the gold standard of histopathology. The diagnostic potential of CT evidence of MTL atrophy alone, SPECT evidence of parietotemporal hypoperfusion alone, and the combination of both of these scan changes in the same individual could then be compared against the diagnostic accuracy of clinical operational criteria in the pathologically confirmed cases. Furthermore, all of these modalities could be compared with the diagnostic accuracy of apolipoprotein E4 (Apo E4) genotyping to predict AD in the histopathologically confirmed cohort. In this population, NINCDS "probable-AD" was 100% specific, 49% sensitive, and 66% accurate; "possible-AD" was only 61% specific, but 93% sensitive and 77% accurate; and the combination of both "probable-AD" and "possible-AD" was 61% specific, 96% sensitive, and 85% accurate. DSM-III-R criteria were 51% sensitive, 97% specific, and 66% accurate. In the same cases and including the 105 living, elderly controls, the diagnostic accuracy of the Oxford Project to Investigate Memory and Aging (OPTIMA) scanning criteria showed CT alone to be 85% sensitive, 78% specific, and 80% accurate; SPECT alone had 89% sensitivity, 80% specificity, and 83% accuracy; and the combination of the two was 80% sensitive, 93% specific, and 88% accurate. The Apo E4 genotype was 74% sensitive but yielded 40% false positives in the histologically confirmed series. The diagnostic accuracy afforded by this method of CT and SPECT used alone is better than that of any established clinical criteria and reveals that the combination of MTL atrophy and parietotemporal hypoperfusion is common in AD, much less common in other dementias, and rare in normal controls. In the NINCDS-ADRDA criteria "possible-AD" cases, the combination of CT and SPECT findings alone were better in all diagnostic indices than the presence of Apo E4 alone in predicting AD. The frequent occurrence of MTL atrophy in AD and also in other "non-AD" dementias later in the course of the disease suggests the concept of medial temporal lobe dementia. This could explain some of the overlap of clinical profiles in the dementias, particularly as the dementia progresses, making clinical differential diagnosis difficult. In this context, the use of SPECT can significantly e
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PMID:Accurate prediction of histologically confirmed Alzheimer's disease and the differential diagnosis of dementia: the use of NINCDS-ADRDA and DSM-III-R criteria, SPECT, X-ray CT, and APO E4 medial temporal lobe dementias. The Oxford Project to Investigate Memory and Aging. 978 48

Dementia is a rapidly increasing health problem in the industrialized countries. With the ageing of the population the number of demented persons increases both in relative and absolute terms. Obviously, there is a need for prevention and intervention strategies. We describe the methods and baseline findings of a large study aimed at identifying potentially modifiable vascular, thrombogenic, and metabolic determinants of dementia. The study population consists of subjects 55 years of age or older. Since the vascular wall of the cerebral vessels is different from that of the coronary or peripheral vessels, we formed three subgroups in which vascular risk factors for dementia are studied. Subjects with stroke were distinguished from subjects with coronary or peripheral artery disease, and from subjects without stroke or coronary or peripheral artery disease. To obtain a large enough number of subjects with stroke, cases and controls from a stroke registry were combined with cases and controls of a population-based study from the same region. For the diagnosis of dementia the DSM-III-R criteria were used. Extensive information on cardiovascular risk factors was collected, including indicators of atherosclerosis. Blood and urine were sampled to study platelet function and thrombogenic and metabolic factors. The study population consists of 7,466 subjects, of whom 300 were recruited from a hospital-based stroke registry. Coronary or peripheral artery disease was present in 956 subjects and stroke in 617. Dementia was present in 434 (5.8%) of all subjects. The prevalence of dementia was 3.0, 24.0, and 4.4% in subjects with a history of coronary or peripheral artery disease, a history of stroke, and subjects without a history of coronary or peripheral artery disease or stroke, respectively. The study will allow us to investigate the role of vascular factors in dementia, irrespective of its cause.
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PMID:The Dutch Vascular Factors in Dementia Study: rationale and design. 945 26

