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Talmasov D, Kelly S, Ecker S, Olivera A, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Relationship Between Hemorrhage Type and Development of Emotional and Behavioral Dyscontrol After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230114. [PMID: 38650464 DOI: 10.1176/appi.neuropsych.20230114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE Emotional and behavioral dyscontrol (EBD), a neuropsychiatric complication of stroke, leads to patient and caregiver distress and challenges to rehabilitation. Studies of neuropsychiatric sequelae in stroke are heavily weighted toward ischemic stroke. This study was designed to compare risk of EBD following intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) and to identify risk factors for EBD following hemorrhagic stroke. METHODS The authors conducted a prospective cohort study of patients hospitalized for nontraumatic hemorrhagic stroke between 2015 and 2021. Patients or legally authorized representatives completed the Quality of Life in Neurological Disorders (Neuro-QOL) EBD short-form inventory 3 months after hospitalization. Univariable and multivariable analyses identified risk factors for EBD after hemorrhagic stroke. RESULTS The incidence of EBD was 21% (N=15 of 72 patients) at 3 months after hemorrhagic stroke. Patients with ICH were more likely to develop EBD; 93% of patients with EBD (N=14 of 15) had ICH compared with 56% of patients without EBD (N=32 of 57). The median Glasgow Coma Scale (GCS) score at hospital admission was lower among patients who developed EBD (13 vs. 15 among those without EBD). Similarly, admission scores on the National Institutes of Health Stroke Scale (NIHSS) and the Acute Physiology and Chronic Health Evaluation II (APACHE II) were higher among patients with EBD (median NIHSS score: 7 vs. 2; median APACHE II score: 17 vs. 11). Multivariable analyses identified hemorrhage type (ICH) and poor admission GCS score as predictors of EBD 3 months after hemorrhagic stroke. CONCLUSIONS Patients with ICH and a low GCS score at admission are at increased risk of developing EBD 3 months after hemorrhagic stroke and may benefit from early intervention.
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Affiliation(s)
- Daniel Talmasov
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sean Kelly
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Sarah Ecker
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Anlys Olivera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Aaron Lord
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Lindsey Gurin
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Koto Ishida
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Kara Melmed
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jose Torres
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Cen Zhang
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Jennifer Frontera
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
| | - Ariane Lewis
- Departments of Neurology and Psychiatry, Columbia University, New York (Talmasov); Department of Neurology, New York University Langone Medical Center (Kelly, Ecker, Olivera, Lord, Gurin, Ishida, Melmed, Torres, Zhang, Frontera, Lewis)
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Olivera A, Ecker S, Lord A, Gurin L, Ishida K, Melmed K, Torres J, Zhang C, Frontera J, Lewis A. Factors Associated With Anxiety After Hemorrhagic Stroke. J Neuropsychiatry Clin Neurosci 2023; 36:36-44. [PMID: 37667629 DOI: 10.1176/appi.neuropsych.20220218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE A significant number of patients develop anxiety after stroke. The objective of this study was to identify risk factors for anxiety after hemorrhagic stroke that may facilitate diagnosis and treatment. METHODS Patients admitted between January 2015 and February 2021 with nontraumatic hemorrhagic stroke (intracerebral [ICH] or subarachnoid [SAH] hemorrhage) were assessed telephonically 3 and 12 months after stroke with the Quality of Life in Neurological Disorders Anxiety Short Form to evaluate the relationships between poststroke anxiety (T score >50) and preclinical social and neuropsychiatric history, systemic and neurological illness severity, and in-hospital complications. RESULTS Of 71 patients who completed the 3-month assessment, 28 (39%) had anxiety. There was a difference in Glasgow Coma Scale (GCS) scores on admission between patients with anxiety (median=14, interquartile range [IQR]=12-15) and those without anxiety (median=15, IQR=14-15) (p=0.034), and the incidence of anxiety was higher among patients with ICH (50%) than among those with SAH (20%) (p=0.021). Among patients with ICH, anxiety was associated with larger median ICH volume (25 cc [IQR=8-46] versus 8 cc [IQR=3-13], p=0.021) and higher median ICH score (2 [IQR=1-3] versus 1 [IQR=0-1], p=0.037). On multivariable analysis with GCS score, hemorrhage type, and neuropsychiatric history, only hemorrhage type remained significant (odds ratio=3.77, 95% CI=1.19-12.05, p=0.024). Of the 39 patients who completed the 12-month assessment, 12 (31%) had anxiety, and there was a difference in mean National Institutes of Health Stroke Scale scores between patients with (5 [IQR=3-12]) and without (2 [IQR=0-4]) anxiety (p=0.045). There was fair agreement (κ=0.38) between the presence of anxiety at 3 and 12 months. CONCLUSIONS Hemorrhage characteristics and factors assessed with neurological examination on admission are associated with the development of poststroke anxiety.
