The Impact of Progressive Rehabilitation Nursing on Physical Rehabilitation and Quality of Life in Patients with Cerebral Infarction

Aim

Cerebral infarction, a common type of stroke, results from a sudden interruption of blood flow to the brain, leading to a myriad of challenges and complications for patients. Among these complications, decreased muscle strength is a prominent issue that can have profound implications for patients' overall well-being and functional independence. Decreased muscle strength in cerebral infarction often manifests as weakness, loss of mobility, and impaired ability to perform activities; the psychological impact of these physical limitations can lead to anxiety and depression, further exacerbating the patient's condition. To investigate the effect of progressive rehabilitation nursing on the physical rehabilitation and quality of life of patients with cerebral infarction, to provide valuable insights and guidance for enhancing the functional recovery of individuals affected by cerebral infarction.

Design

100 cerebral infarction patients combined with decreased muscle strength admitted to our hospital between October 2019 and October 2020 were randomly selected as the study subjects for prospective analysis.

Methods

They were divided into a control group (n = 50) and an experimental group (n = 50) using the random number table method. Patients in the control group underwent rehabilitation treatment, while patients in the experimental group underwent progressive rehabilitation nursing intervention guided by quality nursing intervention. The Fugl-Meyer Assessment (FMA) motor function score, National Institute of Health Stroke Scale (NIHSS) neurological function score, Barthel Index (BI), Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores, nursing efficiency and the incidence rate of adverse mood after 1, 2 and 3 weeks of nursing were recorded and compared between the two groups.

Results

The FMA and BI index scores of patients in the experimental group were notably higher than those in the control group, and the comparison was statistically significant (P < .05); The NIHSS, SAS and SDS scores of patients in the experimental group were notably lower than those of the control group, and the results of the comparison were statistically significant (P < .05); The nursing efficiency and nursing satisfaction of patients in the experimental group was remarkably higher, and the results of the comparison were statistically significant (P < .05); The incidence of bad mood in the experimental group was significantly lower than that in the control group after 1, 2 and 3 weeks of nursing, and the incidence rate of adverse mood in the experimental group was improved with time, that is, 1>2>3 weeks in descending order (P < .05).

Patient or Public Contribution

Progressive rehabilitation nursing not only enhances muscle strength and restores their physical functions to a certain extent while reducing the incidence of adverse reactions and physical function but also mitigates the risk of adverse mood states. Ultimately, it contributes to an improved overall quality of life and psychological well-being of patients affected by cerebral infarction.

The Piano Man: A Case Report of Anterior Thalamic Infarct with Dementia and Preserved Music Ability

OBJECTIVE

The thalamus is the integrative hub of the brain with reciprocal connections throughout the cortex. This case report describes a right-handed 81-year-old male patient who experienced sudden onset cognitive impairment following a focal left anterior thalamic infarct.

METHODS

With consent/assent, the patient was seen for a short neuropsychological assessment 6 weeks post stroke. Neuropsychological assessment included review of medical history, collateral intake, the Toronto Cognitive Assessment, Frontal Systems Behavior Scale-Family Rating Form, the Neuropsychiatric Inventory Questionnaire, and piano performance.

RESULTS

The assessment revealed impaired performance on measures of orientation, memory, executive function, and language, as well as symptoms including hallucinations, apathy, and hypersomnolence, consistent with thalamic dementia. Remarkably, in this context, the patient maintained an ability to play piano and read music.

CONCLUSIONS

The case has implications for understanding the complex integrative functions of the thalamus, including how profound impairment can simultaneously present with cognitive strengths that may not be captured by performance on neuropsychological testing. This case also suggests that magnetic resonance imaging may be indicated in cases presenting with vascular risk factors and sudden onset cognitive impairment, given that computed tomography may not be sensitive to small subcortical infarcts.

Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia

BACKGROUND

Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care.

OBJECTIVE

This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia.

METHODS

The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed.

RESULTS

The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group.

CONCLUSION

HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.

Abnormal singing can identify patients with right hemisphere cortical strokes at risk for impaired prosody

Despite lacking aphasia seen with left hemisphere (LH) infarcts involving the middle cerebral artery territory, right hemisphere (RH) strokes can result in significant difficulties in affective prosody. These impairments may be more difficult to identify but lead to significant communication problems.We determine if evaluation of singing can accurately identify stroke patients with cortical RH infarcts at risk for prosodic impairment who may benefit from rehabilitation.A prospective cohort of 36 patients evaluated with acute ischemic stroke was recruited. Participants underwent an experimental battery evaluating their singing, prosody comprehension, and prosody production. Singing samples were rated by 2 independent reviewers as subjectively "normal" or "abnormal," and analyzed for properties of the fundamental frequency. Relationships between infarct location, singing, and prosody performance were evaluated using t tests and chi-squared analysis.Eighty percent of participants with LH cortical strokes were unable to successfully complete any of the tasks due to severe aphasia. For the remainder, singing ratings corresponded to stroke location for 68% of patients. RH cortical strokes demonstrated a lower mean fundamental frequency while singing than those with subcortical infarcts (176.8 vs 130.4, P = 0.02). They also made more errors on tasks of prosody comprehension (28.6 vs 16.0, P < 0.001) and production (40.4 vs 18.4, P < 0.001).Patients with RH cortical infarcts are more likely to exhibit impaired prosody comprehension and production and demonstrate the poor variation of tone when singing compared to patients with subcortical infarcts. A simple singing screen is able to successfully identify patients with cortical lesions and potential prosodic deficits.

The prevalence of psychiatric symptoms before the diagnosis of Parkinson's disease in a nationwide cohort: A comparison to patients with cerebral infarction

Objectives

Psychiatric symptoms (PS) can be non-motor features in Parkinson’s disease (PD) which are common even in the prodromal, untreated phase of the disease. Some PS, especially depression and anxiety recently became known predictive markers for PD. Our objective was to explore retrospectively the prevalence of PS before the diagnosis of PD.

Methods

In the framework of the Hungarian Brain Research Program we created a database from medical and medication reports submitted for reimbursement purposes to the National Health Insurance Fund in Hungary, a country with 10 million inhabitants and a single payer health insurance system. We used record linkage to evaluate the prevalence of PS before the diagnosis of PD and compared that with patients with ischemic cerebrovascular lesion (ICL) in the period between 2004–2016 using ICD-10 codes of G20 for PD, I63-64 for ICL and F00-F99 for PS. We included only those patients who got their PD, ICL and psychiatric diagnosis at least twice.

Results

There were 79 795 patients with PD and 676 874 patients with ICL. Of the PD patients 16% whereas of those with ischemic cerebrovascular lesion 9.7% had a psychiatric diagnosis before the first appearance of PD or ICL (p<0.001) established in psychiatric care at least twice. The higher rate of PS in PD compared to ICL remained significant after controlling for age and gender in logistic regression analysis. The difference between PD and ICL was significant for Mood disorders (F30-F39), Organic, including symptomatic, mental disorders (F00-F09), Neurotic, stress-related and somatoform disorders (F40-F48) and Schizophrenia, schizotypal and delusional disorders (F20-F29) diagnosis categories (p<0.001, for all).

Discussion

The higher rate of psychiatric morbidity in the premotor phase of PD may reflect neurotransmitter changes in the early phase of PD.