Many efforts have been made to trace the causes of Alzheimer's disease (AD). There are, however, many points of controversy among reports from the same country as well as among reports from different countries. The current study is a case-control study to determine the risk factors in the development of AD in Greece. Sixty-five patients with AD and 69 age-matched controls were examined. All patients with AD fulfilled the DSM-IV criteria for AD and NINCDS-ADRDA criteria for probable AD. Demographic characteristics such as gender, current marital status, who he/she is living with, education, main place of residence in childhood, adulthood, and late life, occupational hazards, patient's medical history (history of diabetes mellitus and hypertension), life habits like alcohol consumption and smoking, and a history of head trauma, heart attack, stroke, parkinsonism, or depression were collected from the subject or from an informant. A family history of selected diseases (hypertension, diabetes mellitus, dementia, Parkinson's disease, Down's syndrome, stroke) was also elicited. Ages of father and mother at birth were also recorded. Chi-square test, Kruskal-Wallis analysis of variance, cluster analysis, and logistic regression analysis were used for statistical analysis. The results (chi-square test) showed a statistically significant difference between patients with dementia of the Alzheimer type and controls as far as marital status (p = .04), the subject's history of major depressive episode (p = .02), and family history of dementia (p = .002) were concerned. Logistic regression analysis results produced a complex model of family aggregation of dementia, with patients with a history of depression and family history of dementia having an up to seven times higher risk of developing AD. These findings, especially a family history of dementia, are consistent with most of the literature.
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PMID:Risk factors for clinically diagnosed Alzheimer's disease: a case-control study of a Greek population. 951 31

In this article the authors describe two different ways in which the relationship between affective disorders and cerebrovascular disease can be studied. First, the occurrence of so called 'post stroke depression' offers an opportunity to study this relationship. Second, neuroradiological investigations in patients with a major depressive disorder can be performed. The authors review the literature on both subjects. Until now, unequivocal conclusions concerning vascular lesions on CT or MRI and depressive features in the elderly cannot be drawn from research data available. Moreover, the so-called Post-stroke depression is still not fully understood. Some difficulties encountered in this area of research are also addressed. The authors suggest a neurological cause for the late onset types of major depressive illness and also suggest that these depressions are phenomenologically different from the early onset subtypes of depressive illness. The post stroke depression also seems to differ phenomenologically from major depression according to DSM-criteria.
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PMID:[Cerebrovascular lesions and depression]. 952 96

The study of discrete organic cerebral lesions resulting in clearly definable psychiatric disorders may provide an understanding of the underlying pathophysiological basis of these disorders. However, the relation between lesion location and psychiatric illness after stroke remains unclear. Fifty five patients referred to hospital were identified who had a single lesion on CT which was consistent with their neurological presentation and who did not have evidence of a persistent affective disorder at the time of the stroke. Six months after stroke standardised psychiatric assessment disclosed that 26% of the patients met DSM-IV criteria for an anxiety or depressive disorder, with depression the most common diagnosis (20%). Pathological emotionalism was diagnosed in 18% of patients, particularly those who were depressed (p<0.0001). Depression was significantly associated with larger lesions involving the right cerebral hemisphere (p=0.01). The importance of depression as a consequence of stroke has been clarified by the studies in this area. However, wide confidence intervals support the possibility that significant results may be due to chance. A systematic review of these studies is now needed if a consensus is to be reached.
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PMID:Depression and its relation to lesion location after stroke. 952 52

The effect of social functioning and depression on recovery from stroke was examined in 142 patients with acute stroke who were followed over 2 years. Examination included a semistructured mental status examination, the Social Functioning Examination (SFE) and diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) symptom criteria for major and minor depressive disorders. At short-term follow-up (3 to 6 months), both impairment in social functioning and depression were related to impaired recovery in activities of daily living and cognitive functioning. On the other hand, at long-term follow-up (1 to 2 years), only depression influenced recovery from physical impairment. In addition, we found no significant interaction between depression and social impairment on activities of daily living or social functioning. These data suggest that both depression and impaired social function have independent negative effects on physical recovery from stroke. These data also suggest that treatment of depression as well as early psychosocial intervention may play an important role in the quality of life after acute stroke.
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PMID:The relationship between social impairment and recovery from stroke. 970 98