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Affiliation(s)
- Anlys Olivera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Sarah Ecker
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Aaron Lord
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Lindsey Gurin
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Koto Ishida
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Kara Melmed
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jose Torres
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Cen Zhang
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Jennifer Frontera
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
| | - Ariane Lewis
- Departments of Neurology (all authors), Psychiatry (Olivera, Gurin), Neurosurgery (Lord, Melmed, Frontera, Lewis), and Rehabilitation Medicine (Gurin), NYU Langone Medical Center, New York
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Starosciak AK, Wang K, Ying H, Ravipati K, Spring S, Gutierrez CM, Gardener H, Rose DZ, Foster D, Dong C, Jameson A, Alkhachroum A, Romano JG, Sacco RL, Rundek T, Asdaghi N. Preexisting Depression and Ambulatory Status After Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities. J Neuropsychiatry Clin Neurosci 2023; 35:361-367. [PMID: 37151036 PMCID: PMC10754056 DOI: 10.1176/appi.neuropsych.20220211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Stroke is a global public health burden, and therefore it is critical to identify modifiable risk factors to reduce stroke incidence and improve outcomes. Depression is such a risk factor; however, the association between preexisting depression and stroke outcomes, such as independent ambulation, is not well studied, especially among racial-ethnic minority groups. To address this gap in the literature, effects of preexisting depression on ambulatory status at hospital discharge after stroke were evaluated among individuals participating in the racially and ethnically diverse Florida-Puerto Rico Collaboration to Reduce Stroke Disparities project. METHODS Data were analyzed from a total of 42,031 ischemic stroke patients, who were independently ambulatory prior to their stroke, after discharge from 84 hospitals between 2014 and 2017. Preexisting depression was confirmed by medical history or antidepressant medication use. Multilevel multivariate logistic regression analyses were used to assess the association of preexisting depression with independent ambulation at hospital discharge. Effects of sex and race-ethnicity on this association were examined. RESULTS Of 42,031 participants (mean±SD age=70.4±14.2 years; 48% were female; race-ethnicity: 16% Black, 12% Hispanic living in Florida, and 7% Hispanic living in Puerto Rico), 6,379 (15%) had preexisting depression. Compared with participants without depression, those with preexisting depression were older, were more likely to be female and non-Hispanic White, and had a greater burden of vascular risk factors or comorbid conditions. Independent ambulation at hospital discharge was less frequent among women, Black participants, and individuals with vascular risk factors or comorbid conditions. In multivariate models, preexisting depression decreased the likelihood of independent ambulation at discharge (odds ratio=0.88, 95% CI=0.81, 0.97). No interactions were found between preexisting depression and race-ethnicity or sex. CONCLUSIONS Preexisting depression was independently associated with dependent ambulation at hospital discharge after stroke, regardless of sex and race-ethnicity. Treating depression may contribute to primary stroke prevention and could improve ambulatory status at discharge.