Relationship between recovery of motor function and neuropsychological functioning in cerebral infarction patients: the importance of social functioning in motor recovery

Impaired motor function is a common disabling sequela after stroke. It is closely associated with the patient's quality of life and independence. Neuropsychological dysfunctions also frequently occur in stroke patients. In this paper, we evaluate the relationship between the recovery of motor function and neuropsychological functions, including cognition, language, emotion, behavior, personality, and social interaction, to provide appropriate and effective therapy for stroke patients. Motor function, neuropsychological status, social functioning, as well as emotional aspects such as depression and anxiety symptoms, were initially evaluated one month after cerebral infarction onset. The evaluations were repeated three months after the onset. Motor function was assessed with the Modified Barthel Index. The neuropsychological status was evaluated using the Mini-Mental State Examination, Global Deterioration Scale, digit span test, Korean-Boston Naming Test, Vineland Social Maturity Scale, Neuropsychiatric Inventory, Beck's Depression Inventory, and Beck Anxiety Inventory. In the results, the Modified Barthel Index, Mini-Mental State Examination, Global Deterioration Scale, digit span test, and Vineland Social Maturity Scale were significantly different between the two-time points (P < 0.05). Initial Social Maturity Scale Social Age and Social Maturity Scale Social Quotient categories of the Vineland Social Maturity Scale and Mini-Mental State Examination scores were significantly correlated with Modified Barthel Index improvement (P < 0.05). The amount of change in the Social Maturity Scale Social Age and Social Maturity Scale Social Quotient scores was significantly correlated with Modified Barthel Index improvement (P < 0.05). In multiple linear regression analysis, only the initial Social Maturity Scale Social Quotient score and the amount of score change in Social Maturity Scale Social Quotient showed a significant correlation with Modified Barthel Index improvement (P < 0.05). Social function and interaction are important in motor recovery of ischemic stroke patients.

Assessing the Reliability of Reported Medical History in Older Adults

BACKGROUND

Age-associated increases in medical complexity, frailty, and cognitive impairment may compromise reliable reporting of medical history.

OBJECTIVE

To evaluate the influence of increasing age and cognitive impairment on concordance between reported history of stroke and cerebral infarction, and reported history of diabetes and elevated hemoglobinA1c in community-dwelling older adults.

METHODS

The association between participant-specific factors and accurate reporting of stroke or diabetes was evaluated using multivariable logistic regression in 1,401 participants enrolled in longitudinal studies of memory and aging, including 425 participants with dementia (30.3%). Stroke and diabetes were selected as index variables as gold standard measures of both were obtained in all participants: magnetic resonance neuroimaging for cerebral infarcts and hemoglobinA1c (≥6.5%) for diabetes.

RESULTS

Concordance between reported history of stroke and imaging-confirmed cerebral infarction was low (sensitivity: 17.4%, 8/46; specificity: 97.9%, 799/816). Small infarcts were strongly associated with inaccurate reporting (OR = 265.8; 95% CI: 86.2, 819.4), suggesting that occult/silent infarcts contributed to discordant reporting. Reporting accuracy was higher concerning diabetes (sensitivity: 83.5%, 147/176; specificity: 96.2%, 1100/1143). A history of hypertension (OR = 2.3; 95% CI: 1.3, 4.2), higher hemoglobinA1c (OR = 1.9; 95% CI: 1.5, 2.4), and hemoglobinA1c compatible with impaired glucose tolerance (OR = 3.1; 95% CI 1.8, 5.3) associated with increased odds of discordant reporting. Cognitive impairment and increased age were not independently associated with reliable reporting.

CONCLUSION

Factors beyond advancing age and cognitive impairment appear to drive discordance in reported medical history in older participants. Objective testing for cerebral infarcts or diabetes should be performed when relevant to diagnostic or therapeutic decisions in clinical and research settings.

A Case of Leukoencephalopathy and Small Vessels Disease Caused by a Novel HTRA1 Homozygous Mutation

Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) is a heritable, rare small vessel disease, which is caused by HTRA1 mutations and mostly reported Japanese and Chinese population. CARASIL is an orphan disease, which presents with progressive motor and cognitive impairment, alopecia, and spondylosis. The disease typically starts with lumbago at early twenties. Ischemic strokes start at mid-twenties. Patients have no cardiovascular or any other risk factors. Multiple lacunar infarcts and leukoencephalopathy cause progressive neurologic involvement. Leukoencephalopathy and small vessel disease without any risk factors is a significant finding for the differential diagnosis of HTRA1 gene pathology. This report presents clinical and genetic features of a rare case of typical CARASIL from Turkey who was followed with uncertain diagnoses for years.

Salvianolate injection in the treatment of acute cerebral infarction: A systematic review and a meta-analysis

To evaluate the effectiveness and safety of Salvianolate injection (SI) in the treatment of acute cerebral infarction (ACI).We electronically searched databases including PubMed, The Cochrane Library, EMBASE, Chinese Biomedical Literature Database, Chinese National Knowledge Infrastructure, and WanFang Data to collect randomized controlled trials (RCTs) focused on SI treating ACI up to August 2017. Two reviewers independently screened literatures, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software.A total of 39 RCTs involving 4516 patients were included. The results of meta-analysis showed that compared with the Western medicine (WM) therapies group [experimental group (EG)], the total effective rate of SI + WM [control group (CG)] was higher (relative risk = 1.29, 95% CI: 1.24-1.35, P < .00001) in 21 RCTs; SI could improve movement function evaluation scores, including National Institute of Health Stroke Scale, Barthel Index, activities of daily living (P < .00001). There was no significant difference in modified Rankin Scale scores between the 2 groups (P = .008) EG was better than CG in improving Montreal Cognitive Assessment scores (P = .001) and Mini-Mental State Examination scores (P < .00001). SI could improved not only the hemorheology indexes, including plasma viscosity, whole blood high-shear viscosity, whole blood low-shear viscosity, fibrinogen (P < .00001), but also high-sensitivity C-reactive protein and C-reactive protein. EG could achieve a better effect on improving the neural deficit scores (P < .00001). There was no significant difference about adverse drug reactions/adverse drug events between the EG and CG (P = .73).Salvianolate can promote recovery of the motor and cognitive function of patients with ACI. However, due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.

The association of different types of cerebral infarction with post-stroke depression and cognitive impairment

The aim of this study was to investigate post-stroke depression (PSD) and cognitive impairments in patients with different types of cerebral infarction.A total of 110 patients with cerebral infarction treated in our hospital from January 2015 to February 2016 were included in present study. Forty-seven patients were PSD patients and 63 patients were non-PSD patients. The Hamilton Depression Rating Scale (HAMD) and Mini-Mental State Examination (MMSE) were employed to assess depression and cognition of patientsAmong PSD patients, the proportion of patients with partial anterior circulation infarction (PACI, 68.75%) was significantly higher than patients with lacunar circulation infarction (LACI, 29.17%) and posterior circulation infarction (POCI, 26.67%) (P < .05). No significant difference was found in PSD patients with LACI and POCI (P > .05). The MMSE score of patients with PACI (18.05 ± 2.61) was lower than patients with POCI and LACI (P < .05), however, no significant difference was found in patients with LACI and POCI (P > 0.05). The incidences of cognitive impairment in patients with PACI, LACI, and POCI were 12.50%, 14.58%, and 13.33%, respectively. The MMSE score of PSD patients (21.23 ± 2.12) was significantly lower than non-PSD patients (P < .05).Compared with LACI and POCI patients, PACI patients had a higher incidence of PSD and impaired cognitive functions. In addition, affective disorders such as depression may be correlated with cognitive impairment in patients with cerebral infarction.

