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

The Clock Drawing Test (CDT) is a recognized and accepted instrument for the early diagnosis of dementia in the elderly. In a prospective study we evaluated the association between the results of this test and a broad range of clinical, functional and sociodemographic variables. The study was conducted on elderly patients hospitalized for rehabilitation following stroke or hip fracture (HF) in the geriatric ward of a university hospital in southern Israel. The administration of the CDT and its scoring system were adapted from Sunderland et al. and Wolfe-Klein et al. The study was conducted on all 425 elderly patients who were hospitalized during the study period and who were capable of completing the test. Stepwise multiple regression was used to evaluate the association between the results of the CDT and the other variables. The mean CDT score (+/- SD) for the entire study population was 7.8 +/- 2.5 and 145 patients (34%) had scores of 6 or below. Of the 41 variables that were tested, significant associations with the CDT were found for the following four variables only: the Folstein minimental test (beta = 0.447, p < 0.0001), the cognition value from the admission FIM (beta = 0.252, p < 0.0001), years of education (beta = 0.183, p = 0.0001), and the patient's age (beta = -0.075, p = 0.037). The total variance of the CDT explained by these four variables (Adjusted R2) was 0.554. We conclude that in the study population there was a significant proportion of patients with low CDT scores. This score, in this population, is influenced in particular by two other measures of cognitive function and by the formal level of education, together with a weaker effect of age.
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PMID:Factors affecting the results of the clock drawing test in elderly patients hospitalized for physical rehabilitation. 1038 34

We examined six clock-drawing task (CDT) scoring systems relative to the Executive Interview (EXIT25, a measure of Executive Control Function [ECF]) and the Mini-Mental State Exam (MMSE). Subjects included n = 33 National Institute of Neurological, Communicative Disorders, and Stroke "probable" Alzheimer's disease (AD) cases and n = 52 independent living controls. AD cases and controls differed on the EXIT25, MMSE, and all CDTs. All CDTs were significantly correlated with the EXIT25 (ranging from r = .56 to r = .78). These associations generally persisted after adjusting for Age, Education, and MMSE scores. In backwards stepwise linear multivariate regression models, only CLOX: An Executive Clock-Drawing Task scores contribute significantly to EXIT25 scores (R2 = .68) and MMSE scores (R2 = .72). Clock drawing draws upon both executive and general cognitive resources. CLOX explains incrementally more variance in ECF than other CDTs.
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PMID:Clock drawing is sensitive to executive control: a comparison of six methods. 1054 25

Many 'first generation' African Caribbean residents in the UK have now reached ages where risk of cognitive impairment and dementia starts to increase. In addition, conditions which may impair cognitive function, such as hypertension, diabetes and stroke, have high prevalence rates in African Caribbean populations. However, there is a lack of normative data for cognitive tests in this ethnic group. Cognitive assessment was carried out in a south London community population of 285 African Caribbean participants aged 55-75 years. Tests were drawn principally from the consortium to establish a registry for Alzheimer's disease (CERAD) battery (Boston Naming Test, verbal fluency, word list recall, and Trailmaking Tests A and B) and also included orientation items from the Mini-Mental State Examination (MMSE) and the Clock Drawing Test. Independent effects of age, sex, education and occupation were identified on scores for most but not all cognitive tests. Compared with normative data for African American populations, lower scores on verbal fluency and the Boston Naming Test were observed but scores on memory tests were comparable. Normative data for the tests are presented, stratified by level of education.
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PMID:Cognitive function in UK community-dwelling African Caribbean elders: normative data for a test battery. 1137 69

This study demonstrates the reliability of 3 Clock Drawing Test (CDT) scoring systems when applied to the protocols of stroke patients. The sample included 20 randomly selected sets of both freehand and predrawn circle versions ofthe CDT completed by patients undergoing comprehensive stroke rehabilitation. The protocols were scored independently by 2 raters using each of 3 published scoring systems (Freedman et al., 1994; Libon, Malamut, Swenson, Sands, & Cloud, 1996; Rouleau, Salmon, Butters, Kennedy, & McGuire, 1992). Interrater agreement and intrarater consistency were measured using the intraclass correlation coefficient (ICC). The results demonstrate that the raters used comparable criteria for each score (high interrater reliability) and that each applied similar scoring criteria throughout the set of protocols (high intrarater consistency). Scores related to the overall contour of the clockface tended to have lower ICCs. Reliability coefficients were comparable for both CDT versions. The results provide evidence for the accurate and consistent scoring of the CDT in stroke.
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PMID:Interrater reliability of three clock drawing test scoring systems. 1168 53

The utility of the Clock Drawing Test (CDT) in localizing lesions has not been thoroughly examined to date. In the present study, six scoring systems (Freedman et al., 1994; Ishiai, Sugishita, Ichikawa, Gono, & Watabiki, 1993; Mendez, Ala, & Underwood, 1992; Rouleau, Salmon, Butters, Kennedy, & McGuife, 1992; Sunderland et al., 1989; Tuokko, Hadjistavropoulos, Miller, & Beattie, 1992; Watson, Arfken, & Birge, 1993; Wolf-Klein, Silverstone, Levy, & Brod, 1989) were used to assess clock drawings by 76 stroke patients and 71 normal controls. Significant differences were found between normals and stroke patients on all scoring systems for both quantitative and qualitative features of the CDT. Quantitative indices were not helpful in differentiating between various stroke groups (left versus right versus bilateral stroke; cortical versus subcortical stroke; anterior versus posterior stroke). Qualitative features were helpful in lateralizing lesion site and differentiating subcortical from cortical groups. Correlational analyses revealed that CDT performance was related to visuospatial processing and measures commonly used in cognitive screening.
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PMID:Quantitative and qualitative performance of stroke versus normal elderly on six clock drawing systems. 1459 Jun 33