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Affiliation(s)
- Amy K Starosciak
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Kefeng Wang
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Hao Ying
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Kaushik Ravipati
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Samantha Spring
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Carolina M Gutierrez
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Hannah Gardener
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - David Z Rose
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Dianne Foster
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Chuanhui Dong
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Angus Jameson
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Ayham Alkhachroum
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Jose G Romano
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Ralph L Sacco
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Tatjana Rundek
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
| | - Negar Asdaghi
- Miami Neuroscience Institute, Baptist Health South Florida, Miami (Starosciak); University of Miami Miller School of Medicine, Miami (Wang, Ying, Spring, Gutierrez, Gardener, Dong, Alkhachroum, Romano, Sacco, Rundek, Asdaghi); Florida International University Herbert Wertheim College of Medicine, Miami (Ravipati); University of South Florida Morsani College of Medicine, Tampa (Rose); American Heart Association, Southeast Region, Atlanta (Foster); Pinellas County Emergency Medical Services, Largo, Fla. (Jameson)
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Abstract
OBJECTIVE A history of multiple cerebral infarctions is generally regarded as an important risk factor for vascular dementia. The authors examined the risk of vascular dementia in patients with multiple acute ischemic lesions. METHODS The authors conducted a hospital-based prospective study of 11,200 patients with first-time stroke who underwent 1.5 or 3-T MRI and a global cognitive assessment. Univariate and multivariate logistic regression analyses estimated the risk of dementia associated with multiple lesions versus a single lesion. RESULTS Having multiple lesions, compared with having a single lesion, was significantly associated with dementia in patients with stroke (odds ratio=5.83, 95% CI=5.08, 6.70; p<0.001). The apoliproprotein ε4 allele was more frequent in patients with multiple lesions than in those with a single lesion (odds ratio=1.70, 95% CI=1.39, 2.07; p<0.001). Severe leukoaraiosis (odds ratio=15.77, 95% CI=8.38, 29.68; p<0.001) and microbleedings (odds ratio=1.31, 95% CI=1.06, 1.63; p<0.01) were strong confounders for dementia in the multivariate analysis. Multiple logistic regression analysis showed that multiple lesions in one hemisphere versus a single lesion (odds ratio=2.14, 95% CI=1.83, 2.51; p<0.001), involvement of strategic regions (odds ratio=4.73, 95% CI=4.07, 5.49; p<0.001), and stroke lesion volume (odds ratio=1.31, 95% CI=1.03, 1.66; p=0.03) were significantly associated with dementia. There was a preponderance of lesions on the left side in patients with dementia (odds ratio=2.56, 95% CI=2.11, 3.11; p<0.001). CONCLUSIONS Multiple spontaneous anterior or posterior circulation lesions after stroke increase a patient's risk of developing dementia. Recognition of multiple ischemic lesions after stroke may allow targeted rapid therapeutic interventions to prevent subsequent cognitive deterioration.
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Affiliation(s)
- Emre Kumral
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Fatma Ece Bayam
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Hasan Arslan
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
| | - Mehmet Orman
- Department of Neurology (Kumral, Ece Bayam, Arslan) and Department of Neuropsychology (Arslan), Ege University Medical School Hospital, Izmir, Turkey; and Department of Administration and Statistics, Ege University, Izmir, Turkey (Orman)
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Mikami K, Sudo T, Orihashi Y, Kimoto K, Mizuma A, Uesugi T, Kawamura R, Honma K, Nagata E, Yamamoto K, Takizawa S, Matsumoto H, Robinson RG. Effective Tools to Predict Depression in Acute and Subacute Phase of Ischemic Stroke. J Neuropsychiatry Clin Neurosci 2021; 33:43-48. [PMID: 33086923 DOI: 10.1176/appi.neuropsych.20040076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke. METHODS Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke. CONCLUSIONS The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.
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Affiliation(s)
- Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Takeshi Sudo
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Yasushi Orihashi
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Keitaro Kimoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Atsushi Mizuma
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Tsuyoshi Uesugi
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Reina Kawamura
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Kazunari Honma
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Eiichiro Nagata
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Shunya Takizawa
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Robert G Robinson
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
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Abstract
OBJECTIVE After attempting to move a plegic limb, patients with anosognosia for hemiplegia (AHP) may claim that limb movement occurred, even though the limb remained motionless. The authors investigated the characteristics, natural history, and anatomical basis of AHP phenomenology. METHODS Twenty-nine right-hemisphere stroke patients with acute anosognosia for hemiplegia (AHP) were prospectively assessed for the presence and characteristics of movement claims and observable behavior during movement attempts. RESULTS AHP was transient, with the condition resolving in 68% of patients by 1 week. Patients made movement claims during 31% of unilateral movement attempts and 50% of bilateral movement attempts. Movement claims were idiosyncratic, lacked internal consistency within individual patients, and even dissociated from explicit denial, as several patients made movement claims after they began to explicitly acknowledge hemiplegia. Observable behavior during movement attempts revealed allochiria (moving the right arm instead of the left) in 31% of patients, signs of implicit knowledge of weakness in 24%, and intact intention in 34%. Lesion analysis revealed that allochiria was associated with inferior right parietal lobe damage. CONCLUSIONS These results highlight that heterogeneity, phenomenological complexity, and transience are hallmarks of AHP. This advances clinical AHP assessment by showing that assessment of performance, rather than just verbal response, uncovers multiple dimensions of AHP. Allochiria emerges as an anatomically distinct subcomponent of the disorder. These findings also have theoretical implications, because they do not lend support to unitary pathogenic models proposing that illusions of movement or impaired intention form the basis of AHP. Most patients rapidly improve, which should invigorate the search for typical compensatory mechanisms underlying spontaneous recovery.