Selective impairments in components of affective prosody in neurologically impaired individuals

The intent and feelings of the speaker are often conveyed less by what they say than by how they say it, in terms of the affective prosody - modulations in pitch, loudness, rate, and rhythm of the speech to convey emotion. Here we propose a cognitive architecture of the perceptual, cognitive, and motor processes underlying recognition and generation of affective prosody. We developed the architecture on the basis of the computational demands of the task, and obtained evidence for various components by identifying neurologically impaired patients with relatively specific deficits in one component. We report analysis of performance across tasks of recognizing and producing affective prosody by four patients (three with right hemisphere stroke and one with frontotemporal dementia). Their distinct patterns of performance across tasks and quality of their abnormal performance provides preliminary evidence that some of the components of the proposed architecture can be selectively impaired by focal brain damage.

Repetitive transcranial magnetic stimulation for depression after basal ganglia ischaemic stroke: protocol for a multicentre randomised double-blind placebo-controlled trial

INTRODUCTION

Studies suggest that repetitive transcranial magnetic stimulation (rTMS) is effective for the treatment of depression and promotes the repair of white matter. This study aims to assess the effectiveness of rTMS in treating depression after basal ganglia ischaemic stroke and to examine whether such effects are related to restoration of white matter integrity.

METHODS AND ANALYSIS

Sixty-six participants will be recruited from Zhujiang Hospital, Nanfang Hospital and Sichuan Bayi Rehabilitation Hospital and randomised in a 1:1 ratio to receive active rTMS treatment or sham rTMS treatment in addition to routine supportive treatments. The data will be collected at 0, 2 and 4 weeks after the commencement of treatment. The primary outcome is the measurement of 24-item Hamilton Depression Rating Scale scores, and the secondary outcomes include diffusion tensor imaging results and the results of neuropsychological tests including the National Institutes of Health Stroke Scale, Activities of Daily Living Scale, Montreal Cognitive Assessment, Clinical Global Impressions scales, Aphasia Battery in Chinese, Social Support Revalued Scale and Medical Coping Modes Questionnaire.

ETHICS AND DISSEMINATION

This study has been approved by the Ethics Committee of Zhujiang Hospital of Southern Medical University. The findings will be disseminated by publication in a peer-reviewed journal and by presentation at international conferences.

TRIAL REGISTRATION NUMBER

NCT03159351.

Coordinated Plasticity of Synapses and Astrocytes Underlies Practice-Driven Functional Vicariation in Peri-Infarct Motor Cortex

Motor rehabilitative training after stroke can improve motor function and promote topographical reorganization of remaining motor cortical movement representations, but this reorganization follows behavioral improvements. A more detailed understanding of the neural bases of rehabilitation efficacy is needed to inform therapeutic efforts to improve it. Using a rat model of upper extremity impairments after ischemic stroke, we examined effects of motor rehabilitative training at the ultrastructural level in peri-infarct motor cortex. Extensive training in a skilled reaching task promoted improved performance and recovery of more normal movements. This was linked with greater axodendritic synapse density and ultrastructural characteristics of enhanced synaptic efficacy that were coordinated with changes in perisynaptic astrocytic processes in the border region between head and forelimb areas of peri-infarct motor cortex. Disrupting synapses and motor maps by infusions of anisomycin (ANI) into anatomically reorganized motor, but not posterior parietal, cortex eliminated behavioral gains from rehabilitative training. In contrast, ANI infusion in the equivalent cortical region of intact animals had no effect on reaching skills. These results suggest that rehabilitative training efficacy for improving manual skills is mediated by synaptic plasticity in a region of motor cortex that, before lesions, is not essential for manual skills, but becomes so as a result of the training. These findings support that experience-driven synaptic structural reorganization underlies functional vicariation in residual motor cortex after motor cortical infarcts.SIGNIFICANCE STATEMENT Stroke is a leading cause of long-term disability. Motor rehabilitation, the main treatment for physical disability, is of variable efficacy. A better understanding of neural mechanisms underlying effective motor rehabilitation would inform strategies for improving it. Here, we reveal synaptic underpinnings of effective motor rehabilitation. Rehabilitative training improved manual skill in the paretic forelimb and induced the formation of special synapse subtypes in coordination with structural changes in astrocytes, a glial cell that influences neural communication. These changes were found in a region that is nonessential for manual skill in intact animals, but came to mediate this skill due to training after stroke. Therefore, motor rehabilitation efficacy depends on synaptic changes that enable remaining brain regions to assume new functions.

Effects of dl-3-n-butylphthalide on serum VEGF and bFGF levels in acute cerebral infarction

OBJECTIVE

To observe the curative effect of dl-3-n-Butylphthalide (NBP) on patients with acute cerebral infarction (ACI) and its effects on levels of serum vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF).

PATIENTS AND METHODS

A total of 160 ACI patients treated in our hospital who met the criteria were selected and randomly divided into treatment group (n=80, including 42 males and 38 females) and control group (n=80, including 40 males and 40 females). The control group was treated with routine drug therapy, while the treatment group was treated with butylphthalide on this basis. The curative effect was evaluated using the National Institute of Health Stroke Scale (NIHSS) and the Activity of Daily Life Scale (ADL Scale). The levels of the two factors in serum were measured using enzyme-linked immunosorbent assay (ELISA), and the changes in the levels of the two factors in serum at different time points before and after treatment were compared between the two groups.

RESULTS

After treatment, the levels of the two factors in serum in both groups were significantly increased compared with those before treatment (p<0.05), and the increase in treatment group was more significant than that in control group (p<0.05). The scores of ADL scale in both groups were significantly increased after treatment compared with those before treatment, and the increase in treatment group was more significant than that in control group (p<0.05). The scores of NIHSS in both groups were significantly decreased compared with those before treatment, and the decrease in treatment group was more significant than that in control group (p<0.05).

CONCLUSIONS

NBP can improve the expressions of VEGF and bFGF in serum of ACI patients, and its effect is superior to that of conventional drugs.

Affective speech prosody perception and production in stroke patients with left-hemispheric damage and healthy controls

PURPOSE

'Affective prosody' defines the supra-segmental features of speech that, when manipulated, can change the type and intensity of emotion conveyed by the speaker. Although the right hemisphere is predominantly linked to the processing of affective prosodic cues, existing literature also suggests that damage to the left hemisphere can result in similar deficits. This study aims to demonstrate, and add to the evidence, that patients with left-hemisphere injury experience difficulties with affective prosodic perception and production, measured via a new combination of assessments and analyses. It is also hypothesised that aphasia severity will be correlated with impaired processing of affective prosody.

RESULTS

Stroke and control participants differed significantly on prosody perception tests of matching auditory affective cues to visual images. Prosodic production was measured by participants vocalising different affective expressions of words and monosyllables - from which significant differences were found in perceptual judgements of emotion accuracy and intensity, and acoustic analyses of pitch range and variance. There were significant correlations between participants' Western Aphasia Battery (WAB) scores, quality of life, and prosody production.

