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

Efficacy of omaron (a combination of piracetam 400 mg and cinnarizin 25 mg) has been studied 3 months after stroke in 90 post-stroke patients. Forty-five patients receiving the basic therapy (antihypertensive and antithrombotic drugs, statins) have been included in the control group and 45 patients of the main group received in addition omaron (1 pill 3 times daily during 2 months). Intensity of neurologic disturbances, degree of disability, cognitive functions assessed by neuropsychological tests (the Mini-Mental State Examination, the Frontal Assessment battery, the Five words test, the Clock drawing test, the Schulte test) and emotional state (the Centre for Epidemiologic Studies Depression scale, the Spilberger scale) have been measured. During the period of the study, none of the patients had stroke or myocardial infarction. The improvement of indices of neurological status, decrease of disability degree and normalization of arterial pressure were found in both groups after 2 months of treatment. The significant improvement (p<0,05) of performance on tests for neurocognitive functions and parameters of emotional state was noted in patients treated with omaron compared to those of the control group. The good tolerability of omaron, absence of serious side-effect in combination with other drugs used for prevention of secondary stroke were reported.
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PMID:[Use of omaron in patients with post-stroke cognitive disorders]. 1967 26

Mammalians circadian pacemaker resides in the paired suprachiasmatic nuclei (SCN) and influences a multitude of biological processes, including the sleep-wake rhythm. Clock genes are the genes that control the circadian rhythms in physiology and behavior. 24h rhythm is demonstrated for the function of physiology and the pathophysiology of diseases. The effectiveness and toxicity of many drugs vary depending on dosing time. Such chronopharmacological phenomena are influenced by not only the pharmacodynamics but also pharmacokinetics of medications. The underlying mechanisms are associated with 24h rhythms of biochemical, physiological and behavioral processes under the control of circadian clock. Thus, the knowledge of 24h rhythm in the risk of disease plus evidence of 24h rhythm dependencies of drug pharmacokinetics, effects, and safety constitutes the rationale for pharmacotherapy. Chronotherapy is especially relevant, when the risk and/or intensity of the symptoms of disease vary predictably over time as exemplified by allergic rhinitis, arthritis, asthma, myocardial infarction, congestive heart failure, stroke, and peptic ulcer disease. Morning once-daily administration of corticosteroid tablet medications results in little adrenocortical suppression, while the same daily dose split into four equal administrations to coincide with daily meals and bedtime results in significant hypothalamus-pituitary-adrenal (HPA) axis suppression. However, the drugs for several diseases are still given without regard to the time of day. Identification of a rhythmic marker for selecting dosing time will lead to improved progress and diffusion of chronopharmacotherapy. To monitor the rhythmic marker such as clock genes it may be useful to choose the most appropriate time of day for administration of drugs that may increase their therapeutic effects and/or reduce their side effects. Furthermore, to produce new rhythmicity by manipulating the conditions of living organs by using rhythmic administration of altered feeding schedules or several drugs appears to lead to the new concept of chronopharmacotherapy. Several drugs cause alterations in the 24h rhythms of biochemical, physiological and behavioral processes. The alteration of rhythmicity is sometimes associated with therapeutic effects, or may lead to illness and altered homeostatic regulation. Attention should be paid to the alteration of biological clock and consider it an adverse effect, when it leads to altered regulation of the circadian system which is a serious problem affecting basic functioning of living organisms. One approach to increasing the efficiency of pharmacotherapy is administering drugs at times during which they are best tolerated. From viewpoints of pharmaceutics, the application of biological rhythm to pharmacotherapy may be accomplished by the appropriate timing of conventionally formulated tablets and capsules, and the special drug delivery system to synchronize drug concentrations to rhythms in disease activity. New technology for delivering medications precisely in a time-modulated fashion by bedside or ambulatory pumps is developing to manage human diseases. Therefore, we introduce an overview of the dosing time-dependent alterations in therapeutic outcome and safety of drug. The underlying mechanisms and usefulness are introduced from viewpoint of chronopharmacology and chronotherapy.
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PMID:Chronotherapeutic strategy: Rhythm monitoring, manipulation and disruption. 2018 74