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Affiliation(s)
- Daniel Antoniello
- Montefiore Hospital/Albert Einstein College of Medicine, Bronx, N.Y. (Antoniello, Gottesman)
| | - Reena Gottesman
- Montefiore Hospital/Albert Einstein College of Medicine, Bronx, N.Y. (Antoniello, Gottesman)
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7
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Parand L, Niu K, Yerstein O, Mendez MF. Fantastic Thinking and Frontal Cerebrovascular Disease. J Neuropsychiatry Clin Neurosci 2020; 32:201-203. [PMID: 31331214 DOI: 10.1176/appi.neuropsych.19040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Leila Parand
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Kathy Niu
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Oleg Yerstein
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
| | - Mario F Mendez
- The Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles (Parand, Yerstein, Mendez); the V.A. Greater Los Angeles Healthcare System (Mendez); and the Neuropsychiatry Program, University of Massachusetts, Worcester, Mass (Niu)
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8
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Pasinska P, Kowalska K, Klimiec E, Wilk A, Szyper-Maciejowska A, Dziedzic T, Klimkowicz-Mrowiec A. Poststroke Delirium Clinical Motor Subtypes: The PRospective Observational POLIsh Study (PROPOLIS). J Neuropsychiatry Clin Neurosci 2019; 31:104-111. [PMID: 30404531 DOI: 10.1176/appi.neuropsych.18040073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although delirium is the most common neurobehavioral complication after stroke, its motor subtypes-hypoactive, hyperactive, mixed, and none-as well as their risk factors are not well characterized. Motor subtypes influence recognition and prognosis of delirium in hospitalized patients. METHODS The aim of this prospective study was to assess the frequency of poststroke delirium subtypes and to describe their predictive models. Consecutive patients with stroke were screened for delirium with the Confusion Assessment Method for the Intensive Care Unit. Delirium was diagnosed according to DSM-5 criteria, and subtypes were classified with the Delirium Motor Subtype Scale-4. Baseline demographic characteristics, biochemistry, stroke-related data, medications, neurological deficits, and premorbid cognitive and functional impairments were assessed. RESULTS Out of 750 patients (mean age, 71.75 years [SD=13.13]), 203 (27.07%) had delirium: 85 (11.34%) were hypoactive, 77 (10.27%) were mixed hypoactive-hyperactive, 31 (4.13%) were hyperactive, and 10 (1.33%) had an unspecified type. Cognitive impairment at the time of hospital admission and spatial neglect, among other factors, were identified as the best predictors for all motor delirium subtypes. CONCLUSIONS Screening for poststroke delirium is important because the hypoactive subtype bears the worst prognosis and is misdiagnosed the most compared with other subtypes. All identified factors for the predictive models of delirium subtypes are routinely assessed during hospital admission. Their occurrence in patients with stroke should alert the treating physician to the high risk for a particular delirium subtype.
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Affiliation(s)
- Paulina Pasinska
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Katarzyna Kowalska
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Elzbieta Klimiec
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Aleksander Wilk
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Aleksandra Szyper-Maciejowska
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Tomasz Dziedzic
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
| | - Aleksandra Klimkowicz-Mrowiec
- From the Department of Neurology, School of Medicine, Jagiellonian University, Krakow, Poland (PP, KK, EK, AW, AS-M, TD, AK-M)
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9
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Lisle BN, Hurley RA, Taber KH. Poststroke Depression: Contributions From Network Science. J Neuropsychiatry Clin Neurosci 2019; 30:A4-261. [PMID: 30351997 DOI: 10.1176/appi.neuropsych.18080188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin N Lisle
- Dr. Lisle is affiliated with the Department of Neurology at Wake Forest School of Medicine in Winston-Salem, North Carolina. Drs. Hurley and Taber are affiliated with the Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line at the Salisbury VA Healthcare System in Salisbury, North Carolina. Dr. Hurley is affiliated with the Departments of Psychiatry and Radiology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. Dr. Taber is affiliated with the Division of Biomedical Sciences at the Via College of Osteopathic Medicine in Blacksburg, Virginia, and the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston
| | - Robin A Hurley
- Dr. Lisle is affiliated with the Department of Neurology at Wake Forest School of Medicine in Winston-Salem, North Carolina. Drs. Hurley and Taber are affiliated with the Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line at the Salisbury VA Healthcare System in Salisbury, North Carolina. Dr. Hurley is affiliated with the Departments of Psychiatry and Radiology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. Dr. Taber is affiliated with the Division of Biomedical Sciences at the Via College of Osteopathic Medicine in Blacksburg, Virginia, and the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston
| | - Katherine H Taber