CONCLUSION

Individuals with left-hemisphere damage after stroke have impaired affective prosodic perception and production that may be associated with reduced quality of life.

Efficacy and Safety of Vinpocetine as Part of Treatment for Acute Cerebral Infarction: A Randomized, Open-Label, Controlled, Multicenter CAVIN (Chinese Assessment for Vinpocetine in Neurology) Trial

OBJECTIVE

The objective of this study was to evaluate the efficacy and safety of intravenous vinpocetine administration as part of a comprehensive treatment for acute cerebral infarction in a Chinese population.

METHODS

610 acute cerebral infarction patients were randomized into two groups: the vinpocetine group (469 patients) received cytidine disphosphate choline 0.4-0.5 g in combination with aspirin 75-100 mg or clopidogrel 75 mg once daily, plus vinpocetine 30 mg intravenously once daily for 7 days, while the control group (141 patients) received cytidine disphosphate choline 0.4-0.5 g in combination with aspirin 75-100 mg or clopidogrel 75 mg once daily for 7 days. Additionally, patients received medications for symptoms such as hypertension, hyperglycemia, hyperlipidemia, and intracranial hypertension when necessary. Mini-Mental State Examination (MMSE), National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale, and Barthel Index (BI) scores and transcranial doppler (TCD) were assessed at baseline, 7, 14, and 90 days after treatment. Adverse events (AEs) and abnormalities in blood, urine, liver, and kidney function were monitored.

RESULTS

MMSE, NIHSS, and BI scores were significantly higher in the vinpocetine group than in the control group 90 days after treatment, indicating significantly improved cognitive skill, neurological function, and quality of life (QOL) in the vinpocetine group versus the control group. Importantly, such effects of vinpocetine were maintained over time. In addition, TCD monitoring showed significantly increased cerebral blood flow associated with vinpocetine versus control. No significant difference in safety was noted between the two groups.

CONCLUSIONS

When used as part of treatment for acute cerebral infarction, vinpocetine improves patients' cerebral blood flow, cognitive quality, neurological functions, and QOL. Vinpocetine could be an effective and safe component of treatment regimen for acute cerebral infarction.

L-NAME combats excitotoxicity and recuperates neurological deficits in MCAO/R rats

PURPOSE OF RESEARCH

Since, transient focal cerebral ischaemia exhibits detrimental effect not only during the course of ischaemia but also after the onset of reperfusion, the current study is focussed on identifying the appropriate therapeutic time point at which NG-nitro-l-arginine methyl ester (l-NAME) exerts better neuroprotection.

PRINCIPAL RESULTS

Pre-ischaemic administration of l-NAME ameliorated neurological deficits much better than the during ischaemic and post-ischaemic groups. Pre-ischaemic l-NAME has also mitigated glutamate excitotoxicity, increased glutamine synthetase activity, ATP and NAD levels, decreased nitrate/nitrite content, down regulated TNF-α and upregulated IL-10 expressions and reduced the cerebral infarction significantly than the during ischaemic and post-ischaemic groups.

MAJOR CONCLUSION

Current study revealed that l-NAME improved neurological deficit at the pre-ischaemic state in transient focal cerebral ischaemia and has also significantly ameliorated glutamate excitotoxicity. Though l-NAME showed neuroprotective effects when administered at during and post-ischaemia (during reperfusion), it exerts considerable neuroprotection when administered pre-ischaemically.

Factors related to executive dysfunction after acute infarct

Aim

The aim of this study was to investigate the association of infarct location with post-stroke executive dysfunction.

Methods

One hundred seventy-seven patients hospitalized with acute infarction were enrolled. General information and NIHSS score at admission were recorded. The infarct site was recorded from magnetic resonance T2-W1 and FLAIR images, and the extent of white matter disease was assessed using the Fazekas score. Seven days after symptoms, executive function was assessed using the validated Chinese version of Mattis Dementia Rating Scale (MDRS) Initiation/Perseveration (I/P) [MDRS I/P].

Results

The average MDRS I/P score of the 177 infarction patients was 24.16±5.21, considerably lower than the average score (32.7±3.1) of a control group of normal individuals. Patients with infarcts in the corona radiata or basal ganglia had significantly lower MDRS I/P scores that those without infarcts at these locations. The number of infarcts in the basal ganglia was also significantly associated with low MDRS I/P scores. Male gender and low NIHSS score were significantly associated with low MDRS I/P score, and high-density lipoprotein cholesterol was significantly associated with high MDRS I/P score. The number of infarcts in areas other than the basal ganglia as well as corona radiata and the extent of white matter disease had no influence on this score.

Conclusions

The number of infarcts in the basal ganglia corona radiata, low NIHSS score, and male gender are significantly and independently related to poor executive function (that is, low MDRS I/P score) after acute infarct.

A case for the implementation of cognitive-communication screenings in acute stroke

PURPOSE

The purpose of this article was to illustrate the importance of the implementation of cognitive-communication screenings in acute stroke and to discuss the need for further research on whether and how these screenings are implemented. Cognitive-communication screenings after stroke are the subject of existing practice guidelines and are supported by accumulated evidence.

METHOD

The author uses an autoethnographic narrative--a tool founded in phenomenology--to provide an in-depth description of the experiences of a family in which one member experienced right-hemispheric stroke. She uses systematic introspection to produce a narrative using literary techniques.

RESULTS

The narrative illustrates the experiences of one family when one of their members has a right-hemisphere stroke, and cognitive-communication impairments are never formally identified by professionals involved in the patient's care.

CONCLUSIONS

The narrative is linked to the published literature and the importance of identifying and managing cognitive-communication impairments after stroke. A model of implementation science is presented as one way to consider the challenges clinicians face when attempting to implement evidence-based practices. The model and examples from other fields show avenues for further research.

AD pathology and cerebral infarctions are associated with memory and executive functioning one and five years before death

We provide rigorous psychometric evidence for distinct patterns of cognitive impairment for Alzheimer's disease (AD) and cerebral infarctions using 440 participants from the Religious Order Study. Latent variable models were used to decompose the effects of AD pathology and cerebral infarctions assessed at autopsy on overall cognition and specific neuropsychological tests at one and five years prior to death. Results support clinical and univariate psychometric analyses that memory impairment is more pronounced in AD, and executive impairment is more pronounced in the presence of cerebral infarctions. These specific effects are subtle relative to the stronger associations of both AD neuropathology and cerebral infarctions with overall levels of cognitive impairment.

Assisting patients with disabilities to actively perform occupational activities using battery-free wireless mice to control environmental stimulation

The latest studies have adopted software technology to turn the battery-free wireless mouse into a high performance object location detector using a newly developed object location detection program (OLDP). This study extended OLDP functionality to assess whether two patients recovering from cerebral vascular accidents would be able to actively perform occupational activities by controlling their favorite environmental stimulation using battery-free wireless mice and OLDP software. Using an ABAB design we found substantial increases in both participants' target responses (i.e. the performance of occupational activities) to activate the control system to produce environmental stimulation during intervention phrases. The practical and developmental implications of the findings are discussed.