To examine the correlates of dependent living after ischemic stroke, a consecutive cohort of 486 patients aged 55-85 years was examined 3 months after the index stroke. Detailed medical, neurological and radiological stroke evaluation, structured measures of cognition, emotion and behavior, activities of daily living (ADL), physical disability, and assessment of dependent living were performed. Independent correlates of dependent living 3 months after stroke were the presence of the major hemispheral stroke syndrome (odds ratio, OR, 11.8, 95% confidence interval, CI, 7.2-19.9), and a combination of handicap (Rankin Scale, OR 3.9, 95% CI 2.6-6.1), cognition (DSM-III-R dementia, OR 3.9, CI 1.5-10.7, any cognitive decline, OR 4.5, CI 2.0-11.2), and ADL [Functional Activities Questionnaire (FAQ), OR 1.2, 95% CI 1.1-1.2]. The Rankin Scale explained 51.5%, FAQ 5.9% and presence of DSM-III-R dementia or any cognitive decline 3.4% of the total variance between dependent and independent patients after stroke. Independent of the effects of physical disability, presence of cognitive impairment has important functional consequences on stroke patients. Our findings emphasize the importance of the evaluation of cognitive functions in both observational and interventional clinical trials, as well as in treatment planning, rehabilitation and guidance of patients with ischemic stroke.
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PMID:Correlates of dependent living 3 months after ischemic stroke. 971 23

This study was designed to assess the return to work, the poststroke depression and the quality of life after a cerebral infarction in young adults and was conducted on 71 consecutive young patients (aged 15-45 years) affected by a cerebral infarct who were hospitalized for the first time and discharged at least 1 year before the study. Data about risk factors, etiology, side and territory of stroke, social characteristics of the patient (age, sex, profession, educational level, family situation), poststroke seizures, recurrent stroke, other vascular events, and deaths were collected. Neurological deficits were graded with the National Institutes of Health (NIH) Stroke Scale. Poststroke depression (PSD) was quantified using the DSM-IIIR criteria and the Montgomery Asberg Depression Rating Scale. Outcomes were rated with the Ranking Scale, the Barthel Index and the Glasgow Outcome Scale. Quality of life was assessed with the Sickness Impact Profile. Follow-up information was obtained by interview and neurological examination. Follow-up information was obtained in 65 patients at a mean of 31.7 +/- 13.0 (range 12-59) months, as 2 patients died and 4 were lost to follow-up and were thus excluded from this study. Poststroke seizures occurred in 7 patients (10.8%) and recurrent strokes in 4 patients (6.2%), but none were fatal. The outcome after stroke among survivors was usually good, since more than two-thirds of the patients (69.8%) reported no problem, 11.1% moderate handicap and one-fifth major handicap. Forty-six patients (73%) returned to work: the time period ranging from several days after stroke to 40 months, with a mean of 8 months. However, adjustments in their occupation were necessary for 12 patients (26.1%). PSD was common, since 48.31% of the patients were classified as depressed. PSD was associated with the localization of the infarct (carotid territory), a severe disability, a bad general outcome, and an absence of return to work. Their opinion about their quality of life was negative among approximately 30% of the patients, especially in emotional and alertness behaviors. social interaction, recreation and pastimes. The general outcome after cerebral infarct in young adults is usually good. However, the risk of a PSD is high, and only half of the patients had returned to their previous work. A remaining psychosocial handicap and depression of sexual activity impaired the quality of life. In multivariate analysis, a low NIH score at admission is a significant predictor for return to work, the absence of PSD, and a good quality of life.
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PMID:Functional recovery and social outcome after cerebral infarction in young adults. 971 28


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