In the summer of 2000, an outbreak of WNF affected Israel. Thirty-two elderly patients were admitted to Meir Hospital. WNF encephalitis may result in residual functional damage. However, little information is available regarding the rehabilitation of these patients. Five elderly subjects with residual functional damage were referred to geriatric rehabilitation. Patients were treated with the routine program for neurological rehabilitation after stroke, including daily physiotherapy and occupational therapy. All five were over 77 years and independent before admission. The mean FIM score on admission was 71 (S.D. = +/-8.5) and increased to 102 (S.D. = +/-14) on discharge. MMSE on admission was 60% (S.D. = +/-7.5%), and increased to over 90% on discharge in all of the patients. Clock Completion Test was normal in four on admission, and improved to normal in the fifth patient on discharge. WNF encephalitis may present with functional and intellectual impairment in the elderly. Routine geriatric neurological rehabilitation may benefit those with prolonged functional decline.
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PMID:Rehabilitation of West Nile Fever (WNF) encephalitis in elderly. 1591 Oct 34

The diurnal variation in the incidence of myocardial infarction and stroke may reflect an influence of the molecular clock and/or the time dependence of exposure to environmental stress. The circadian variation in blood pressure and heart rate is disrupted in mice, Bmal1(-/-), Clock(mut), and Npas2(mut), in which core clock genes are deleted or mutated. Although Bmal1 deletion abolishes the 24-h frequency in cardiovascular rhythms, a shorter ultradian rhythm remains. Sympathoadrenal function is disrupted in these mice, which reflects control of enzymes relevant to both synthesis (phenylethanolamine N-methyl transferase) and disposition (monoamine oxidase B and catechol-O-methyl transferase) of catecholamines by the clock. Both timing and disruption or mutation of clock genes modulate the magnitude of both the sympathoadrenal and pressor but not the adrenocortical response to stress. Despite diurnal variation of catecholamines and corticosteroids, they are regulated differentially by the molecular clock. Furthermore, the clock may influence the time-dependent incidence of cardiovascular events by controlling the integration of selective asynchronous stress responses with an underlying circadian rhythm in cardiovascular function.
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PMID:Circadian variation of blood pressure and the vascular response to asynchronous stress. 1736 Jun 65

Arterial pressure (AP), heart rate (HR), and cardiovascular diseases, including ischemic heart attack and cerebrovascular accident, show diurnal variation. Evidence that circadian-related genes contribute to cardiovascular control has been accumulated. In this study, we measured the AP and HR of Clock mutant mice on the Jcl/ICR background to determine the role of the Clock gene in cardiovascular function. Mice with mutated Clock genes had a dampened diurnal rhythm of AP and HR, compared with wild-type control mice, and this difference disappeared after adrenalectomy. The diurnal acrophase in both mean arterial pressure and HR was delayed significantly in Clock mutant mice, compared with wild-type mice, and this difference remained after adrenalectomy. Clock mutant mice had a lower concentration of plasma aldosterone, compared with wild-type mice. Our data suggest that the adrenal gland is involved in the diurnal amplitude, but not the acrophase, of AP and HR, and that the function of the Clock gene may be related to the nondipping type of AP elevation.
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PMID:Diurnal amplitudes of arterial pressure and heart rate are dampened in Clock mutant mice and adrenalectomized mice. 1840 80

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.
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PMID:[Cognitive disturbances in patients with arterial hypertension]. 1845 93

The association between obesity, other cardiovascular risk factors, and cognitive function in a Canadian First Nations population was investigated using a cross-sectional design. Eligible individuals were aged >/=18 years, without a history of stroke, nonpregnant, with First Nations status, and who had undergone cognitive function assessment by the Clock Drawing Test (CDT) and Trail Making Test Parts A and B. Parts A and B were combined into an Executive Function Score (TMT-exec). Hypertension, a previous history of cardiovascular disease, dyslipidemia, metabolic syndrome, insulin resistance, and the presence and duration of diabetes were examined in addition to obesity. In the case of TMT-exec only, obese individuals were at an approximately fourfold increased risk for lowered cognitive performance compared to those who were not obese in multivariable models (odds ratio (OR): 3.77, 95% confidence interval (CI): 1.46-9.72) whereas there was no effect for overweight individuals compared to those with a normal weight in unadjusted analysis. Those having an increased waist circumference also had 5 times the risk compared to those without an increased waist circumference (OR: 5.41, 95% CI: 1.83-15.99). Adjusted for age, sex, and insulin resistance, individuals having the metabolic syndrome were at an approximately fourfold increased risk compared to those without the metabolic syndrome (OR: 3.67, 95% CI: 1.34-10.07). No other cardiovascular risk factors were associated. Obesity and metabolic syndrome were associated with lowered cognitive performance. These results highlight the importance of studying the health effects of obesity beyond traditional disease endpoints, even in a relatively youthful population.
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PMID:Obesity and lowered cognitive performance in a Canadian First Nations population. 1947 88


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