Poor health-related quality of life is associated with long-term mortality in young adults with cerebral infarction

BACKGROUND

Our aim was to investigate the effect of health-related quality of life (HRQOL) on subsequent mortality in young ischemic stroke patients in a population-based study.

METHODS

Young ischemic stroke patients were invited to a follow-up on average 6 years after their index stroke. HRQOL was measured by Short-Form 36 (SF-36) and the Nottingham Health Profile (NPH). Data on socioeconomic and functional states were obtained. Subsequent survival was obtained by examining the official population registry. Multivariate analyses were performed.

RESULTS

One hundred eighty-eight patients were included. The mean age on follow-up was 48 years, and the subsequent follow-up period was 12 years. Cox regression analysis revealed that mortality was associated with NHP sum score (P < .001) after adjusting for age (P = .09), sex (P = .11), and alcoholism (P = .04). Cox regression analyses, including subscores of SF-36 or NHP separately, revealed that mortality was associated with pain (P = .05), sleep disturbances (P = .02), and physical function (P = .02) after adjusting for confounders.

CONCLUSIONS

Poor HRQOL is associated with subsequent long-term mortality in young adults with ischemic stroke and this may pertain particularly to pain, sleep disturbances and low physical fitness.

Psychiatric symptoms in a patient with Churg-Strauss syndrome

We report a case of Churg-Strauss syndrome (CSS) in a patient with multiple cerebral infarctions and psychotic symptoms. A 67-year-old man presented a high-grade fever and delirium. He was clinically diagnosed with Churg-Strauss syndrome on the basis of the presence of asthma, neuropathy, blood eosinophilia, and increased myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (MPO-ANCA) activities. Though multiple cerebral infarctions are irreversible, this patient's psychiatric symptoms improved with steroid treatment. Psychiatric symptoms associated with CSS are very rare.

Headache, migraine, and structural brain lesions and function: population based Epidemiology of Vascular Ageing-MRI study

OBJECTIVE

To evaluate the association of overall and specific headaches with volume of white matter hyperintensities, brain infarcts, and cognition.

DESIGN

Population based, cross sectional study.

SETTING

Epidemiology of Vascular Ageing study, Nantes, France.

PARTICIPANTS

780 participants (mean age 69, 58.5% women) with detailed headache assessment.

MAIN OUTCOME MEASURES

Brain scans were evaluated for volume of white matter hyperintensities (by fully automated imaging processing) and for classification of infarcts (by visual reading with a standardised assessment grid). Cognitive function was assessed by a battery of tests including the mini-mental state examination.

RESULTS

163 (20.9%) participants reported a history of severe headache and 116 had migraine, of whom 17 (14.7%) reported aura symptoms. An association was found between any history of severe headache and increasing volume of white matter hyperintensities. The adjusted odds ratio of being in the highest third for total volume of white matter hyperintensities was 2.0 (95% confidence interval 1.3 to 3.1, P for trend 0.002) for participants with any history of severe headache when compared with participants without severe headache being in the lowest third. The association pattern was similar for all headache types. Migraine with aura was the only headache type strongly associated with volume of deep white matter hyperintensities (highest third odds ratio 12.4, 1.6 to 99.4, P for trend 0.005) and with brain infarcts (3.4, 1.2 to 9.3). The location of infarcts was predominantly outside the cerebellum and brain stem. Evidence was lacking for cognitive impairment for any headache type with or without brain lesions.

CONCLUSIONS

In this population based study, any history of severe headache was associated with an increased volume of white matter hyperintensities. Migraine with aura was the only headache type associated with brain infarcts. Evidence that headache of any type by itself or in combination with brain lesions was associated with cognitive impairment was lacking.

Neuropsychology of acute stroke

Neuropsychology includes both the psychiatric manifestations of neurological illness (primary brain-based disorders) and neurobiology of "idiopathic" psychiatric disorders. Neurological primary brain disorders provoke broad spectrum of brain pathophysiology that cause deficit sin human behaviour, and the magnitude of neurobehavioral-related problems is a world wide health concern. Speech disorders of aphasic type, unilateral neglect, anosognosia (deficit disorders), delirium and mood disorders (productive disorders) in urgent neurology, first of all in acute phase of stroke are more frequent disorders then it verified in routine exam, not only in the developed and large neurological departments. Aphasia is common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Unilateral neglect is a disorder that mostly effects the patient after the lesion of the right hemisphere, mostly caused by a cerebrovascular insult (infarct or haemorrhage affecting a large area - up to two thirds of the right hemisphere), and in general the left-side neglect is the most widespread neuropsychological deficit after the lesion of the right cerebral hemisphere. Reports on the incidence of visual neglect vary and they range from 13 to 85%. Anosognosia is on the second place as neuropsychological syndrome of stroke in right hemisphere, characterized by the denial of the motor, visual or cognitive deficit. This syndrome, defined as denial of hemiparesis or hemianopsia, is a common disorder verified in 17-28% of all patents with acute brain stoke. There are different reports on frequency of delirium in acute stroke, from 24 to 48%, and it is more frequent in hemorrhagic then ischemic stoke. Post stroke depression (PSD) is one of the more frequent consequences on the stroke, and the prevalence of PSD has ranged from 5 to 63% of patients in several cross-sectional studies, peaking three to six months after a stroke.

Differences in quality of life after stroke and myocardial infarction

INTRODUCTION

There is obvious decline in quality of life after MI and stroke. The main factors that reduce quality of life in these patients were the inability of returning to normal activities, pain and the development of depression / anxiety. We wanted to know what has the biggest influence on recovery and differences in quality of life in patients after stroke and heart attack.

SUBJECTS AND METHODS

Cross-sectional study was conducted using HADS and WHOQOL-Bref questionnaire. Criteria for exclusion were diabetes, previous depression, cancer or other co morbidities that influenced the quality of life. It has been surveyed total of 396 patients, of whom 378 patients satisfied the criteria of inclusion in the study. Based on the personal data of patients, they were divided according to gender, age, educational level, and social support expressed by number of members with whom patient lives.

RESULTS

In all the observed parameters of the SU group had better results than the stroke group. The recovery after a stroke affected age, length of education and depression. Age, gender and length of education influence on a heart attack recovery. Disease duration did not affect the quality of life in either group. Significantly more patients after a stroke had depression compared to MI (p<0.001). Anxiety was not found significant in differences between groups (p=0.051). Metabolic syndrome was more frequent in the stroke group, but the difference between groups was not significant (stroke/MI) (p=0.098). In the group of stroke patients who had MS patients more often had depression (p=0.003) for different of respondents from the group with MI.

CONCLUSION

Quality of life was significantly worse in patients after stroke compared to those with MI. The recovery from stroke was most significantly impacted by depression and age and level of education, while the recovery from heart attack was at most affected by gender, age and level of education.

Clinical studies on event-related potentials (ERPs) N400 and the related factors in patients with poststroke depression (PSD)

OBJECTIVE

To evaluate event-related potentials (ERPs), N400, and the related factors in patients with poststroke depression (PSD).

METHODS

Eighty-five stroke patients with depression, conforming to the diagnoses standard of Chinese Classification of Mental Diseases (3rd edition) (CCMD-3), were treated with fluoxetine hydrochloride for 3 months and another 85 stroke patients without depression were selected as the control group. The traits about N400 and blood platelet 5-HT concentrations of all patients were measured.