Cognitive dysfunction occurs in more than half of stroke survivors and can have far-reaching consequences for functioning in daily life. Assessment of cognitive function can play a major role in determining the appropriate discharge destination after a hospital stay. The present study aimed to determine the feasibility of cognitive screening in the acute phase poststroke and to investigate whether this cognitive screening can accurately predict discharge destination to either a dependent or an independent living situation. A total of 287 patients with a first-ever cerebral stroke consecutively admitted to a stroke unit of a general hospital were eligible for the study. All patients underwent neuropsychological screening, consisting of the Mini-Mental State Examination (MMSE), Cognitive Screening Test (CST), and Clock-Drawing Test, within 7 days poststroke. Screening was feasible in 73.2% of the patients. Logistic regression analysis showed that the Barthel Index (BI) score (ie, ability to perform activities of daily living) could predict the discharge destination with 47% explained variance when age and BI score were taken into account. Adding the 3 cognitive tests to the model with age and BI improved the explained variance substantially (53%), with a significant contribution of BI and CST. Cognitive screening in the acute phase poststroke appeared to be feasible and capable of supporting the decision of whether to discharge a patient to home or to a dependent living situation. Functional status improved the predictive value of the model; the MMSE was not suitable for prediction. A comprehensive set of various predictors, including cognition, is recommended to support discharge planning.
J Stroke Cerebrovasc Dis 2011 Nov
PMID:Cognitive functioning in the acute phase poststroke: a predictor of discharge destination? 2083 83

129 patients aged 18-84 in early rehabilitation period of the first hemispheric ischemic stroke and 48 patients with cerebrovascular disorders without stroke in anamnesis were observed. Cognitive functions (MMSE, FAB, Clock Drawing Test, the 5-Word test, attention assessment, Semantic Verbal Fluency test) and emotional sphere (CES-D) were studied. Investigation was carried out twice during the early recovery period 3-4weeks and 3months after the stroke. Statistically significant decrease of cognitive functions in comparison with control group data was revealed. Cognitive deficiency and depressed mood were fixed in patients after the first hemispheric ischemic stroke. The level of cognitive decline correlated with expression of neurological deficiency and age. The expression of hypothymia correlated with age, dominated by women, did not depend on stroke localization and education. Women, elderly people and patients with severe neurological deficits had higher risk of emotional disorders after the first hemispheric ischemic stroke. There was a tendency to reduce the frequency of hypothymia and cognitive decline in the early rehabilitation period.
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PMID:Cognitive impairment and hypothymia in post stroke patients. 2323 40

Neurorehabilitation of poststroke cognitive impairments is an important medical problem. The purpose of the present study was to estimate the efficacy of new methods of restoration of impaired cognitive functions using computer correction programs. 43 poststroke patients aged 57-69, (male - 23, female - 20) were randomized into two groups. First group patients have been treated with the standard methods and supplementary neuropsychological computer training for 14days, 25-35min of duration per day. Control group received standard treatment according to Federal and local medical recommendations. Initial and achieved levels of cognitive functioning were estimated with the use of Mini Mental State Examination, Frontal Assessment Battery, the Clock Drawing Test, the Montreal Cognitive Assessment, Schulte's test, Hospital Anxiety and Depression Scale. We found that including the computer correction programs into the complex protocol of rehabilitation of post-stroke patients confirmed their efficacy in both clinical aspects and the Patient Global Impression Scale. Although the results are encouraging, further studies are required with larger samples and longer follow-up to identify characteristics of those patients who are most likely to benefit from computer training of cognitive functions.
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PMID:Correction of post-stroke cognitive impairments using computer programs. 2331 91

The efficiency of using of original stimulating programs for correction of memory decline, attention impairment and optical-spatial gnosis disorders was evaluated in 100 post stroke patients with the degree of cognitive decline from mild cognitive impairment to mild dementia in the acute period of stroke. In addition to traditional methods of treatment, we applied training using computer programs within 20-30 minutes daily 5 times a week during 14 days. Efficiency of treatment was measured by the MMSE, the FAB, the Clock drawing test, Shulte's tables and a letter correction test. After the treatment, the statistically significant improvement of cognitive functions was found in the group of patients receiving the correction with computer programs.
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PMID:[Cognitive disorders and its correction in the acute period of ischemic stroke]. 2339 Jun 53