- Dr. Lisle is affiliated with the Department of Neurology at Wake Forest School of Medicine in Winston-Salem, North Carolina. Drs. Hurley and Taber are affiliated with the Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line at the Salisbury VA Healthcare System in Salisbury, North Carolina. Dr. Hurley is affiliated with the Departments of Psychiatry and Radiology at Wake Forest School of Medicine in Winston-Salem, North Carolina, and the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston. Dr. Taber is affiliated with the Division of Biomedical Sciences at the Via College of Osteopathic Medicine in Blacksburg, Virginia, and the Department of Physical Medicine and Rehabilitation at Baylor College of Medicine in Houston
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10
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Abstract
The misidentification of one's own limb (LM) after right hemisphere stroke is a striking phenomenon that is incompletely understood. The authors prospectively studied the natural history and anatomy of LM in 36 patients with hyperacute right middle cerebral artery infarct. Unlike in previous studies, rapid clinical assessment was prioritized. The authors found LM to be common and transient, involving 61% at onset, evolving to 15% at 1 week. Voxel-based lesion-symptom mapping found supramarginal gyrus (SMG) damage associated with LM. This substantiates the SMG's importance in LM and has broader implications for lesion analysis: timing matters. Rapid assessment of transient disorders minimizes false negatives, which can improve lesion analysis.
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Affiliation(s)
- Daniel Antoniello
- From the Montefiore Hospital/Albert Einstein College of Medicine, Bronx, N.Y. (DA, RG)
| | - Reena Gottesman
- From the Montefiore Hospital/Albert Einstein College of Medicine, Bronx, N.Y. (DA, RG)
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11
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Abstract
Delusions are beliefs that remain fixed despite evidence that they are incorrect. Although the precise neural mechanism of delusional belief remains to be elucidated, there is a predominance of right-hemisphere lesions among patients with delusional syndromes accompanied by structural pathology, suggesting that right-hemisphere lesions, or networks with key nodes in the right hemisphere, may be playing a role. The authors discuss the potential theoretical basis and empiric support for a specific right-hemisphere role in delusion production, drawing on its roles in pragmatic communication; perceptual integration; attentional surveillance and anomaly/novelty detection; and belief updating.
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Affiliation(s)
- Lindsey Gurin
- From the Departments of Neurology and Psychiatry, New York University Langone Medical Center, New York (LG); and the Departments of Neurology and Rehabilitation Medicine, New York University Langone Medical Center, New York (SB)
| | - Sonja Blum
- From the Departments of Neurology and Psychiatry, New York University Langone Medical Center, New York (LG); and the Departments of Neurology and Rehabilitation Medicine, New York University Langone Medical Center, New York (SB)
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12
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Tang WK, Liu XX, Liang H, Chen YK, Chu WCW, Ahuja AT, Abrigo J, Mok VCT, Ungvari GS, Wong KS, Spalletta G. Location of Acute Infarcts and Agitation and Aggression in Stroke. J Neuropsychiatry Clin Neurosci 2017; 29:172-178. [PMID: 27707197 DOI: 10.1176/appi.neuropsych.15110400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The role of the infarct location in the development of poststroke agitation (PSA) is largely unknown. This study examined the association between the locations of infarcts and PSA at 9 months following the index stroke in 213 patients with the Chinese version of the Neuropsychiatric Inventory. Compared with the non-PSA group, PSA patients had a higher number and volume of acute pontine infarcts. Ventral pontine and lateral cerebellar infarcts were independent predictors of PSA in the multivariate analysis.
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Affiliation(s)
- Wai Kwong Tang
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Xiang Xin Liu
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Huajun Liang
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Yang Kun Chen
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Winnie Chiu Wing Chu
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Anil T Ahuja
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Jill Abrigo
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Vincent Chung Tong Mok
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Gabor S Ungvari
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Ka Sing Wong
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
| | - Gianfranco Spalletta
- From the Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China (WKT, XXL, HJL); the Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong Province, P.R. China (YKC); the Department of Imaging & Interventional Radiology, Chinese University of Hong Kong, Hong Kong SAR, China (WCWC, ATA, JA); the Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China (VCTM, KSW); the University of Notre Dame Australia/Marian Centre, Perth, Australia and School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia (GSU); and the Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Via Ardeatina, Rome, Italy (GS)
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