RESULTS

There were significant differences between the incubation periods and average amplitudes of N400 in patients with PSD and those in patients without PSD (p < 0.01), while the blood platelet 5-HT concentrations of PSD patients were much lower than those of the patients without PSD (p < 0.01). For PSD patients, the N400 incubation periods were significantly shortened, averaged amplitudes were significantly increased (p < 0.01), and the blood platelet 5-HT concentrations were significantly raised after 3 months' treatment.

CONCLUSIONS

For ERPs N400 in PSD patients, the incubation period is significantly prolonged and the average amplitude is reduced. Blood platelet 5-HT concentration may influence ERPs N400 in PSD patients.

SIGNIFICANCE

N400 detections are helpful to the early diagnostic of PSD, and provide objective electrophysiology indexes for follow-up visits.

Post-stroke depression: can we predict its development from the acute stroke phase?

OBJECTIVES

To identify possible predictive factors for post-stroke depression (PSD) in the acute phase of stroke.

METHODS

The study design was prospective, observational cohort study of patients with acute cerebral infarction (CI). Neurological and neuropsychological evaluations were conducted within the first 10 days from the onset of stroke and repeated at the 3-month follow-up. DSM-IV criteria were used to define PSD.

RESULTS

From a total of 85 patients with CI, 59 patients completed the 3-month follow-up and 17 of them (28.8 %) fulfilled PSD criteria at the 3-month follow-up. Melancholy index of the Hamilton Depression Rankin Scale (HDRS) was associated with a risk three times greater than that of PSD at the 3-month follow-up in the univariate analysis (OR 3.07; 95% CI 1.53-6.16; P = 0.002) with no significant influence of stroke severity or the location of brain infarction (right or left side). The receiver operating characteristic curves pointed to a melancholy index > or =1.5 as the optimal cut-off level associated with the development of PSD at the 3-month follow-up.

CONCLUSIONS

Melancholy index of the HDRS > or =1.5 could be a useful clinical tool to detect patients with acute stroke at high risk of developing PSD.

Mental imagery for relearning of people after brain injury

OBJECTIVE

This paper reported on the application of mental imagery to the relearning of daily task performance in people with brain injury.

METHOD

The changes in two subjects who had suffered from cerebral infarction shown throughout a 3-week mental imagery programme were described. The subjects' improvement in task performance and other clinical outcomes illustrated the programme's therapeutic effects on skill relearning, maintenance and generalization.

RESULTS

After completing the programme, the subjects showed improvements in performance at both the trained and untrained tasks. Feedback from the patients also suggested its ability to enhance their day-to-day functioning. Clinical assessment results indicated that the subjects experienced an increase in the attention and sequential processing functions but not in the motor and other cognitive functions.

CONCLUSION

Mental imagery appears to be effective at enhancing the task relearning of subjects after brain injury. The skills acquired under this treatment regime can be retained and then generalized to other tasks. Its therapeutic effect is probably mediated by the improved attention and planning and execution functions associated with the rehearsal. Further research should conduct clinical controlled trials to gather evidence on its efficacy at promoting functional regain in people suffering from neurological disorders.

High serum levels of leptin are associated with post-stroke depression

BACKGROUND

Depression is a frequent mood disorder that affects around 33% of stroke patients and has been associated with both poorer outcome and increased mortality. Our aim was to test the possible association between inflammatory and neurotrophic molecular markers and the development of post-stroke depression.

METHOD

We studied 134 patients with a first episode of ischemic stroke without previous history of depression or speech disorders. We screened for the existence of major depression symptoms in accordance with DSM-IV criteria and a Yesavage Geriatric Depression Scale (GDS) score >11 at discharge and 1 month after stroke. At these times, serum levels of molecular markers of inflammation [interleukin (IL)-1beta, IL-6, intracellular adhesion molecule 1 (ICAM-1), tumor necrosis factor (TNF)-alpha, leptin and high-sensitivity C-reactive protein (hs-CRP)] and neurotrophic factors [brain-derived neurotrophic factor (BDNF)] were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Twenty-five patients (18.7%) were diagnosed as having major depression at discharge. Out of 104 patients who completed the follow-up period, 23 were depressed at 1 month (22.1%). Patients with major depression showed higher serum leptin levels at discharge [43.4 (23.4-60.2) v. 6.4 (3.7-16.8) ng/ml, p<0.001] and at 1 month after stroke [46.2 (34.0-117.7) v. 6.4 (3.4-12.2) ng/ml, p<0.001). Serum levels of leptin >20.7 ng/ml were independently associated with post-stroke depression [odds ratio (OR) 16.4, 95% confidence interval (CI) 5.2-51.5, p<0.0001]. Leptin levels were even higher in the eight patients who developed depression after discharge [114.6 (87.6-120.2) v. 7.2 (3.6-13.6) ng/ml, p<0.0001].

CONCLUSIONS

Serum leptin levels at discharge are found to be associated with post-stroke depression and may predict its development during the next month.

[Case of callosal disconnection syndrome with a chief complaint of right-hand disability, despite presence of left-hand diagonistic dyspraxia]

e report the case of 48-year-old right-handed male patient with an infarction affecting most part of the body and the splenium of the left half of the corpus callosum. Neuropsychological examination revealed typical signs of callosal disconnection including left-sided apraxia, diagonistic dyspraxia, left-sided agraphia, left-hand tactile anomia, left hemialexia, and right-sided constructional disability. Moreover, he complained of impairment in activities involving the right hand disability and agraphia. He could not stop behaving with his right hand when he had a vague idea. For example, he involuntarily picked up a tea bottle with his right hand when he had a desire to drink, although the action was not appropriate to that occasion. The imitation and utilization behavior did not imply this case, because his right hand behaviors were not exaggerated in response to external stimuli, such as the gestures of the examiner or the subjects in front of the patient. Unexpectedly, he complained about impairment of the activity of his right hand and was unaware of left hand apraxia or diagonistic dyspraxia; this trend continued for 6 months, at the time of this writing. We argue that the patient may have been subconsciouly aware of the symptoms of his left hand but had not verbalized them.

[A case report of a HIV-infected patient, who was denied to return home because of his psychological complications along with hepatocellular carcinoma]

Although a social support system has been developed in recent times, some of the difficult cases which complicate serious diseases due mainly to lack of family care power, have been reported. We experienced one HIV-infected patient who suffered from hepatic carcinoma and had been taken care of at home, but he was denied to return home after hospitalization. It has been reported that the management of homecare station has become worsened and the number of stations has been decreasing in various locations. If the patients were selected by homecare stations in which the management was going from bad to worse, it would be difficult to maintain a nationwide quality of homecare system. By presenting such an extreme case in the homecare services, we propose a homecare scoring system, in consideration of homecare service limitations, which will be helpful assessing a difficult case of a patient taken care of at home.

Poststroke depression in patients with small subcortical infarcts

OBJECTIVES

Small subcortical infarcts (SSIs) can result from small vessel disease (SVD) and intracranial and extracranial large artery disease (LAD). No study has explored poststroke depression (PSD) in different etiological types of SSIs.

METHODS

Patients with SSIs resulting from LAD and SVD were included in the study. Poststroke depression was evaluated with the 15-item version of the geriatric depression scale (GDS) 3 months after stroke.