Clinical, neuropsychological and neurophysiological examination was performed in 53 patients, aged 33-75 years, in the early rehabilitation period of the first hemispheric ischemic stroke. Cognitive functions were measured with the MMSE, the FAB, the Clock Drawing Test, the 5-Word test, the Schulte probe, verbal fluency test, etc. Cognitive evoked potentials were recorded in 30 patients. Examination was carried out a month after the stroke and after 2 months of therapy with neuromidin (ipidacrinum). The control group consisted of 37 people without stroke in the case history. The statistically significant decrease of cognitive functions in comparison with control group was revealed at the first visit. The statistically significant regression of cognitive deficit, with the most distinct positive dynamics of frontal functions and semantic verbal fluency, was identified as a result of the treatment. The significant improvement in cognitive evoked potentials in the form of the reduction of P3 latency was recorded after the treatment.
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PMID:[Neuromidin in the treatment of cognitive impairment in the early rehabilitation period of ischemic stroke]. 2361 99

[Purpose] The aims of the present study were to analyze the validity and reliability of the Clock Drawing Test (CDT) as a screening tool for cognitive impairments in both stroke patients and older adults in South Korea. [Subjects and Methods] Forty-three stroke patients and 42 elderly residents living in urban communities were recruited. They were divided into three groups according to K-MMSE scores. Kruskal-Wallis one-way ANOVA was used for construct validity, Friedman two-way ANOVA for discriminative validity, and Spearman's rank order correlation coefficient for inter-rater reliability. [Results] Regardless of groups, construct and discriminative validity tests showed statistically significant results, and Spearman's rho was over 0.56. [Discussion] CDT demonstrated acceptable validity and reliability. CDT using the productive methods and Freedman's scoring systems may be suitable for cognitive decrease in stroke patients and the elderly.
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PMID:The psychometric properties of the clock drawing test in South Korea. 2514 Jan 9

The assessment of aphasics' cognitive performance is challenging and such patients are generally excluded from studies that describe cognitive deficits after stroke. We evaluated aphasics' performance in cognitive tasks compared to non-aphasic subjects. A sample of 47 patients (21 aphasics, 17 non-aphasics with left hemisphere lesions and 9 non-aphasics with right hemisphere lesions) performed cognitive tasks (attention, verbal and visual memory, executive functions, visuospatial skills and praxis). Aphasic patients performed poorer than all non-aphasics in Digit Span (p < 0.001), Clock-Drawing Test (p = 0.006), Verbal memory (p = 0.002), Visual Memory (p < 0.01), Verbal Fluency (p < 0.001), and Gesture Praxis (p < 0.001). Aphasia severity correlated with performance in Trail Making test part B (p = 0.004), Digit Span forward (p < 0.001) and backwards (p = 0.011), and Gesture Praxis (p = 0.002). Aphasia is accompanied by deficits not always easy to be evaluated by cognitive tests due to speech production and motor impairments. Assessment of cognitive functions in aphasics might contribute to optimize therapeutic intervention.
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PMID:Cognitive deficits in post-stroke aphasia. 2646

Stroke is a leading cause of disability worldwide. Cognitive functions and, in particular, executive function, are commonly affected after stroke, leading to impairments in performance of daily activities, decrease in social participation and in quality of life. Appropriate assessment and understanding of executive dysfunction are important, firstly to develop better rehabilitation strategies for executive functions per se and secondly to consider executive function abilities on rehabilitation strategies in general. The purpose of this review was to identify the most widely used assessment tools of executive dysfunction for patients with stroke, and their psychometric properties. We systematically reviewed manuscripts published in English in databases from 1999 to 2015. We identified 35 publications. The most frequently used instruments were the Stroop, Digit Span and Trail making tests. Psychometric properties were described for the Executive Function Performance Test, Executive Clock Drawing Task, Chinese Frontal Assessment Battery and Virtual Action Planning - Supermarket, and two subtests of the Cambridge Cognitive Examination - Revised. There is a paucity of tools to reliably measure executive dysfunction after stroke, despite the fact that executive dysfunction is frequent. Identification of the best tools for executive dysfunction assessment is necessary to address important gaps in research and in clinical practice.
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PMID:Diversity of approaches in assessment of executive functions in stroke: limited evidence? 2662 42


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