RESULTS

Of the 127 patients with SSIs, 44 had LAD and 83 had SVD. The LAD group had a significantly higher mean GDS score and higher frequency of PSD (p<0.05). The etiological type LAD was a significant independent risk factor for PSD.

CONCLUSION

PSD is more common in patients with SSIs resulting from LAD. This suggests that cerebral blood perfusion may play an important role in the development of PSD.

[A survey on cerebral infarction/transient ischemic attack inpatients compliance with secondary stroke prevention and follow-up 90 days]

OBJECTIVE

Poor compliance with evidence-based-medicine guidelines could significantly influence the effect of stroke prevention strategies. The objectives of this survey are to investigate the current status in Beijing of cerebral infarction/TIA (transient ischemic attack) inpatients' adherence to the evidence-based-medicine secondary prevention and behavior modifications both at the discharge and at 90-day follow up.

METHODS

The survey included cerebral infarction/TIA patients successively admitted from 1, Oct 2006 to 1, May 2007, used ACEI/ARB, Statin, anti-platelet agents therapy, accepted carotid endarterctomy or angioplasty or stent, and modified behaviors to stop smoking and control weight. Data of patients during hospitalization were obtained from the medical documents in the inpatient department of 7 centers. The detailed information included the medicine therapy, lifestyle modifications, patients' social demographic background (age, sex, education and way of payment), major risk factors for stroke, and ischemic event subtypes (TIA or cerebral infarction). Above information of part of patients were collected through telephone interview at 90-day follow-up if the patients were not able to visit the clinic.

RESULTS

708 cerebral infarction/TIA inpatients who didn't have contraindications were included. Among them, the patents who haven't used anti-platelet agents, nor taken statin, nor accepted ACEI/ARB were about 0.4%, 41.8% and 63.6% respectively. Neither 27% of the patients have accepted the instructions on stop smoking. While about 588 patients suitable to drug therapy were followed up at 90 days, but the percentage of these patients who haven't compliance on anti-platelet agents, statin, ACEI/ARB was 26.9%, 52.6% and 59.4% respectively. Only 66.9% of the smoking patients have received the doctor instructions on smoking cessation.

CONCLUSION

Stroke recurrence rate in China is higher than that of average figures in western countries. One of the key reasons of high recurrence of stroke in China is the poor adherence to stroke secondary prevention guidelines. Thus, investigate current status of secondary prevention among hospitals in capital of China and promote strategies to enhance the adherence to the guidelines and fill the gap between the clinical practice and evidence-based medicine in China, which is able to lower the stroke recurrence and save lives are urgently needed. Physician should take great care of the patient's compliances on the evidenced-based-medicine secondary prevents and behavior modifications, and take effective measures to improve the compliances.

[Sensory syndrome and aphasia after left insular infarct]

INTRODUCTION

Sensorial impairment without hemiplegia is usually caused by a thalamic lesion.

CASE REPORT

A 28-year-old woman presented with hemianesthesia associated with aphasia following a left insular lesion, subsequent to subarachnoid hemorrhage. Brain MRI Flair sequence revealed a high intensity signal in the left insular and frontal subcortical regions. Insular infarct was diagnosed, associated with hemorrhagic sequelae.

DISCUSSION/CONCLUSION

Study of the normal and pathologic insular cortex suggest several implications of the region in somatosensory and language functions. However, the insular cortex has been mainly associated with central pain. Lasting objective hypoesthesia has been very rarely documented. The left insular cortex has also been implicated in speech apraxia but our patient presented with fluent aphasia mostly affecting the rhythm of speech, as it has been observed in thalamic aphasia.

Voxelwise Bayesian lesion-deficit analysis

Relating cognitive deficits to the presence of lesions has been an important means of delineating structure-function associations in the human brain. We propose a voxel-based Bayesian method for lesion-deficit analysis, which identifies complex linear or nonlinear associations among brain-lesion locations, and neurological status. We validated this method using a simulated data set, and we applied this algorithm to data obtained from an acute-stroke study to identify associations among voxels with infarct or hypoperfusion, and impaired word reading. We found that a distributed region involving Brodmann areas (BA) 22, 37, 39, and 40 was implicated in word reading.

Sitting balance as an early predictor of functional improvement in association with depressive symptoms in stroke patients

The aim of the present study was to assess the relationship between sitting balance at an early stage and activities of daily living (ADL) function in 452 stroke patients. The effect of sitting balance on the two core elements of depression (apathy and depressive mood) was also examined. The ability to maintain a sitting position for 10 min (10-min sitting balance) was assessed, along with ADL using the Functional Independence Measurement, and psychological status using the Zung Self-rating Depression Scale (depressive mood), Apathy Scale (apathy) and Neuropsychiatric Inventory. Proportional-hazards analysis was used to determine the independent effect of post-stroke depression on functional outcome. Comparisons between sitting balance and psychological status were performed using logistic multiple regression analysis. Cox multiple regression analysis showed that significant differences were obtained for the sitting balance (P < 0.0002) and Mini-Mental State Examination scores (P < 0.02) in all six ADL subscales, and for age in four of the six ADL subscales (Dressing-Upper Body and Dressing-Lower Body, Toileting, Walking). Kaplan-Meier survival curves for reaching independence in ADL subscales showed highly significantly differences in achievement rate and time to reach goal for each subgroup on 10-min sitting balance (with or without assistance) and on age (young, <65; elderly, >/=65 years). Ten-minute sitting balance correlated with depressive mood and apathy. A rapid and simple screening method, 10-min sitting balance was related to scores for two core depressive symptoms, lowered mood and apathy, and was predictive of post-stroke ADL outcomes in the rehabilitation unit along with age.

Early cognitive outcome after neonatal stroke

The purpose of this study was to assess the cognitive development of 27 children with nonhemorrhagic neonatal stroke (occurring within the first 28 days of life). The cognitive evaluation consisted of the Bayley Scales of Infant Development, administered at 12 and/or 24 months poststroke. Compared with the normative sample, children with neonatal stroke obtained significantly lower scores on the Bayley Psychomotor Development Index at 12 months poststroke and on the Bayley Mental and Psychomotor Development Indices at 24 months poststroke. Outcome did not differ based on stroke type or laterality of infarct. However, there was a trend toward higher scores on the Bayley Psychomotor Development Index at 24 months in the left hemisphere group compared to the right hemisphere group. Overall, children with neonatal stroke evidenced significant impairment within the first 2 years poststroke. Further research is required to confirm whether cognitive impairments in these children resolve, remain in the low-average range, or increase with development as more complex skills are learned.

White matter changes and late-life depressive symptoms: longitudinal study

BACKGROUND

Evidence from cross-sectional studies suggests a link between cerebral age-related white matter changes and depressive symptoms in older people, although the temporal association remains unclear.

AIMS

To investigate age-related white matter changes on magnetic resonance imaging (MRI) as an independent predictor of depressive symptoms at 1 year after controlling for known confounders.

METHOD

In a pan-European multicentre study of 639 older adults without significant disability, MRI white matter changes and demographic and clinical variables, including cognitive scores, quality of life, disability and depressive symptoms, were assessed at baseline. Clinical assessments were repeated at 1 year.

RESULTS

Using logistic regression analysis, severity of white matter changes was shown to independently and significantly predict depressive symptoms at 1 year after controlling for baseline depressive symptoms, quality of life and worsening disability (P<0.01).

CONCLUSIONS

White matter changes pre-date and are associated with the development of depressive symptoms. This has implications for treatment and prevention of depression in later life.

The role of vascular risk factors in late onset bipolar disorder

BACKGROUND

The association between late life depression and cerebro-vascular risk and cerebro-vascular disease is well established. Do similar links exist with late onset bipolar disorder?

AIMS AND OBJECTIVES

Patients with early onset (less than 60 years of age) bipolar disorder were compared with those of late onset (aged 60 and above) in relation to cognitive function, physical health and vascular risk factors.

METHOD

Cross-sectional survey of elderly bipolar disorder patients (above 65 years) involved with secondary care mental health services. Thirty patients with early onset were compared with 20 patients with a late onset bipolar disorder. Diagnosis of bipolar disorder was according to ICD-10 criteria and without an associated clinical diagnosis of dementia. Assessment of cognition included tests of frontal-executive function, and cerebro-vascular risk was quantified with the Framingham stroke risk score.

RESULTS

The late onset group had a higher stroke risk score than the early onset group, this difference persisting despite taking age and gender differences into account. However, late onset patients' cognitive function (including frontal lobe tests) and physical health status was no different to the early onset group.

CONCLUSION

There is higher 'cerebrovascular risk' in elderly patients with late onset bipolar disorder, compared to patients with an early onset. This suggests that cerebrovascular risk may be an important factor for the expression of bipolar disorders in later life, and has significant management implications for older bipolar patients.

Procoagulant stress reactivity and recovery in apparently healthy men with systolic and diastolic hypertension

OBJECTIVE

The aim of this study was to investigate whether systemic systolic hypertension (SHT) and diastolic hypertension (DHT) are associated with an exaggerated response of factor VII clotting activity (FVII:C), factor VIII clotting activity (FVIII:C), fibrinogen, and d-dimer to acute psychosocial stress.

METHODS

We performed the 15-min Trier Social Stress Test (i.e., combination of task preparation, job interview and mental arithmetic) in a sample of 42 middle-aged apparently healthy and unmedicated men with normal and elevated blood pressure (BP) (i.e. screening systolic and/or diastolic BP>or=130/85 mmHg). Blood samples for coagulation measures were obtained immediately pre and post stress and 20 min and 60 min thereafter. Repeated measures analyses of covariance controlled for age, body mass index, screening mean arterial BP, and resting level of coagulation factors.

RESULTS

There was a stress-by-DHT interaction for changes across all time points in FVII:C (P=.027), FVIII:C (P=.018), and d-dimer (P=.011) explaining between 14% and 17% of the variance. Compared to subjects without DHT, diastolic hypertensives had higher FVII:C immediately post stress (P=.085, Cohen's d=.60) and at 20-min recovery (P=.19, d=.46), higher FVIII:C at 20- (P=.028, d=.78) and at 60-min (P=.035, d=.75) recovery, and higher D-dimer at 20-min recovery (P=.10, d=.58). A significant stress-by-SHT interaction for fibrinogen (P=.050) became nonsignificant when controlling for covariates.

CONCLUSION

Diastolic hypertension exaggerated the acute procoagulant response to stress in middle-aged men. This effect was particularly observed during recovery of hypercoagulability from stress. The findings suggest a psychobiological mechanism linking stress with an increased atherothrombotic risk in hypertensive individuals.

Occult PTSD with panic attacks in a patient post-TIA: case report

Affective disorders are common sequelae of cerebrovascular events. A myriad of evidence demonstrates that clinically significant depression can often follow a stroke. However, less is known about the extent to which anxiety disorders present after these experiences, and in particular, post-traumatic stress disorder (PTSD) with panic attacks. To our knowledge, the association between transient ischemic attacks (TIAs) and PTSD with panic attacks has not been described in the literature. Here we describe a patient with depression and PTSD with panic attacks following a transient ischemic attack. Many non-psychiatric physicians learn about post-stroke depression so they are equipped to screen for it. However, to many physicians, PTSD with panic attacks usually conjures the image of an individual who experienced either trauma or rape. Therefore, it is important to increase the awareness of such complications after TIAs. Increased awareness of these TIA sequelae has important implications for detection by non-psychiatric healthcare providers. Furthermore, prompt recognition and treatment has important implications for patient quality of life.

Venlafaxine efficacy and tolerability in the treatment of post-stroke depression

OBJECTIVE

To determine the efficacy of venlafaxine in treatment of post-stroke depression.

METHODS

The sample consisted of 30 adult subjects with symptoms of post-stroke depression. All subjects received treatment with venlafaxine in therapeutic dose range in the period of three months. All subjects were assessed prior to treatment and in 1 month-follow-up and 3 months follow-up using the standardized instruments for assessment of depressive symptoms (Hamilton Depression Rating Scale HAM-D-21), and for efficacy and tolerability with the Clinical Global Impressions scale (CGI). All subjects signed an informed consent form prior to entering in the study.

RESULTS

The results indicate a statistically significant reduction of depressive symptoms following three months of treatment with venlafaxine. The difference between three assessments with The Clinical Global Impressions scale was statistically significant. Unwanted effects were registered in two of the subjects (increased blood pressure) and they were of mild intensity.

CONCLUSIONS

Venlafaxine proved to be very efficient, well tolerated and safe in the treatment of depression occurring after cerebrovascular incidents to the subjects in this study.

Coexisting Cerebral Infarction in Alzheimer's Disease Is Associated with Fast Dementia Progression: Applying the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences Neuro

OBJECTIVES

To determine whether patients with Alzheimer's disease (AD) and coexisting cerebral infarction (CI) that satisfy the National Institute for Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) neuroimaging criteria for vascular dementia (VaD) progress faster than those who do not satisfy the neuroimaging criteria.

DESIGN

Retrospective cohort study.

SETTING

Multidisciplinary memory clinic in a tertiary hospital.

PARTICIPANTS

One hundred thirty consecutive patients with AD, with or without CI, followed up regularly for more than 1 year.

MEASUREMENTS

The patients were classified according to the distribution and severity of CI as defined according to the NINDS-AIREN neuroimaging criteria into those with AD and no CI (AD-N), those with AD and CI not fulfilling neuroimaging criteria (AD-I), and those with AD and CI fulfilling neuroimaging criteria (AD-V), and their differences in dementia progression were tested. The loss of independence, indicated by institution admission or a clinical dementia rating (CDR) score of 3, was defined as the endpoint for a poor outcome.

RESULTS

The mean age was 75.8, and 68.5% were women. The initial Mini-Mental State Examination (MMSE) score was 15.3+/-0.4, and the average duration of follow up was 30.4 months. Fifty-four patients had reached study endpoint at the time of analysis. AD-V (hazard ratio (HR)=3.1, 95% confidence interval (CI)=1.2-8.2), use of psychotropic drugs (HR=2.7, 95% CI=1.1-6.4), and initial MMSE score (HR=0.9, 95% CI=0.8-1.0) were independent predictors of poor outcome in the Cox regression model.

CONCLUSION

In AD, co-occurrence of CI with distribution and severity as defined in the NINDS-AIREN neuroimaging criteria for VaD is associated with faster dementia progression.